Pulp disorders and periridicular lesions - Pulp

Question 1

What is pulpitis?

Answer 1

inflammation of the dental pulp

Question 2

Most common cause of pulpitis?

Answer 2

caries

Question 3

What can cause severe pain in pulpitis?

Answer 3

bacterial products may cause pulp to develop hyperaemia and the patient may experience pain

Question 4

Is early pulpitis reversible or irreversible?

Answer 4

reversible

Question 5

What can happen when bacteria enter the pulp?

Answer 5

a pulp abscess can form or complete pulpal necrosis may occur

Question 6

Clinical features of pulpitis?

Answer 6

hard to localise pain

Radiating to the jaw, face, ear or neck

Continuous or intermittent

Can be acute or chronic (reversible or irreversible)

Question 7

Clinical features of acute pulpitis?

Answer 7

severe throbbing pain

Hot and cold stimuli

Keeps pt awake

Severe pain lasts for 10-15 mins

Maybe continuous

Question 8

Chronic pulpitis clinical features?

Answer 8

spontaneous attacks

Dull aching pain

Lasts for an hour or more

Question 9

Clinical features of reversible pulpitis vs irreversible?

Answer 9

age (secondary dentine and blood supply to tooth)

Size of various lesion

Symptoms

Radiography

Vitality tests

Question 10

Most common aetiology of pulpitis?

Answer 10

microbial insult

Question 11

Attrition vs abrasion?

Answer 11

abrasion - foreign body (e.g tb)

Attrition - tooth to tooth contact

Question 12

How can bacteria reach the pulp? (microbial insult)

Answer 12

dental caries

Attrition

Abrasion traumatic restorations

Traumatic cracks and fractures

Invaginated odontomes

Periodontal disease involving apical pockets

Accessory root canals

Question 13

Why does age affects how oulpitis proceeds?

Answer 13

younger have more patent tubules and richer blood supply

Bacteria pioneer pulp from further away

older people have secondary dentine and less blood supply, bacteria have to travel further to reach the pulp

Question 14

How does chemical injury cause pulpitis?

Answer 14

restorative procedures

Irritant substances directly applied to exposed pulp

They Diffuse through dentine and form Reactionary dentine, leading to Sclerosis and exults in Dead tracts of fish

Question 15

Chemical vs bacterial injury?

Answer 15

chemical injury one time

Bacterial continuous

Question 16

How does thermal injury cause pulpitis?

Answer 16

restorative procedures
- Frictional heat during cavity prep

Need Coolant

Forms Reactionary dentine, causing Sclerosis, leading to Dead tracts

Question 17

Barotrauma?

Answer 17

changes in atmospheric pressure

E.g. divers, pilots etc

If tooth is cracked, rapid expansion causes severe pain

Question 18

How does barotrauma cause pulpitis?

Answer 18

aerodontalgia
High altitudes
Divers

Nitrogen bubbles - causing irreversible pulpitis

Fat emboli from altered lipoproteins - causing irreversible pulpitis

Question 19

Does barotrauma cause pulpitis?

Answer 19

not directly but can cause irritation

It’s an exacerbating factor of there is a various lesion of breach of integrity of the pulp

Question 20

Effect of pulp anatomy and pulpitis?

Answer 20

a chamber totally surrounded by dentine (confined tissue surrounded by a chamber - dentine) - no space to expand
- no space for swelling, cause collapse of the vasculature and necrosis of teh cells and cause even more inflammatory infiltrate coming in

Limited ability to tolerate oedema

Venous collapse due to rise in pressure

Local tissue hypoxia and anoxia - no oxygen as the blood vessels have collapsed
- leading to Localised necrosis

Question 21

What is the initial mild inflammatory response of the pulp caused by caries?

Answer 21

infiltration of the sub odontoblastic zones with lymphocytes and macrophages

Response to antigenic products from bacteria and various dentine

Question 22

What happens to blood vessels when bacteria reach the pulp? (Pulpitis caused by caries)

Answer 22

Congested and dilated blood vessels

More exudate coming form blood vessels

Due to confined area it will lead to the collapse and necrosis

Question 23

What eventually happens in pulpitis caused by caries?

Answer 23

formation of exudate:

Compromised circulation

Cell death

Suppuration - pus

Neutrophils

Lose structure leading to Pulp abscess

Causing pain until the pulp is completely necrotic - unless spreads to surrounding tissues

Question 24

Features of a pulp abscess caused by caries?

Answer 24

may become static - if the host immune response is strong enough

May reduce in size - if treat tooth and allow to heal

Suppuration surrounded by proliferating granulation tissue (pyogenic membrane) - how the pup keep the abscess contained

Puss may become walled by fibrous tissue

Question 25

what is the end result if caries are untreated?

Answer 25

pulp necrosis Will be sterile unless bacteria reach the pulp

Question 26

In a pulp polyp what type of response occurs?

Answer 26

hyperplastic response, granulation tissue formation

Question 27

What can happen to the surface of the polyp?

Answer 27

May become epitheliailsed - pink in colour Occurs through spontaneous grafting of cells in the saliva

Question 28

what does an ulcerated polyp appear like?

Answer 28

appears dark red yellow flecked fleshy mass - no sensation

Question 29

Why may cavity prep and restorative material cause pulpitis?

Answer 29

speed of instrument rotation Heat generated Presssure (really rough preparing cavity) Lack of Coolants Increased cavity depth - more likely to cause inflammation Frictional heat Hard tissue ablation using lasers And chemical pulpitis from the materials used

Question 30

How does an epithelialised polyp appear?

Answer 30

firm, pink, does not bleed easily No sensation

Question 31

What happens if you over dry dentine - previous inflammation?

Answer 31

Odontoblasts nuclei aspirated into the dentine tubules - shown in picture

Question 32

What can you do to the pulp before using an irritating material?

Answer 32

pulp capping Maintain vitality following traumatic exposure and pulpotomy

Question 33

Can the pulp heal without removal of caries?

Answer 33

yes, focal pulpitis could heal when tubules are blocked with sclerotic dentine and formation of tertiary

Question 34

True pulp stones resemble what?

Answer 34

True Denticles resemble dentine (tubular)

Question 35

What do false pulp stones resemble?

Answer 35

False denticles resemble bone (trapped cells)

Question 36

When do pulp stones become interstitial?

Answer 36

when they become surrounded by secondary or tertiary dentine

Question 37

What can cause pulp stones?

Answer 37

complication of root canal therapy Increase with age and after restorative procedures

Question 38

What type of pulp stone is shown here and what causes it?

Answer 38

dystrophic calcifications Looks like Snow storm on radiograph Due to trauma to the apical blood supply leads to pulp obliteration through formation of irregular dentine

Question 39

Pulp necrosis associated with what disease?

Answer 39

sickle cell anaemia pts

Question 40

Can the pt experience no pain with an advancing carious lesion towards the pulp?

Answer 40

yes, immune cells in response to advancing caries and low-grade inflammation can spread through the root apex to the apical periodontal tissues without symptoms

Question 41

What are odontomes?

Answer 41

Odontomas are hamartomas of aborted tooth formation which account for 22% of the odontogenic tumors. They are the most common benign

Question 42

In a carious lesion, what occurs in the pulp first: bacteria or inflammation?

Answer 42

inflammation precedes bacteria due to toxins.

Question 43

When bacteria reach the pulp through caries, at what distance do you see histological changes in permanent teeth?

Answer 43

1mm from pulp twice the distance in primary teeth - primary has patent tubules so bacteria cause irritation from further away

Question 44

What modifications/differences can change the inflammatory process?

Answer 44

The nature of the insult The severity f the insult Host defence Anatomy

Question 45

Once there is cell death due to collapse of the blood vessels, what occurs/ what is the result?

Answer 45

Chemical mediators release by the necrotic tissue Further inflammation Total necrosis Some teeth will have protection by the tertiary dentine

Question 46

How does the pulp try to contain the abscess and allow it to not spread?

Answer 46

For in fibrous tissue sounding the pulp tissue called a pyogenic membrane

Question 47

What is shown here?

Answer 47

Pyogenic membrane - can see collapse of structures Containing the abscess If not treated it will spread

Question 48

What happens if pulpitis card by caries is left untreated?

Answer 48

May continue to expand Bacteria entering the pulp will be destroyed by the neutrophils If there is a cavity, pus drainage

Question 49

Pulp polyp?

Answer 49

Chronic hyperplastic pulpitis, granulation tissue formation Tissue protrudes beyond the boundaries of the pulp chamber Paeds pt have highly vascularised teeth and and a wide apical foramina When tooth has a large cavity the pulp bulges out - from wide open pulp cavities with good apical blood supply

Question 50

Colour of an epithelialised?

Answer 50

More pink rather than reddish - protected by epithelium Don’t bleed as much

Question 51

What happens if you dry dentine that has preexisitng inflammation?

Answer 51

Wheat sheaving appearance ofodontoblasts

Question 52

What is wheat sheaving?

Answer 52

Fluid collecting into vacuoles and compressing groups of cells together

Question 53

Why can cavity prep and restorative materials affect the pulp differently?

Answer 53

The effect of materials is variable Effect affected by thickness of dentine remaining Nature of dentine (younger the dentine is patent, older dentine obliterated) Pulp capping using materials that provide no irritation

Question 54

Younger or older dentine more effected by dental materials?

Answer 54

More badly affected as dentine is patent

Question 55

What causes pulp necrosis?

Answer 55

Main cause: pulpitis Trauma to the apical blood supply - apical blood supply is cut and causes ulnar necrosis —> this causes coagulation necrosis due to ischaemia Liquefactive necrosis following pulpitis and break down of inflammatory cells - if becomes infected could lead to abscess formation - foul smell during endontic tx - sickle cell anemia