Dental Anatomy Quiz on Dentin and Pulpitis

Pulp Therapy of Primary and Young Permanent Teeth

• Pulp therapy aims to preserve primary teeth as fully functional components in the dental arch.
• Proper function includes mastication, phonation, maintaining natural space, and psychological confidence.

Pulp-Dentine Complex

• Dentin, in conjunction with enamel (crown) and cementum (root), protects the pulp.
• Pulp provides dentin with repair.
• The pulp-dentine complex is composed of 70% inorganic, 20% organic matrix, and 10% water.
• The dentin thickness increases from the dentin-enamel junction (DEJ) to the pulp.
• Pulp contains nerve fibers, including myelinated A, delta, and beta fibers (90% and 10%, respectively), and non-myelinated C fibers.

Classification of Pulpal Diseases

• Based on the extent of damage:
  • Pulpitis: Reversible, Irreversible, Hyperplastic pulpitis/internal resorption
  • Pulp degeneration-pulp calcification
  • Necrosis

Diagnosis of Pulp Pathology

• History of pain: Absence of toothache doesn't rule out pulpitis. Children's active lives and short attention spans may mask discomfort.
  • Provoked vs. unprovoked pain (e.g., momentary vs. lingering) is important to note
  • Reversible pulpitis: transient momentary pain from stimuli (osmotic or thermal); resolves with stimulus removal or OTC analgesics
  • Irreversible pulpitis: lingering throbbing pain that may awaken the child
• Clinical examination: Tooth mobility (unreliable), percussion (info about pulp), assessing swelling (possible inflammation/irreversible damage), exudate, and size of exposure/bleeding.
• Pulp testing: Electrical pulp testing (EPT) is unreliable for children due to immature nerve fibers. Thermal testing (using ice or cold substances) is more reliable and less anxiety-provoking.
• Vascularity assessment: Laser Doppler flowmetry (LDF) and pulse oximeter can evaluate blood flow.
• Radiographic examination: Checking the proximity of carious lesions to the pulp (not exposure), presence of periapical/interradicular bone radiolucencies, PMS widening, and pulp calcification. Assessing IRR/ERR and treatment evaluation.

Indications for Vital Pulp Therapy

• Any tooth with reversible pulpitis (characterized by transient momentary pain relieved by stimulus removal, brushing, or OTC analgesics)
• Treating a reversible pulpitis is indicated for vital pulp therapy (IDPC or pulpotomy).

Indications for Non-Vital Pulp Therapy

• Any tooth with irreversible pulp damage (characterized by prolonged, spontaneous or stimulated pain and may awaken the child).
• Treating irreversible pulp damage is indicated for non-vital pulp therapy (pulpectomy).

Contraindications

• Unrestorable tooth
• Internal resorption visible in radiograph (though this is treatable)
• Farcul involvement
• Excessive pathologic root resorption exceeding one-third of the root
• Cyst
• Tooth approach shedding
• Pulp degeneration (fibrous or calcific)
• Uncooperative patients
• Poor parent attitude

Steps of Vital Pulp Therapy for Primary Teeth

• Local anesthesia administration → Rubber dam isolation
• Caries removal (no pulp exposure): IDPC using regenerative materials (RMGIC, Ca(OH)2, RZOE), dentin bonding agents, or GIC followed by full coverage.
• Caries removal (pulp exposure): DPC (Direct pulp capping) for mechanical exposure less than 1mm
• Mechanical exposure (less than 1mm) in primary teeth.
• Caries removal (pulp exposure): DPC (Direct pulp capping) for mechanical or carious exposure (<1 mm) in young permanent teeth

Steps of Non-Vital Pulp Therapy for Primary Teeth

• Steps are essentially the same as vital pulp therapy, but with added or different treatments: Local anesthesia, Rubber dam isolation and caries removal. In this case, pulp exposure is favorable. MTA or formocresol application.

Apexogenesis in Young Permanent Teeth

• Apexogenesis refers to any step to allow root maturity in vital young permanent teeth (e.g., IPD, DPC, partial pulpotomy, cervical pulpotomy).
• Cervical pulpotomy in young permanent teeth involves removing the infected coronal pulp and placing calcium hydroxide or MTA over the healthy amputated radicular stumps.
• A calcific barrier forms in response.

Non-Vital Young Permanent Teeth

• Difficulties in this group include: Loss of pulp vitality, Short roots, No apical seal; Thin dentin walls.
• Treatment options: CH apexification, MTA apical plug, and revascularization.

Pulp Therapy for Young Permanent Teeth

• Important to note the various treatment choices and considerations. For each stage, there are various choices depending on the individual state.

Diagnostic Methods

• Visual-tactile examination
• X-ray based methods (conventional radiography, digital radiography, digital subtraction radiography)
• Light-emitting devices (laser fluorescence devices, Quantitative light-induced fluorescence, fiber-optic transillumination, digital imaging fiber-optic transillumination)
• Electrical caries monitor (ECM)

G.V. Black vs. Modern Concepts

• G.V. Black (Surgical) model vs Modern (Medical) model: Different concepts of preventing caries based on the nature of the disease, extension, prevention, and material types.

Caries Classification (G.V. Black)

• System used for consistent, predictable diagnosis
• various classes and locations of tooth decay are described
• this is an important classification since it describes the level of decay and allows the clinician to follow a consistent approach.

Principles of Cavity Design

• Access: Gaining access to cavity (prepare to standard outline)
• Outline form: Includes all pits and fissures (not carious)
• Extension: Removal of all undermined and unsupported tooth structure (preservation)
• Resistance: Preventive to extension from caries (remove loose enamel)
• Retention: Mechanical and micromechanical (converging walls, dovetailing, undercuts)
• Cleanliness: Finishing walls within cavity.

Anatomic Considerations of Primary Teeth

• Thin enamel and dentin
• Larger and higher pulp horns
• Enamel rods in cervical area directed occlusally
• Greater cervical constriction
• Broad, flat proximal contacts
• Narrow occlusal table

Treatment Plan

• Preventive program
• Individualized tailored restorative care plan
• Choosing suitable restorative material
• Cavity design and preparation
• Cavity preparation (class I, II, III, IV, V)

Traumatic Dental Injuries (TDIs) in Children and Early Adolescents

• Epidemiology, Etiology, and Predisposing Factors
• Classification of Trauma to Anterior Teeth (WHO, Ellis & Davey)

Management of Dental Traumatic Injuries (TDIs) in Young Permanent Teeth

• Enamel infractions (treatment, flow up period)
• Enamel fracture (treatment, flow up period)
• Enamel-Dentin fracture (treatment, fragment restoration, temporary restorations, flow up period)
• Crown fracture with pulp exposure (vital pulp, non-vital pulp, treatment options, flow-up period)
• Crown-Root Fracture without Pulp Exposure (treatment options, flow-up period)
• Root Fracture (treatment options, healing, flow-up period)
• Management of Periodontal Tissue Injuries in Young Permanent Incisors (concussion, subluxation, lateral displacement, extrusive displacement, intrusive displacement, avulsion)
• Splinting Requirements of ideal splint
• Different types of splint
• Reaction of tooth to trauma (Discoloration, Inflammatory root resorption)

Management of Hard Dental Tissue Injuries in Primary Incisors

• Crack and fracture
• Enamel and dentin with pulp exposure
• Crown root fracture
• Root fracture
• Treatment of supporting tissue structure injuries

Test your knowledge on dental anatomy, focusing on dentin composition, functions, and the different types of pulpitis. This quiz covers essential concepts that dental students and professionals should understand. Prepare to reinforce your understanding of tooth structures and their reparative capacities.