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Questions and Answers
What characterizes extremely deep caries?
What is the primary goal of vital pulp treatment?
What is the characteristic of soft dentine?
What is indirect pulp capping?
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What is the difference between selective carious-tissue removal to soft dentine and firm dentine?
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What is the main advantage of selective carious-tissue removal?
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What is the primary concern in aseptic treatment techniques?
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What is the primary goal of preventing pulp exposure?
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What is the recommended approach for carious tissue removal in teeth with reversible pulpitis?
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What is the primary goal of aseptic treatment techniques in vital pulp therapy?
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What type of materials are recommended for use in vital pulp therapy?
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What is the treatment goal in cases of carious pulp exposure?
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What is the benefit of using hydraulic calcium silicate materials in vital pulp therapy?
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What is the purpose of placing a hydraulic calcium silicate material during procedures aimed at avoiding pulp exposure?
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Why is operator skill and experience important in vital pulp therapy?
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What is the recommended approach for restoring teeth with deep (and extremely deep) carious dentine?
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What is the main difference between pulpotomy and pulpectomy?
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What is the primary indicator of irreversible pulpitis?
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What is the recommended method for assessing the status of the pulp?
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What is the primary factor that determines the outcome of vital pulp therapy?
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What is the recommended approach for carious tissue removal to avoid pulp exposure?
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What is the classification of pulpitis according to the American Association of Endodontists?
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What is the purpose of a biomaterial in pulpotomy?
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What percentage of cases may have symptomless irreversible pulpitis?
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What is a possible cause of erosive tooth wear on the palatal surfaces of maxillary teeth?
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What is a common lifestyle factor that can accelerate tooth structure loss?
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What is a characteristic of erosive tooth wear caused by exogenous acidic agents?
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What is an important factor in diagnosing and managing dental erosion?
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What is a possible cause of generalized erosion on the lingual, incisal, and occlusal surfaces of teeth?
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What is the term for the mechanical wear of the incisal or occlusal surface of teeth?
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What is a possible source of erosion associated with chemotherapy?
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Why is consultation with a physician important in diagnosing dental erosion?
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What is the primary cause of intrinsic erosion due to endogenous acids of gastric origin?
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What is a common symptom of GERD (Gastro Esophageal Reflux Disease) that contributes to dental erosion?
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What is rumination, and in which population is it commonly found?
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What is a common occupational factor that contributes to extrinsic erosion?
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What is the definition of erosion?
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What is the primary concern in the diagnosis and management of dental erosion?
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What is the characteristic of erosion lesions on the labial surfaces of the maxillary and mandibular anterior teeth?
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What is a common medical condition that contributes to intrinsic erosion?
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What is the primary cause of enamel wear on the cusp tips or incisal edges?
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What is the term for the abnormal tooth surface loss resulting from direct forces of friction between teeth and external objects?
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What is a common clinical feature of abrasion?
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What is a factor that influences the role of tooth brushing in abrasion?
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What is a habit that may contribute to abrasion?
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What is the term for the wear of tooth structure in the cervical areas?
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What may be a consequence of heavy occlusal loading from clenching?
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Why is it important to round the sharp edges of worn teeth?
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Study Notes
Managing Deep Caries
- Selective carious-tissue removal is advocated in teeth with reversible pulpitis, provided radiographic assessment indicates caries has a zone of dentine separating the carious lesion from the pulp chamber.
One-Stage and Two-Stage Procedures
- Asepsis should be preserved throughout the procedure, including the use of rubber dam.
- A hydraulic calcium silicate or a glass–ionomer cement should be placed over the deep dentine in both one- and two-stage procedures.
Managing Carious Pulp Exposure
- Treatment options after carious pulp exposure include direct pulp capping and pulpotomy (partial and full).
- Pulp preservation in cases of carious pulp exposure is only advocated in teeth with reversible pulpitis.
Vital Pulp Treatment (VPT)
- Strategies aimed at maintaining the health of all or part of the pulp.
- Indirect pulp capping involves applying a biomaterial onto a thin dentine barrier in a one-stage carious-tissue removal technique.
Full Pulpotomy and Pulpectomy
- Full pulpotomy involves complete removal of the coronal pulp and application of a biomaterial directly onto the pulp tissue at the level of the root canal orifice(s).
- Pulpectomy involves total removal of the pulp from the root canal system followed by root canal treatment.
Classifications of Disease Severity
- The American Association of Endodontists (AAE) describes pulpitis as either reversible or irreversible, depending on clinical signs and symptoms.
- Reversible pulpitis symptoms range from no complaint to a sharp pain sensation with hot/cold stimuli, with no tenderness to percussion.
Clinical Decision-Making
- Caries depth radiographically, as well as clinical indicators of activity (e.g. symptoms, progression rate, colour, sensibility tests), should be used to assist clinical decision-making.
- A detailed pain history and meticulous clinical examination, supplemented with a high-quality periapical radiograph and pulp sensibility testing using low-temperature cold testing, are necessary to assess the status of the pulp.
Non-Carious Lesions and Their Management
Erosion
- Definition: Wear or loss of tooth surface by chemical action in the presence of demineralizing agents with low pH
- Classification based on etiology:
- Intrinsic erosion: Caused by endogenous acids of gastric origin (e.g. recurrent vomiting, eating disorders, medical conditions, GERD, rumination)
- Extrinsic erosion: Caused by extrinsic factors (e.g. citrus fruit juices, acidic beverages, carbonated beverages, aspirin, ascorbic acid, diet, lifestyle)
Clinical Features of Erosion
- Palatal surfaces of maxillary teeth (particularly anterior teeth) can be affected by regurgitation of stomach acid
- Extrinsic erosion commonly leads to dissolution of facial aspects of anterior and buccal aspects of posterior teeth
- Erosion processes may cause loss of tooth structure with a clinical presentation of ‘cupped-out’ areas on occlusal surfaces
- Endogenous acidic agents can cause generalized erosion on lingual, incisal, and occlusal surfaces
- Crescent-shaped or dished defects can be caused by exogenous acidic agents (e.g. lemon juice)
Attrition
- Definition: Mechanical wear of incisal or occlusal surface as a result of functional or parafunctional movements of the mandible (tooth-to-tooth contacts)
- Includes proximal surface wear at the contact area due to physiologic tooth movement
Clinical Features of Attrition
- Worn-off enamel of cusp tips or incisal edges can result in cupped-out areas
- Areas may be an annoyance due to food retention or presence of peripheral, sharp enamel edges
- Heavy occlusal loading from clenching may result in presence of ‘craze lines’ limited to enamel
- Craze lines are not sensitive and do not require treatment but may be evidence of excessive masticatory muscle activity
Abrasion
- Definition: Abnormal tooth surface loss resulting from direct forces of friction between teeth and external objects or from frictional forces between contacting teeth components in the presence of an abrasive medium
- Etiology:
- Improper brushing habit (e.g. brushing technique, force, bristle stiffness, time, frequency)
- Habitual chewing on hard objects (e.g. paper clips, pens, pencils)
- Chronic use of agents with high abrasivity (e.g. smokeless tobacco)
Clinical Features of Abrasion
- Loss of tooth structure in cervical areas (abrasion) appears as a rounded notch in the gingival portion of the facial aspects of teeth
- Surface of the defect is usually smooth
- Presence of defects does not automatically warrant intervention
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Description
This quiz covers the selective removal of carious tissue in teeth with reversible pulpitis and the procedures for managing deep caries, including asepsis and cement placement.
