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Questions and Answers
What is the characteristic color of demineralized dentin in acute caries?
What is the characteristic color of demineralized dentin in acute caries?
What is the primary cause of irritation in a deep carious lesion?
What is the primary cause of irritation in a deep carious lesion?
What is the expected outcome of a long duration of untreated acute caries?
What is the expected outcome of a long duration of untreated acute caries?
What is the characteristic appearance of demineralized dentin in chronic caries?
What is the characteristic appearance of demineralized dentin in chronic caries?
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What does the text suggest is the most important factor in managing a deep carious lesion?
What does the text suggest is the most important factor in managing a deep carious lesion?
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What is the relationship between the duration of chronic caries and the chances of pulp repair?
What is the relationship between the duration of chronic caries and the chances of pulp repair?
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What is the most appropriate approach to excavating a deep carious lesion?
What is the most appropriate approach to excavating a deep carious lesion?
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What is the difference between arrested caries and chronic caries?
What is the difference between arrested caries and chronic caries?
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In the context of pulp vitality testing, what does the presence of a pulp exposure during excavation of a carious lesion usually indicate?
In the context of pulp vitality testing, what does the presence of a pulp exposure during excavation of a carious lesion usually indicate?
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Which of the following statements accurately describes the reliability of pain as an indicator of pulp vitality?
Which of the following statements accurately describes the reliability of pain as an indicator of pulp vitality?
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What characteristic of a cariously exposed pulp is suggestive of advanced inflammation?
What characteristic of a cariously exposed pulp is suggestive of advanced inflammation?
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Which of the following is NOT a reliable method used to assess pulp vitality?
Which of the following is NOT a reliable method used to assess pulp vitality?
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What is the primary advantage of using Pulse Oximetry for pulp vitality testing?
What is the primary advantage of using Pulse Oximetry for pulp vitality testing?
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Which of the following characteristics is indicative of pulp necrosis?
Which of the following characteristics is indicative of pulp necrosis?
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What does the term 'microvasculature' refer to in the context of Laser Doppler Flowmetry (LDF) for pulp vitality testing?
What does the term 'microvasculature' refer to in the context of Laser Doppler Flowmetry (LDF) for pulp vitality testing?
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What is the significance of understanding the pulp-dentine reaction when diagnosing pulp vitality?
What is the significance of understanding the pulp-dentine reaction when diagnosing pulp vitality?
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What is the minimum dentin bridge thickness for a tooth to be considered a candidate for direct pulp capping?
What is the minimum dentin bridge thickness for a tooth to be considered a candidate for direct pulp capping?
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What does the "effective depth" refer to in the context of dental caries?
What does the "effective depth" refer to in the context of dental caries?
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According to the content, what is the primary factor influencing the acuteness or chronicity of a carious lesion?
According to the content, what is the primary factor influencing the acuteness or chronicity of a carious lesion?
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What is a key factor contributing to the difficulty in standardizing the pulp-dentine organ's response to decay?
What is a key factor contributing to the difficulty in standardizing the pulp-dentine organ's response to decay?
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According to the content, what is the likely outcome when the effective depth is less than 0.3-0.8mm?
According to the content, what is the likely outcome when the effective depth is less than 0.3-0.8mm?
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What is a factor that affects the individual's response to a carious lesion, as mentioned in the content?
What is a factor that affects the individual's response to a carious lesion, as mentioned in the content?
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Which of the following is NOT a characteristic of deeper carious involvement?
Which of the following is NOT a characteristic of deeper carious involvement?
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What is the primary reason why deep caries management can be challenging?
What is the primary reason why deep caries management can be challenging?
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What is the correct interpretation of "lack of a cause-effect relationship" in relation to the pulp-dentine organ's reaction to decay?
What is the correct interpretation of "lack of a cause-effect relationship" in relation to the pulp-dentine organ's reaction to decay?
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What is the primary goal of conservative dentistry in the context of deep caries?
What is the primary goal of conservative dentistry in the context of deep caries?
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In the step-wise (two-step) excavation protocol, why is a provisional restoration placed after the initial excavation?
In the step-wise (two-step) excavation protocol, why is a provisional restoration placed after the initial excavation?
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What is the primary difference between indirect pulp capping and direct pulp capping?
What is the primary difference between indirect pulp capping and direct pulp capping?
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What is the primary benefit of the 'one-step' technique for managing deep caries?
What is the primary benefit of the 'one-step' technique for managing deep caries?
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What is the purpose of leaving a thin layer of infected dentin in the step-wise excavation protocol?
What is the purpose of leaving a thin layer of infected dentin in the step-wise excavation protocol?
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What is the main factor contributing to the higher clinical success rate of the 'one-step' technique compared to the 'two-step' technique?
What is the main factor contributing to the higher clinical success rate of the 'one-step' technique compared to the 'two-step' technique?
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Which of the following is NOT a factor contributing to the success of conservative dentistry for deep caries?
Which of the following is NOT a factor contributing to the success of conservative dentistry for deep caries?
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What is the primary difference between a pathologic pulp exposure and a traumatic pulp exposure?
What is the primary difference between a pathologic pulp exposure and a traumatic pulp exposure?
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What is the significance of a pin-point exposure with surrounding sound dentine and pin-point hemorrhage?
What is the significance of a pin-point exposure with surrounding sound dentine and pin-point hemorrhage?
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How is the tenderness of a tooth to percussion interpreted in relation to pulpal status?
How is the tenderness of a tooth to percussion interpreted in relation to pulpal status?
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What is the traditional approach to managing deep carious lesions nearing healthy pulp, and what are its potential drawbacks?
What is the traditional approach to managing deep carious lesions nearing healthy pulp, and what are its potential drawbacks?
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What is the modern, more conservative approach to managing deep carious lesions?
What is the modern, more conservative approach to managing deep carious lesions?
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What is the distinction between infected and affected dentin in the context of deep carious lesions?
What is the distinction between infected and affected dentin in the context of deep carious lesions?
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How does radiography contribute to the diagnosis of pulpal status?
How does radiography contribute to the diagnosis of pulpal status?
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What is the significance of a good peripheral seal in managing deep carious lesions?
What is the significance of a good peripheral seal in managing deep carious lesions?
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Which of the following statements about affected dentin are accurate?
Which of the following statements about affected dentin are accurate?
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Flashcards
Deep Caries
Deep Caries
Progressive irreversible disease causing tooth demineralization and destruction.
Management Challenges
Management Challenges
Skill and knowledge required to treat deep carious lesions effectively.
Causes of Carious Irritation
Causes of Carious Irritation
Irritation arises from bacteria, acids, and physic-mechanical factors.
Acute Carious Process
Acute Carious Process
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Chronic Carious Process
Chronic Carious Process
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Texture of Decayed Dentin
Texture of Decayed Dentin
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Duration of Decay Process
Duration of Decay Process
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Arrested Caries
Arrested Caries
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Vital Pulp Therapy
Vital Pulp Therapy
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Presence of Pain
Presence of Pain
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Thermal Pulp Testing
Thermal Pulp Testing
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Electric Pulp Testing
Electric Pulp Testing
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Pulse Oximetry
Pulse Oximetry
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Laser Doppler Flowmetry
Laser Doppler Flowmetry
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Pulp Exposure
Pulp Exposure
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Signs of Advanced Inflammation
Signs of Advanced Inflammation
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Depth of Involvement
Depth of Involvement
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Effective Dentin Bridge
Effective Dentin Bridge
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Healthy Reparative Reaction Depth
Healthy Reparative Reaction Depth
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Unhealthy Reparative Reaction Depth
Unhealthy Reparative Reaction Depth
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Pulpal Involvement Depth
Pulpal Involvement Depth
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Micro-organisms in Dentine
Micro-organisms in Dentine
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Tooth Dentin Resistance
Tooth Dentin Resistance
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Individual Reaction of the Pulp-Dentine Organ
Individual Reaction of the Pulp-Dentine Organ
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Pin-point exposure
Pin-point exposure
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Percussion test importance
Percussion test importance
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Radiograph value
Radiograph value
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Treatment of deep caries
Treatment of deep caries
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Carious dentin types
Carious dentin types
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Discriminating dentin layers
Discriminating dentin layers
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Deep carious dentin management
Deep carious dentin management
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Peripheral seal importance
Peripheral seal importance
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Peripheral Seal
Peripheral Seal
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Stepwise Excavation
Stepwise Excavation
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Indirect Pulp Capping
Indirect Pulp Capping
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Re-entry Visit
Re-entry Visit
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Partial Caries Removal
Partial Caries Removal
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Direct Pulp Capping
Direct Pulp Capping
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Tertiary Dentin Formation
Tertiary Dentin Formation
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Medicament Liners
Medicament Liners
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Microscopic Pulp Exposure
Microscopic Pulp Exposure
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Criteria for Direct Pulp Capping
Criteria for Direct Pulp Capping
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Aseptic Field
Aseptic Field
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Cap Materials
Cap Materials
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Cavity Preparation
Cavity Preparation
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Signs of Pulp Degeneration
Signs of Pulp Degeneration
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Tight Seal Importance
Tight Seal Importance
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Study Notes
Management of Deep Caries
- Deep caries is a progressive, irreversible disease of tooth calcified tissues.
- It's characterized by demineralization of the inorganic component and destruction of the organic substance.
- Management of deep carious lesions is challenging due to skill, knowledge, experience, armamentarium and professional capabilities required.
- The operator must prioritize pulp protection, retention, resistance, and esthetics.
- Irritation from carious processes are from three causes:
- Biological irritation from bacteria and toxins
- Chemical irritation due to acids
- Physico-mechanical irritation arising from declining dentin bridge structure as decay progresses.
Types of Decay
- Acute caries: Rapid, strong irritation with little chance for recovery.
- Demineralized dentin is light yellow/yellow, due to rapid acid infusion.
- Surface has a wet/moist texture.
- Soft, flakes off easily during excavation.
- Care must be taken during excavation to avoid pulp exposure, following a direction parallel to the pulp.
- Chronic decay: Accompanied by substantial repair.
- Periods of elevated irritation/destruction followed by restorative periods.
- Dark brown color due to chromogenic bacteria with dry texture.
- Arrested caries (remineralized) is slightly darker.
- Darkest area of demineralized dentin indicates the oldest part of the lesion.
Duration of Decay Process
- Acute decay (rapidly progressing caries): Rapid destruction of tooth structure. Longer untreated acute lesions result in greater pulpo-dentinal organ damage, and rapidly induce pulp exposure.
- Chronic decay: Longer duration increases repair chances, provided the pulp tissue isn't directly involved.
Depth of Involvement
- Deeper caries leads to greater irritation intensity and risk of pulp destruction. Deeper involvement places irritant sources closer to the pulp, reducing its protective barrier.
- Effective depth is the thickness of the dentin bridge along dentinal tubules. It reflects the irritant pathway length to the pulp.
- Effective depth of 2mm or more indicates healthy reparative reaction; 0.8-2mm indicates an unhealthy reaction; less than 0.3-0.8mm indicates pulpal involvement.
Number and Pathogenicity of Micro-organisms
- Number and pathogenicity of invading micro-organisms significantly affect decay activity (acuteness or chronicity).
- Type and metabolic activities of bacteria in the lesion, and the surrounding oral environment affect dentin demineralization and proteolysis rates.
Tooth Dentin Resistance
- Resistance of hard dentin to spread of decay.
Individual Reaction of the Pulp-Dentin Organ
- Ability of tissues to defend caries can vary between individuals and cases, even for the same caries type/extent.
- Factors include patient age, health, cellularity/vascularity of pulpal tissues, and immune response, as well as structural and periapical condition of the affected tooth.
Clinical Management of Deep Caries Lesions
- Treating deep caries approximating healthy pulp is challenging.
- Traditional methods (removing all carious dentin to reach sound tissue) are invasive and risk over-preparation/pulp exposure.
Now we are going for Conservative Dentistry
- Not all carious dentin is infected with cariogenic micro-organisms.
- Outer carious dentin is infected (brownish), while inner is sterile (yellowish).
- Differentiating these is challenging.
- Removing all soft carious dentin isn't always necessary if the remaining dentin can be sealed well.
Direct Pulp Capping
- Procedure for lining a pulp exposure with a medicament liner (calcium hydroxide or MTA).
- Seals the cavity, stimulating reparative dentin bridge formation.
- Pulp exposure during preparation may be a result of caries progression or trauma.
- Micro-scopic exposures only appear as open tubules, reaching the pulp.
Criteria for Direct Pulp Capping Candidates
- No signs/symptoms of pulp degeneration.
- Sufficient evidence of reasonable reparative capacity in P-D organ.
- Completely aseptic field of operation (isolated by rubber dam).
Direct Pulp Capping Characteristics
- Pinpoint exposure, small diameter compared to pulp size.
- Minimal to no observable hemorrhage (coagulated blood if any).
- Reparable dentin at periphery (verified visually/tactically).
- Exposure site not constricted.
Direct Pulp Capping Procedures
- Collect data regarding P-D organ physiology.
- Remove undesirable and/or undermined enamel/unsound dentin.
- Wash/irrigate cavity floor/exposure site with sterile water.
- Dry using sterile cotton pellets, not air spray.
- Ca(OH)2 or MTA used as capping material.
Additional Notes
- Stepwise (two-step) and partial (one-step) excavation protocols are described.
- Maintaining a good peripheral seal helps prevent bacterial access to nutrients causing further decay.
- Success of treatment depends on understanding and proper handling of these challenges.
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Description
Test your knowledge on the characteristics and management of dental caries, including acute and chronic conditions. This quiz explores important factors in excavation techniques and pulp vitality assessment related to deep carious lesions.