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Endodontics > Care of the Pulp > Flashcards

Care of the Pulp Flashcards

1
Q

What’s in the pulp?

A

Cells
- odontoblast

Nerves (plexus of Raschkow)
- alpha fibres (myelinated)
- C fibres (unmyelinated)

Blood vessels

Vital tissues
- responds to stimuli
- regenerative potential

Part of dentine - pulp complex
- close relationship with dentine

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2
Q

Functions of pulp

A
  • nutrition
  • sensory for temp, pressure and pain
  • tertiary dentine formation by odontoblasts -> reparative healing
  • secondary dentine
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3
Q

Injuries to pulp

A
  • caries
  • cavity prep - heat generation; type of bur used
  • microleakage due to restorative materials
  • trauma
  • toothwear
  • periodontal pathology
  • orthodontic tx
  • radiation therapy
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4
Q

Remaining dentine thickness (RDT)

A
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5
Q

Restorative materiaal

A
  • toxicity (amalgam)
  • water absorption
  • heat of reaction
  • poor marginal adaptation/ seal
  • cementation of restoration
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6
Q

Dentine permeability

A
  • dentine tubules increase in number and diameter as they approach pulp
  • the deeper the cavity, the greater dentine permeability
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7
Q

Dental Pain

A

Alpha fibres
- myelinated
- sharp pain
- stimulated by EPT

C fibres
- unmyelinated
- dull aching pain
- increase pulpal blood flow
- increase pulpal pressure

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8
Q

Difference between reversible and irreversible pulpitis

A

Reversible
- pain to cold
- lasts a short time
- hydrodynamic expression (microleakage)
- A fibres
- no change in pulpal blood flow

Irreversible
- spontaneous pain
- intermittent
- sleep disturbance
- negative to cold
- pain to hot
- C fibres
- increase in pulpal BF

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9
Q

Tx for necrotic pulp

A

Mature teeth with closed apices
- RCT
- XLA

Immature teeth with open apices
- pulpotomy
- pulpectomy then full RCT
- XLA

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10
Q

Non-vital tooth

A
  • discolouration; yellow, grey, pink
  • sinus
  • gross caries
  • large restoration
  • periapical radiolucency
  • periradicular radiolucencies
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11
Q

Primary function of sensibility testing

A
  • test neuron/ nerve function in tooth
  • this test stimulate nerve fibres
  • test for nerve stimulation
  • does not test blood supply- hence cannot test for vitality
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12
Q

How to test tooth vitality?

A
  • laser doppler to assess blood flow
  • tooth vitality is related to blood supply
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13
Q

Problems of sensibility tests

A
  • periradicular inflammation occurs before pulp totally necrotic
  • difficulty in multi rooted teeth
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14
Q

How to use EPT?

A
  • dry and isolate tooth to prevent current transfer to adjacent tooth
  • use conducting medium such as toothpaste and fluoride gel at tip of probe
  • probe is then placed on incisal edge/ cusp tip adjacent to pulp horn
  • most sensory nerves are found here
  • pt completes circuit by holding handle of EPT
  • current occurs automatically and pt can sense a tingling/ hear sensation, can pull probe away from tooth when felt
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15
Q

Positive response for EPT

A
  • vital pulp tissue present at coronal aspect of pulp
  • no indication of reversibility of inflammation/ healing
  • no correlation between pain threshold and pulp condition
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16
Q

Negative response

A
  • reliable indicator for pulpectomy in 97.7% cases
  • EPT on young pulps with open apices/ traumatised teeth are unreliable
17
Q

Thermal test

A
  • work by hydrodynamic forces
  • fluid movement in dentinal tubules due to thermal stimulus
18
Q
A
18
Q

Cold test

A
  • frozen sticks of CO2 9-78degrees)
  • cotton pellet with ethyl chloride/ Endo-ice (-27.2)/ Endo Frost (-50) Butane propane
  • negative response highly indicative of pulpal necrosis
19
Q

How to perform heat test?

A
  • vaseline on tooth
  • apply hot GP/ green stick to tooth
  • initial stimulation of A delta fibres -> sharp pain
  • continued stimulation of C fibres -> dull pain
20
Q

Test drilling

A
  • used when full coverage restorations present
  • no LA given
  • cut into tooth
  • pt reports severe pain/ no pain when cutting dentine
20
Q

Influence of clinical factors

A
  • carious pulp exposure
  • age
  • periodontal disease
  • previous pulpal insult/ trauma
21
Q

Maintenance of pulp vitality

A

Prevention of pulpal damage
- step wise excavation
- seal in caries

Vital pulp therapy
- pulp capping
- partial/ Cvek pulpotomy
- complete pulpotomy

22
Q

How to prevent pulpal damage?

A
  • know tooth anatomy
  • radiographs
  • avoid drilling into pulp
  • caries can be left over pulpal floor

Place temp well- sealed restoration -> step-wise excavation
- remove temp in 6-12 months
- after tertiary dentine barrier is formed
- remove remaining caries and restore definitely

23
Q

Vital Pulp therapy

A

Protect pulp from
- bacteria and toxins
- toxic effects during setting phase of restorative material

24
Q

Materials used in vital pulp therapy must be?

A
  • adhere to dentine rather than restorative material
  • thin, if not will reduce strength of restorative material
  • form bacterial -tight seal
25
Q

Materials for Vital Pulp therapy

A
  • zinc phosphate
  • zinc oxide eugenol
  • Calcium hydroxide, ie: Dycal
  • Tricalcium phosphate
  • Resin; Comp
  • RMGI; Vitrebond
  • Bioceramics; MTA, Biodentine
26
Q

Effects of Calcium hydroxide

A
  • bacteriocidal and bacteriostatic
  • high pH
  • stimulates fibroblasts
  • reparative dentine formation (healing)
  • hard tissue barrier formation
  • stimulate re-calcification of demineralised dentine by stimulating pulpal cells
  • neutralise low pH from acidic restorative materials

Cons
- weak cement
- very soluble if not protected

27
Q

What is MTA?

A
  • mineral trioxide aggregate
  • portland cement 75%, bismuth oxide 20%, gypsum 5%
28
Q

Describe MTA

A
  • high pH similar to calcium hydroxide
  • creates bacteria tight seal
  • sets hard enough to act as base for restorative material
  • biocompatible
  • Grey contains iron
  • white does not contain iron
  • prolongs setting time
  • discolouration of crown if grey is used
29
Q

Biodentine

A
  • quick setting
  • no discolouration

Contents: check photo

30
Q

Partial/ Cvek pulpotomy

A
  • 1-2mm coronal pulp removed initially with high speed
  • additional pulp removed if bleeding excessive
  • once healthy pulp is reached then stop
  • rinse with 5% NaOCL
  • place Calcium hydroxide/ MTA/ Biodentine over pulp tissue
  • palce sealing restoration; GIC
  • place restoration; Comp
31
Q

Complete Pulpotomy

A
  • same as partial pulpotomy but the whole chamber is removed
  • pulp in root canals are retained
32
Q

Tx options for unexposed pulp

A
  • indirect pulp cap
  • stepwise excavation
  • seal caries in
33
Q

Tx for Exposed pulp

A
  • direct pulp cap
  • Partial pulpotomy
  • Complete pulpotomy
  • Full pulpal removal - Pulpectomy
  • progress to full RCT

Endodontics (13 decks)

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