Podcast
Questions and Answers
Which of the following is a primary cause of pulpitis?
Which of the following is a primary cause of pulpitis?
- Enamel hypoplasia
- Attrition
- Gingival recession
- Dental caries (correct)
In the context of pulpitis, what does 'dolor' refer to?
In the context of pulpitis, what does 'dolor' refer to?
- Heat
- Redness
- Swelling
- Pain (correct)
What type of nerve fibers are primarily responsible for eliciting sharp pain in the pulp?
What type of nerve fibers are primarily responsible for eliciting sharp pain in the pulp?
- B-fibers
- C-fibers
- Aδ-fibers (correct)
- Aβ-fibers
Which type of pulpitis is characterized by transient sensitivity to stimuli?
Which type of pulpitis is characterized by transient sensitivity to stimuli?
A patient reports experiencing spontaneous, severe pain that is worse at night. Which condition is most likely?
A patient reports experiencing spontaneous, severe pain that is worse at night. Which condition is most likely?
When assessing pulp vitality, which diagnostic method directly measures blood flow in the pulp?
When assessing pulp vitality, which diagnostic method directly measures blood flow in the pulp?
Which radiographic view is most useful for detecting early carious lesions suggesting reversible pulpitis?
Which radiographic view is most useful for detecting early carious lesions suggesting reversible pulpitis?
What pulpal nerve fibers are associated with dull, lingering pain?
What pulpal nerve fibers are associated with dull, lingering pain?
Which of the following factors contributes to pulpitis as a result of trauma?
Which of the following factors contributes to pulpitis as a result of trauma?
What is the primary goal of pulp vitality testing?
What is the primary goal of pulp vitality testing?
According to the 'SOCRATES' acronym used in medical and dental diagnosis, what does the 'R' stand for?
According to the 'SOCRATES' acronym used in medical and dental diagnosis, what does the 'R' stand for?
What clinical examination findings, specific to pulpitis, might indicate the need for further investigation?
What clinical examination findings, specific to pulpitis, might indicate the need for further investigation?
Which of the following diagnostic tools is most likely to confirm pulpitis?
Which of the following diagnostic tools is most likely to confirm pulpitis?
Which clinical feature differentiates irreversible from reversible pulpitis?
Which clinical feature differentiates irreversible from reversible pulpitis?
Why is it important to determine if the inflammation is irreversible to the dental pulp?
Why is it important to determine if the inflammation is irreversible to the dental pulp?
What are the three most common causes of pulpitis?
What are the three most common causes of pulpitis?
Which aspect of the tooth could indicate clinical signs of inflammation?
Which aspect of the tooth could indicate clinical signs of inflammation?
What are the 4 signs of inflammation identified by Celsus?
What are the 4 signs of inflammation identified by Celsus?
What are the two types of pulpitis?
What are the two types of pulpitis?
Which pulpitis symptoms include sensitivity to hot and cold stimulus?
Which pulpitis symptoms include sensitivity to hot and cold stimulus?
Which examination would involve checking which tooth and location elicits symptoms?
Which examination would involve checking which tooth and location elicits symptoms?
Which pulpitis symptoms include the need for analgesics?
Which pulpitis symptoms include the need for analgesics?
Which of the following is considered a true 'vitality' test?
Which of the following is considered a true 'vitality' test?
Which type of diagnostic test involves the use of ethyl chloride?
Which type of diagnostic test involves the use of ethyl chloride?
Which scenarios can induce trauma that may lead to pulpitis? Select 2 options.
Which scenarios can induce trauma that may lead to pulpitis? Select 2 options.
Which of the following is a specific question to ask during a patient's history to help diagnose pulpitis?
Which of the following is a specific question to ask during a patient's history to help diagnose pulpitis?
What examination would involve identifying which tooth and its current color?
What examination would involve identifying which tooth and its current color?
During the diagnosis of pulpitis, what does the exam help indicate? Select 2 options.
During the diagnosis of pulpitis, what does the exam help indicate? Select 2 options.
Which special test will require the utilization of gutta purcha?
Which special test will require the utilization of gutta purcha?
What is the typical fiber diameter for unmyelinated pulp fibers?
What is the typical fiber diameter for unmyelinated pulp fibers?
Which of the following is a sign of inflammation?
Which of the following is a sign of inflammation?
What characteristic is more indicative of irreversible pulpitis rather than reversible pulpitis?
What characteristic is more indicative of irreversible pulpitis rather than reversible pulpitis?
Flashcards
What is pulpitis?
What is pulpitis?
Inflammation of the dental pulp.
Causes of Pulpitis?
Causes of Pulpitis?
Caries, trauma, and perio-endo lesions.
Signs of Inflammation?
Signs of Inflammation?
Heat, pain, redness, swelling
Myelinated Nerve Fibers
Myelinated Nerve Fibers
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Unmyelinated Nerve Fibers
Unmyelinated Nerve Fibers
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Reversible Pulpitis
Reversible Pulpitis
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Early Lesions in Reversible Pulpitis?
Early Lesions in Reversible Pulpitis?
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Symptoms of Reversible Pulpitis
Symptoms of Reversible Pulpitis
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Irreversible Pulpitis
Irreversible Pulpitis
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Irreversible Pulpitis (Pulp Necrosis)
Irreversible Pulpitis (Pulp Necrosis)
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Symptoms of Irreversible Pulpitis
Symptoms of Irreversible Pulpitis
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How to Diagnose Pulpitis
How to Diagnose Pulpitis
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Key Questions for Pulpitis History?
Key Questions for Pulpitis History?
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Items in Clinical Examination?
Items in Clinical Examination?
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Special Tests for Pulpitis?
Special Tests for Pulpitis?
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True Vitality Test
True Vitality Test
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Radiological Exams for Pulpitis?
Radiological Exams for Pulpitis?
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Study Notes
- Focus is on establishing a framework for pulp vitality
Learning Outcomes
- Identify the causes of pulpitis
- Explain clinical signs and symptoms of pulpitis
- Describe diagnostic assessments to establish pulpitis
Pulpitis Defined
- Inflammation of the pulp
Causes of Pulpitis
- Caries
- Trauma
- Perio-Endo Lesions
Causes of Pulpitis explained
- Caries can cause pulpitis
- Physical and chemical trauma can cause pulpitis
- Depth of restoration, seal of margins, and secondary caries are potential causes of pulpitis resulting from trauma
- Endo-perio lesions can cause pulpitis
Signs of Inflammation
- Calor (heat)
- Dolor (pain)
- Rubor (redness)
- Tumor (swelling)
Signs of Inflammation in Pulp
- Intradentinal axons, dentine, predentine, odontoblast layer and cementum are components of the tooth
- Myelinated and unmyelinated nerves and blood vessels are also tooth components associated with inflammation
Myelinated Nerves
- Are Aδ-fibres
- They have diameters of 1-4 microns
- They are afferent sensory nerves, allowing fast conduction
- They are located in the pulp horn and coronal border of pulp-dentine
- The elict short, sharp pain or sensitivity, pain, temperature and touch
Unmyelinated Nerves
- Are C-fibers
- They have diameters of 0.4-1.2 microns
- They are afferent sensory nerves allowing slow conduction
- They are located in core of pulp and cell-free zone underneath the odontoblast layer
- They elict dull, lingering pain, temperature and touch
- They comprise 70-80% of pulp axons
Reversible Pulpitis
- Early onset
Early signs of Reversible Pulpitis
- Early lesions such as caries or small fractures
- There may be mild local inflammatory changes in pulp tissues
Radiographic Signs of Reversible Pulpitis
- Early carious lesions may be visible on bitewing radiographs
Symptoms of Reversible Pulpitis
- Transient sensitivity to hot, cold, sweet, and sour stimuli
- Symptoms cease when the stimulus is removed
- It may also be asymptomatic
Irreversible Pulpitis
- Is chronic
Signs of Irreversible Pulpitis
- There may be extensive lesions and pulp exposure
- Coronal pulp necrosis can occur, but the radicular pulp may remain vital
- Inflammation is irreversible
Radiographic Signs of Irreversible Pulpitis
- Extensive or deep carious lesions are visible on bitewing radiographs
Symptoms of Irreversible Pulpitis
- Spontaneous severe pain, especially at night
- Persistent throbbing pain
- Loss of sleep
- Need for analgesics
Diagnosis of Pulpitis
- Provisional diagnosis of pulp status will determine the appropriate treatment, namely pulp vitality
- This relies on examining the history, clinical examination, special tests and radiological examination
History Considerations
- Which tooth/location is affected?
- What elicits the symptoms?
- What relieves the symptoms?
- When does it occur or go away?
- Is the pain short and sharp, or dull and lingering?
- Are analgesics being taken?
SOCRATES
- Site: Where is the pain, or where is the maximal site of the pain?
- Onset: When did the pain start and was it sudden or gradual? Was it also progressive or regressive?
- Character: What is the pain like (ache or stabbing)?
- Radiation: Does the pain radiate anywhere?
- Associations: Any other signs or symptoms associated with the pain?
- Time course: Does the pain follow any pattern?
- Exacerbating/relieving factors: Does anything change the pain?
- Severity: How bad is the pain?
Clinical Examination Considerations
- Which tooth has pulpitis?
- What is the tooth color?
- Is there a cavitation or fracture?
- What are the margins of existing restoration?
- What is the depth of restoration?
- Is the marginal ridge intact?
- Is there pulp exposure?
- What are the surrounding tissues?
Special Tests
- Thermal tests (cold and hot) can be used
- Electric pulp tests can also be used
- 'Vitality' tests can be used measuring pulp blood flow using laser doppler flowmetry
Radiological Examination
- Bitewing radiographs
- Periapical radiographs
Summary of Pulpitis
- The diagram covers the causes, signs, diagnosis and symptoms
- Crucially this is linked to history taking, deciding on care options and local anaesthetic considerations
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