Flashcards in Pulp Deck (54)
Which pulp tissue becomes inflamed first, middle and last?
first: pulp horn
second: coronal pulp
third: radicular pulp
Pulp regeneration is similar in the deciduous dentition compared to the permanent dentition? Reference
Which feature of enamel breakdown indicates the degree to which the pulp is inflamed?
marginal ridge breakdown.
with increase in marginal ridge breakdown the pulpal inflammation is more widepsread
Which caries, proximal or occlusal, shows the greatest amount of pulp inflammation? Reference
Kassa et al 2009
What are the four potential pulp statuses?
What is the pulp response to caries?
initially tertiary dentine is laid down
following this, if the lesion is allowed to progress this leads to irreversible pulpitis and necrosis
What is the most reliable method for diagnosing pulp status?
Why do we need to determine the pulp status correctly?
To determine the most appropriate treatment option
What are the challenges with regards to diagnosing pulp statuses in children?
lack of correlation between clinical signs and symptoms
What to we use to diagnose the pulp status?
What are the symptoms of irreversible pulpitis?
not always relived by analgesics
dull throbbing ache
What are the symptoms of reversible pulpitis?
disappears on removal of stimulus
relieved with analgesia
What clinical findings suggest pulp involvement?
clinical extent of caries
Which features on the radiographs can be use to assess pulp status?
extent of caries
Resorption (internal/external, physiological)
Which special investigations can be performed to investigate pain?
Mobility (normal vs abnormal)
TTP (distinguish between food impaction and peri-radicular resorption)
Which 4 factors about the patient will indicate whether or not the tooth should be extracted or restored?
Which medical factors would make you more inclined to retain the tooth?
patients at risk from GA
Which medical factors would make you more inclined to extract the tooth?
Which social factors would you consider when considering treatment options?
co-operation and compliance
age of the child
Which dental factors would affect treatment decisions?
gross dental neglect
time to exfoliation: if due to exfoliate within one year/advanced root resporption: provisional restoration or extract
If more than one year: retain
value of the tooth?
effect on developing dentition?
What are the two treatment options for vital pulp therapy?
Pulp cap (direct or indirect)
Pulpotomy (vital or desensitising)
What are the two treatment options for non-vital pulp therapy?
What are the requirements for a vital pulp therapy?
Vital Pulp (no history of spon pain, reversible pulpitis, no sinus)
No radiographic pathology (resorption)
What is a pulp cap?
a method of maintaining pulp vitality by placing a dressing directly or indirectly over the exposed pulp or onto residual dentine left over a nearly exposed pulp
What is the purpose of a pulp cap?
To promote pulp healing
When is an indirect pulp cap indicated?
symptom free tooth with deep caries where full caries removal would lead to pulp exposure
What is the process of indirect caries removal?
All margins free from caries
remove as much of the softened caries from the margins as possible
place CaOH ontop (setting)
What can be used to help locate where the infected dentine is?
eg 0.5% fuschin dye
According to Welbury 2012 which type caries, proximal or occlusal should indirect pulp cap be avoided?
proximal since Kassa 2009 showed that caries proximally causes much more wide spread inflammation than occlusal. deep proximal lesions should be restpred with a pulpotomy first.