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Oral Biology > Care of the Pulp > Flashcards

Care of the Pulp Flashcards

(50 cards)

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1
Q

What makes up the pulp (5)

A
  1. Cells
  2. Nerves
  3. BV’s
  4. Vital tissue
  5. Part of the dentine-pulp complex
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2
Q

What nerves are present in the pulp? (2)

A
  1. Alpha fibres (myelinated)

2. C-fibres (unmyelinated)

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3
Q

Function of vital tissue in the pulp? (2)

A
  1. Responds to stimuli

2. Regenerative potential

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4
Q

List functions of the pulp (4)

A
  1. Nutrition
  2. Sensory
    - Temperature
    - Pressure
    - Pain
  3. Protective
    - Tertiary dentine formation (odontoblasts)
    - Reparative healing
  4. Formative
    - Secondary dentine
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5
Q

List possible injuries to pulp (4)

A
  1. Caries
  2. Cavity prep
  3. Restorations
    - Restorative materials
    - Microleakage
  4. Periodontal pathology
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6
Q

How does pulp injury occur through cavity prep? (6)

A
  1. Heat generation
    - Use coolant
  2. Type of bur used
    - Size, speed, sharpness, force, vibration
  3. Dehydration of dentine
    - Air + water
  4. Cutting odondoblast processes
  5. Direct injury to pulp
  6. Remaining dentine thickness
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7
Q

How does pulp injury occur through restoration material? (5)

A
  1. Toxicity
  2. Water absorption
  3. Heat of reaction
  4. Poor marginal adaptation /seal
  5. Cementation of restoration
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8
Q

Where are there more dentine tubules?

A

They increase in no. and diameter as they approach the pulp

The deeper the cavity the greater the dentine permeability

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9
Q

What do dentine tubules contain? (6)

A
  1. Bacterial substances
  2. Polysaccharides
  3. Antibodies
  4. Immune complexes
  5. Complement proteins
  6. Tissue destruction products
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10
Q

List examples of bacterial substances present in the pulp (4)

A
  1. Enzymes
  2. Peptides
  3. Exotoxins
  4. Endotoxins
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11
Q

Function of micro-organisms in respect to pulp health

A

Maintain pulpal and periradicular pathology

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12
Q

What fibres contribute to dental pain (2)

A
  1. Alpha fibres

2. C fibres

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13
Q

What type of pain do Alpha fibres cause?

A

Sharp pain

Myelinated

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14
Q

What type of pain do C fibres cause? (4)

A
  1. Non myelinated
  2. Dull aching pain
  3. Increased pulpal blood flow
  4. Increased pulpal pressure
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15
Q

What test stimulates alpha fibres?

A

EPT

- Electric Pulp Test

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16
Q

How is endodontic disease diagnosed? (2)

A
  1. Pulpal diagnosis

2. Periapical diagnosis

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17
Q

How quickly should traumatic pulp exposure be treated?

A

Ideally within 24hrs, if not RCT required

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18
Q

Reversible pulptitis tx

A

If adequate vital pulp therapy is performed

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19
Q

Irreversible pulpitis tx (2)

A
  1. Pulpectomy followed by RCT

2. Extraction

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20
Q 
Compare:
Reversible Pulpitis (3)
Irreversible Pulpitis (3)
A

REVERSIBLE PULPITIS:

  • Pain to cold, lasts a short time
  • Microleakage (A-fibres)
  • No change in pulpal blood flow

IRREVERSIBLE PULPITIS:

  • Spontaneous intermittent pain with sleep disturbance
  • Negative to cold, pain to hot (C-fibres)
  • Increase in pulpal blood flow
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21
Q

Necrotic pulp tx for mature teeth - with closed apices (2)

Study These Flashcards
A

Mature teeth (closed apices):

  1. RCT
  2. Extraction
22
Q

Necrotic pulp tx for immature teeth - with open apices (3)

Study These Flashcards
A
  1. Pulpotomy
  2. Pulpectomy then RCT
  3. Extraction
23
Q

How does an acute apical abscess present? (5)

Study These Flashcards
A
  1. Rapid onset
  2. Spontaneous pain
  3. Pus formation
  4. Extreme tenderness to pressure
  5. Swelling
24
Q

How does a chronic apical abscess present? (3)

Study These Flashcards
A
  1. Gradual onset
  2. Little/no discomfort
  3. Intermittent discharge of pus through sinus tract
25
Where is a condensing osteitisis usually seen?
Usually seen at apex of tooth
26
List some signs of non-vital tooth (5)
1. Discolouration - Yellow - Grey - Pink 2. Sinus 3. Gross caries 4. Large restoration 5. Radiographic evidence - Periapical radiolucency - Periradicular radiolucency
27
Function of sensibility testing
Differentiate 'vital' from 'non-vital' pulp - Pt response can be very subjective so compare the response with a contralateral tooth then re-examine the same tooth
28
Examples of sensibility tests (3)
1. EPT - Electric Pulp Test 2. Thermal Tests - Cold tests (Ethyl Chloride) - Heat Tests (Hot Gutta Percha) 3. Test drilling
29
What are the problems with sensibility tests (2)
- These tests stimulate nerve fibres but do not indicate state of blood supply - Tooth vitality is related to blood supply not nerve stimulation
30
What assesses pulpal blood flow?
Laser doppler
31
What teeth are difficult to test for sensibility testing?
Multi-rooted teeth
32
Function of an EPT
> Electric current used to stimulate sensory nerves at pulp-dentine junction > A-delta fibres stimulated
33
What does a negative response for an EPT indicate?
Indicator for pulpectomy
34
What does a negative response for a Thermal test indicate?
Indicator for pulpal necrosis
35
Why are heat tests a caution? (2)
Too much heat may cause irreversible pulpititis 1. Initial stimulation of A-delta fibres - Sharp pain 2. Continued stimulation of C fibres - Dull radiating pain
36
When is test drilling used? (2)
- When full coverage restorations are present | - No LA given and cut into tooth
37
What does a test drilling diagnosis show?
Patient reports severe pain/no pain felt when cutting dentine
38
What is an alternative to test drilling?
1. Isolate crowned tooth with rubber dam 2. No LA 3. Spray cold water + air
39
Influence of clinical factors for the care of the pulp (4)
1. Carious pulp exposure 2. Age 3. PDL disease 4. Previous pulpal trauma
40
How do we prevent pulpal damage? (4)
1. Know tooth anatomy - Size, location + proximity of pulp 2. Avoid drilling into pulp - Caries can be left over pulpal floor in some cases 3. Cavity close to pulp - Use of cavity sealers - Indirect pulp cap 4. Cavity into pulp (exposure) - Direct pulp cap
41
Function of cavity sealers (2)
1. Protect pulp from bacteria + products | 2. Toxic effects during setting phase of restorative material
42
Where do cavity sealers adhere to?
Adhere to dentine rather than restorative material
43
Different types of cavity sealers (3)
1. Varnishes 2. Liners 3. Base materials
44
Difference of cavity base/liners to sealers?
Thicker sealant
45
Examples of cavity liners (3)
1. Zinc phosphate 2. Zinc oxide eugenol 3. CaOH 4. RMGI
46
Effects of CaOH (3)
1. Bacteriocidal - High pH stimulates fibroblasts - Reparative dentine formation 2. Stimulates decalcification of demineralised dentine by stimulating pulpal cells 3. Neutralises low pH from acidic restorative materials
47
Negative effects of CaOH (3)
1. Cytotoxic - Can kill pulp 2. Weak cement 3. Very soluble if not protected
48
Function of dentine bonding agents?
Reduction in micro-leakage
49
Name for a partial pulpal removal?
Pulpotomy
50
Name for a full pulpal removal?
Pulpectomy | - Progress to RCT

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