Dental Anatomy Quiz on Dentin and Pulpitis

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Questions and Answers

What percentage of dentin is composed of inorganic matter?

20%

90%

70% (correct)

10%

Which of the following contributes to the reparative capacity of dentin?

Enamel

Cementum

Pulp (correct)

All of the above

What is the function of dentin?

Provides structural support to the tooth.

Protects the pulp from external stimuli.

Contributes to tooth color.

All of the above (correct)

What is the primary function of mylinated nerve fibers in the pulp?

Sensing pain. Signup and view all the answers

Which type of pulpitis is characterized by pain that subsides when the stimulus is removed?

Reversible pulpitis Signup and view all the answers

Which of the following is NOT a sign or symptom of pulp degeneration?

Pain that is constant and intense. Signup and view all the answers

What is the main reason why the absence of toothache does not rule out pulpitis in children?

Children may not always report pain due to their short attention spans. Signup and view all the answers

What is the primary role of cementum in the tooth?

All of the above. Signup and view all the answers

Which type of pulpitis is characterized by an increase in pulp tissue size and can lead to tooth displacement?

Hyperplastic pulpitis Signup and view all the answers

Which of the following is a true statement about dentin?

Dentin is sensitive to changes in temperature. Signup and view all the answers

What type of pain is characteristic of reversible pulpitis?

Transient momentary pain triggered by stimuli Signup and view all the answers

Which pulp testing method is considered more reliable than electric pulp testing in children?

Thermal test Signup and view all the answers

What clinical sign indicates irreversible pulp damage?

Swelling, fistula, or unexplained gingival inflammation Signup and view all the answers

What is the best treatment for a tooth with irreversible pulp damage?

Pulpectomy Signup and view all the answers

Which factor does not indicate an unrestorable tooth?

Proximity of carious lesion from the pulp Signup and view all the answers

Which analysis method assesses pulp vascularity?

Pulse oximeter Signup and view all the answers

What would typically cause unprovoked, lingering pain in a child?

Irreversible pulp damage Signup and view all the answers

Which statement is true regarding EPT for children?

It can lead to apprehension in young patients Signup and view all the answers

Which factor is NOT typically assessed during a clinical examination of teeth?

Patient's dental history Signup and view all the answers

What is the ideal treatment for reversible pulpitis?

Vital pulp therapy with regenerative materials Signup and view all the answers

Study Notes

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

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Description

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.