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41 Cards in this Set
- Front
- Back
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During preparation of teeth, potential impact of pulpal pathology should be discussed with pt. to achieve "informed consent". (T/F)
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True
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Tooth hypersensitivity peaks in 3rd and 5th decades of life (T/F)
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True
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What is the % of post opt. sensitivity?
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-1 in 7 adult patients (14%) following restoration placement (40 million in US)
-Incidence of post-opt. sensitivity appear to be high intially and decline over time |
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Pulp Function?
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-Performs both formative and supportive functions
-Formation of dentin leads to formation of enamel |
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Odontoblasts form dentin and these hihgly specialized cells participate in dentin formation in 3 ways?
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-Synthesize and secrete organic matrix
-Inital transporting inorganic components to newly formed matrix -creating an environment that permits minieralization of matrix |
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Describe the dentin that is placed in response to injury such as caries, trauma, restorative procedures?
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-Dentin is less organized than primary or secondary dentin
-Localized to the site of injury (teritary dentin) -Teritary dentin AKA reactionary or reparative dentin |
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Physiological stimuli of nerves in the pulp ONLY result in___?
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-Sensation of pain
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Describe the formation of smear layer and function of smear layer?
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-Cutting dentin results in smear layer (fragments of mineral crystals, organic matrix) (5-50 microns in thickness)
-Extend into dentinal tubules help reduce dentinal fluid flow/permeability and act as barriers against bacterial penetration of dentinal tubules |
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Dentinal tubules get bigger as you go from the pulp to DEJ (T/F)
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False: Gets bigger as you go from DEJ to pulp
-15-20,000 tubules per sq mm at DEJ (diameter 0.5-0.9 microns) -45-65,000 tubules per sq mm at the pulp (diameter 2-3 microns) |
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Dentin's cellular components are?
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-Odontoblasts and Odontoblastic processes
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Extracellular matrix component of dentin are ___?
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-Collagen (Type I and III) and hydroxyapatite
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Describe the hydrodynamic theory of dentinal sensitivity?
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-A tubular network that is patent, cross-linked via branches.
-These tubules are filled with fluid of pulpal origin, odontoblastic processes and neurons. -Bilateral (inward and outward) movement of the dentinal fluid stimulates the neural receptors eliciting pain response |
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Positivie pulpal pressure (__) moves fluid outward, describe the rest
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Fluid moves out in a rapid manner, resultant flow may cause deformation of plasma membrane of mechano-receptors at pulpal end of tubules, and activate A-delta fibers = sharp pain
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What events cause outward fluid movement?
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-Tooth preparation (heat & air spray)
-Air drying of prep. dentin -Cold -Hyperosmotic solutions -Probing of prepared dentin or root surface -Heat from: (light curing units, composite resins, tooth prep) |
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What events cause intward movement of fluid?
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-Occlusion and tooth flexure
-Crown delivery/cementation (hydraulic pressure) -Result in activation of C-fibers, with delayed, dull, lingering pain response |
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Reduce or inhibit post-op and or tooth and root sensitivity by?
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-Sealing the tubules
-Stop fluid flow |
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Describe the inflammatory theory?
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-branches of nerve axons exist in coronal and cervical pulp regions.
-Stimulation of dentin in the coronal pulp could release neuropepties in cervical pulp. |
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You can reduce or inhibit post-op sensitivity by replacing old restorations or sealing the dentin beneath new ones (T/F)
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True
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Osmotic responses can result around leaking restoration s or exposed root surface (what type of osmotic responses)?
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-Sugar
-Salt -Acid solutions can elicit osmotic response |
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How can you detect leakage?
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-Concentrated CaCl2 solution
-Any exposed root surfae is prone to osmotic response |
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It is not possible for clinicians to detect discrepancies less than 50 microns. Bacteria hasve diameters of 0.5 microns
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-False: 40 microns
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Pulp increase by 6 degree = incidence of pulpal death by ___
-Pulp temp. increases by 10 degree = incidence of pulpal death by ___. |
-6 degree = 15%
-10 degree = 95% -Heat of polymerization: PMMA resins, other provisional materials (5-45 degree C) |
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Heat that is generated during tooth preparation and provisionalization is affected by:
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-Proximity to the pulp tissues
-Cutting efficiency of dental burs -Amount of water coolant -Exothermic setting reaction of dental material (PMMA and composite resins) -Use of light curing units |
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What are some methods used to manage temp. increases in pulp?
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-Copious water spray
-Let pulp cool b/t consecutive lgith cure cycles -Construct "indirect" temporaries -Replace burs frequently |
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Carbide burs prepare dentin and enamel more efficiently, and with less heat than diamond burs (T/F)
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True: Diamond prepared surfaces are 31% more retentive than carbide prepared surface for crown prep.
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Threaded pins placed w/in ___ of pulp have been shown to results in severe pulpal inflammation.
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-0.7 mm
-1.0 mm from pulp = no inflammation -Slot retention have no inflammation regardless of proximity to dental pulp |
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What are the methods for tx of root sensitivity?
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-Chemical: metallic ions, CHX varnish, Fluoride and Fluoride varnishs (Duraphat, Colgate)
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Why is it necessary to clean the dentin prior to crown cementation?
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-Consider how much contamination of dentin has occurred during crown prep and temporization
-consider amt of contamination that occured during crown try-in |
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What are the material to consider for dentin "disinfection"?
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-Pumice
-Acids (total etch technique) -CHX gluconate: Consepsis scrubs (ultradent), Peridex (P&G), Perioguard (Colgate) |
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Describe Gluma Desensitizer?
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-Heraeus Kulzer
-Glutaraldehyde/HEMA -30 sec application time, w/o curing -Forms transverse septa 200 microns into dentin tubules |
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What type of patients should be consider for Endodontic Therapy?
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-Chronic hypersensitive patients
-Success 34-100% |
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Incidence of pulpal necrosis following crown placement is what?
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-Up to 17% incidence
-Inform your patients |
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Effective use of dental cements first rule?
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-Follow the manufacturer's direction
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Methology to prepare the tooth for cementation?
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-Remove and evaulate the temporary
-Pumice the tooth (remove XS cement, pumice prep w/ Whip Mix Preppies) -Etch the tooth -Rinse thoroughly -Isolate the tooth -Keep tooth properly isolated |
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Preparing the completed crown or FPD for cementation?
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-Gold or Ceramo-metal: Air abrade inside of casting, protect the margins
-All Ceramic: Do not air abrade UNLESS the material can be acid etch and silanated, OR is TZP zirconium |
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It all part of propfer informed consent, Incidence of 11-17%. (T/F)
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True
-Always tell pt that there is a chance of pulp necrosis after crown preparation |
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Sealing of prepared dentin has not been shown to raise or lower the long term incidence of pulp damage subsequent to crown preparation and placement (T/F)
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True
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Use of desensitizer may reduce crown retention (T/F)
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True
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What are some of the etiological factors of tooth/root sensitivity?
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-Tooth preparation, dentin desiccation, osmotic responses, bacterial/bacterial products, thermal responses, dentin exposure, cutting efficiency of dental burs and where you place threaded pin/slots
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What are some steps you can take as a clinician to reduce the rate tooth/root sensitivity in your patients?
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-Use Copious water spray as coolant
-Let pulp cool b/t consecutive light cure cycles -Construct "indirect" temporaries -Replace burs frequently -Be aware of where you place pins |
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Describe some methods used to treat tooth/root sensitivity?
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-Chemical: metallic ions, CHX varnishes, Fluoride and Fluoride varnishes (Duraphat, Colgate)
-Dentrifices -Non-traditional -Endodontic therapy |
