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Dental Pulp > Week 1 > Flashcards

Week 1 Flashcards

1
Q

what do endodontists do?

A

manage inflammation of
the specialized connective tissues within and surrounding the teeth; more specifically, they deal with inflammation (and infection) that generally commences in the pulp tissue and progresses to the periradicular tissues via portals of communication that convey the neurovascular supply

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2
Q

Normal/Healthy Pulp

A 
Requires no treatment
Routine diagnostic tools:
 Sensibility tests
    - Cold
     - Hot
     - EPT
 Percussion test
 Palpation test
 Periodontal probing
 X-ray
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3
Q

Diseased Pulp

diagnosis?
histologically?

A

Diagnosis

  1. Reversible pulpitis
  2. Irreversible pulpitis
  3. Necrotic pulp (non-vital)

Requires treatment/intervention
 Vital pulp therapy
 Non-vital pulp therapy (pulpectomy)

Histologically

  • Inflamed: acute vs chronic (pulpitis)
  • Infected or even localized abscess
  • Necrotic as a result of infection or trauma
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4
Q

ept stands for?

A

Electric pulp testing

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5
Q

Non-surgical endodontic treatments

A

a. Vital pulp therapy
- - Purpose: to keep vital pulp
b. Non-surgical RCT for non-vital pulp (NSRCT)
- - Purpose: to remove infected pulp & root dentin to restore periapical health
c. Regenerative endodontics
- - Purpose: to revascularize and/or regenerate pulp tissue for immature teeth

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6
Q

Surgical treatments

A

Purpose: to remove infected root end tissues (root tip, granuloma/cyst)

  • Peri-radicular curettage
  • Root-end resection (Apicoectomy)
  • Root resection (root amputation) or hemi-section
  • Intentional replantation
  • Incision & Drainage (I & D)
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7
Q

NSRCT stands for?

A

NON-SURGICAL ROOT CANAL THERAPY

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8
Q

CDJ means?

A

Cementodentinal Junction

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9
Q

Direct pulp capping

A

A dental material placed directly on a mechanical or traumatic vital pulp exposure

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10
Q

Indirect pulp capping (step-wise caries excavation)

A

Incremental removal of caries over a period of time to allow pulpal healing and to minimize exposure

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11
Q

Pulpotomy (pulp amputation)

A
  • – Surgical removal of the coronal portion of a vital pulp as a means to preserving vitality of the remaining radicular portion
  • – Usually performed as an emergency procedure for temporary relief of symptoms or as a therapeutic measure
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12
Q

Partial pulpotomy (Shallow pulpotomy, Cvek pulpotomy)

A

Surgical removal of a small diseased portion of vital pulp as means of preserving the remaining coronal and
radicular pulp tissue

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13
Q

Full Pulpotomy

A
  • Removing infected coronal pulp and leaving only the vital intact radicular pulp
  • Indication:
  • Carious pulp exposure in deciduous and young
    permanent teeth
  • Pulp must be vital and asymptomatic
  • All the carious dentin and coronal pulp are to
    be removed
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14
Q

Partial Pulpotomy (Cvek pulpotomy)

A
  • Removing 2 mm of coronal pulp from the exposure site with a high-speed sterile
    diamond bur with ample flushing with sterile saline
  • Bleeding control with saline solution
  • Capping with Ca(OH)2 and sealed with ZnOE cement and later replaced with amalgam
  • Follow the same protocol for direct pulp capping
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15
Q

apexogenesis

A

Apexogenesis refers to a VITAL pulp therapy procedure performed to encourage physiological development and formation of the root end.

Apexification is a method of inducing a calcified barrier at the apex of a nonvital tooth with incomplete root formation.

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16
Q

Apexification

A

Apexification = method of inducing a calcified barrier at the apex of a NONvital tooth with incomplete root formation.

Apexogenesis refers to a vital pulp therapy procedure performed to encourage physiological development and formation of the root end.

17
Q

Functions of dentin

A 
1. Form a network for the diffusion of nutrients
throughout dentin
2. Dentinal fluid and sensitivity
3. Protect coronal pulp
   a) Prevent bacterial penetration
    - Streptococci 0.5 μm in diameter
     - Usually no bacteria in the tubules at the extreme front of the carious lesion
   b) Dentinal fluid
   c) Tertiary dentin formation
   d) Sclerotic dentin formation
   e) Low thermal conductivity
4. Protect coronal & radicular pulp
5. Hardness, elastic modulus and shape for chewing and fracture resistance
18
Q

dentin tubules have what shape?

A

inverted cone shape

19
Q

Surface dentin vs Deep dentin near pulp has ___ % surface area containing tubules

A
  • Surface dentin: 1% surface area contains tubules, mostly intertubular dentin
  • Deep dentin near pulp: 22% surface area contains tubules
20
Q

Number of tubules in crown per square millimeter

A
  • 45,000 near the pulp
  • 29,000 in the mid-dentinal area
  • 20,000 in the periphery
21
Q

Cvek pulpotomy is aka?

A

Partial Pulpotomy

22
Q

___ shape curvature of dentin tubules due to crowding of _______ as they move toward pulp

A

S shape

  • due to crowding of odontoBlasts as they move toward pulp
23
Q

1) coronal dentin is most and least permeable where?

2) is axial or coronal dentin more permeable?

A

1) Most permeable in pulp horn area; Least permeable
in central occlusal region

2) axial more permeable than occlusal dentin

24
Q

Cervical and mid-root dentin have higher permeability

and higher tubular density than?

A

apical dentin

  • apical has more convoluted tubules, areas with no tubule openings, and more crowded
25
Q

decreased tubular permeability:

1) immediatly
2) long-term
3) chemically
4) physically

A

1) For vital teeth, dentin permeability can dramatically decrease during the first day following injury (85%)
2) laying down teritary dentin, crystalline deposits
3) desensitizing reagents
4) sealing off the tubular openings

26
Q

pupal changes with age?

begins when?

A

BEGINS AT 20 yrs

  • decrease pulpal cells: odontoblasts and fibroblasts
  • increase relative fibrous content
  • decrease supportive elements like vessels and nerve endings
  • – atherosclerotic and calcification
  • diffuse calcifications
  • pulp stones
27
Q

Calcifications in typically occurs in ______ pulp and ______ pulp

A

coronal pulp and radicular pulp

28
Q

diffuse calcifications

A

linear calcification usually close to blood vessels, nerves or collagen
*predominantly in the radicular region of the pulp

29
Q

Dentin changes with age

A

BEGINS at 30 years

  • tubular area decreses - results in decreased fracture resistance by 20-40%
  • increase in minerals
  • decrease response or false negative responses to cold test
  • increase in hardness of outer dentin (near DEJ)
30
Q

1a) Transparent zone of pathologic scerotic dentin?

1b) Tubules are completely or partially occluded by intratubular precipitation of?

A

1a) at the base of slow progressive active lesions and arrested lesions
1b) whitlockite (magnesium-substituted tricalcium phosphate) crystals or peritubular dentin-like deposition

31
Q

pulp stones?
true vs false?
free vs attached vs embedded pulp stones?

A

Discrete circular calcific masses within
pulpal tissue

** True pulp stone = small island of dentin with tubules and
odontoblasts
** False pulp stone = concentric layering of calcified tissue
** Free = island of calcified tissue
** Attached = fused to dentin wall
** Embedded = stones that have become surrounded by dentin

32
Q

MOLECULES AFFECTING DENTINOGENESIS

A

1) IL-1β
- Promoting the proliferation of dental pulp stem cells
- Short-term treatment with IL-1β increased gene expression of osteocalcin
- long term decreses gene
2) TNF-α
- Promoting mineralization in short- term cultures and inhibit mineralization in long term dental apical papilla cell culture
3) IL-1 α + TNF-α
- Synergistically increased BD-2 mRNA expression
4) NGF
5) TGF-β

33
Q

MOLECULES REGULATING TERTIARY DENTIN

FORMATION

A

1) TGF-β
- Expressed by odontoblasts
- Secreted to dentin matrix and released upon demineralization
- Important in pulp repair
2) NGF
- Expressed by odontoblasts (mainly odontoblast process), pulp fibroblasts and nerve fibers
- Upregulated under caries and cavity preparation in odontoblast cell bodies or newly differentiated odontoblast like cells

34
Q

primary, secondary, tertiary and Sclerotic

A

primary= before root forms

secondary= after root completlyformed

tertiary= Reparative and Reactionary dentin

Sclerotic= Pathologic: abrasion, attrition, caries

Dental Pulp (4 decks)

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