Pulpitis Slides PDF

In partnership with Pulpitis Jiann Khaw Tutor Dentist Image source: MCA Records 2 Art credit: Vartan Kurjian  A framework to establish The Aim pulp vitality 3 Learning Outcomes: At the end of this session, you should be able to: 1. Identify...

In partnership with Pulpitis Jiann Khaw Tutor Dentist Image source: MCA Records 2 Art credit: Vartan Kurjian  A framework to establish The Aim pulp vitality 3 Learning Outcomes: At the end of this session, you should be able to: 1. Identify causes of pulpitis 2. Explain clinical signs and symptoms of pulpitis 3. Describe diagnostic assessment to establish pulpitis GDC Learning Outcome: 1.1, 1.1.1, 1.1.5, 1.2.5, 1.2.7, 1.9.1 C1.1, C1.2, C1.18, C1.30, C2.1.1, C2.1.4, C2.1.8, C2.2.3, C2.4.2 4 Image source: Island Records 2001 5 Art credit: Rory Crichton  Pulp - itis Pulp inflammation 6 Causes of Pulpitis Caries Trauma Perio-Endo Lesion Image source: J. Khaw Image source: J. Khaw Image source: Berman, L & Hargreaves, K (2020) Cohen's Pathway of the Pulp, 12th Edition. 7 Causes of Pulpitis Caries Image source: J. Khaw Image source: Google Image source: J. Khaw ICDA 8 S? Causes of Pulpitis Trauma 1. Depth of restoration 2. Seal of restoration – margins 3. Secondary caries Image source: J. Khaw Image source: J. Khaw Physical trauma i. Thermal trauma ii. Chemical trauma 9 Causes of Pulpitis Caries = Endo-Perio Perio-Endo Lesion Image source: Berman, L & Hargreaves, K (2020) Cohen's Pathway of the Pulp, 12th Edition. Image curtesy of P. Songra 10 Signs of Inflammation 4 clinical signs (according to Celsus, 1st Century AD) Calor (Heat) Dolor (Pain) Rubor (Redness) Tumor (Swelling) Image source: J. Khaw 11  Signs of inflammation in Pulp How can pulpitis be confirmed? Diagram showing cross section of tooth with labelled nerve, blood vessels and odontoblast in pulp 12 Source: Berkovitz et al.  Myelinated Aδ-fibres 1-4 microns (diameter) Afferent sensory nerve Fast conduction Impulse Axon Myelin Pulp horn & coronal border of pulp-dentine Elicit short, sharp pain/sensitivity Pain, temperature, touch Diagram showing cross section of tooth with labelled nerve, blood vessels and odontoblast in pulp 13 Source: Berkovitz et al.  Unmyelinated C-fibres 0.4-1.2 microns (diameter) Afferent sensory nerve Slow conduction Impulse Axon Core of pulp and cell-free zone underneath odontoblast layer Elicit dull, lingering pain Pain, temperature, touch 70-80% of pulp axons Diagram showing cross section of tooth with labelled nerve, blood vessels and odontoblast in pulp 14 Source: Berkovitz et al.  1. REVERSIBLE Types of 2. IRREVERSIBLE Pulpitis 15 1. Reversible Pulpitis Early onset 16  Early lesion: caries or small fracture Mild local inflammatory changes in pulp tissues Image source: Luca Bondiolli and Arnaud Mazurier at esrf.fr 17 Radiographic Appearance: Image SLide Bitewing radiograph showing early carious lesion (URE) suggesting reversible pulpitis ICDAS Image source: J. Khaw ? 18 Reversible pulpitis Symptoms includes:  Transient sensitivity to hot, cold, sweet, sour (acidic)  Symptom cease when stimulus is removed  Or no symptoms Weeping Women by Picasso (1937) Image source: Tate Collection Nerve 19 ? 2. Irreversible Pulpitis Chronic 20  Extensive lesion +/- pulp exposure Inflammation irreversible  Coronal pulp necrosis but Radicular pulp may be vital Image source: Luca Bondiolli and Arnaud Mazurier at esrf.fr How does this affect vitality test or 21 Radiographic Appearance: Image SLide Bitewing radiograph showing extensive (deep) carious lesion suggesting irreversible pulpitis Image source: J. Khaw 22 Irreversible pulpitis Symptoms includes:  Spontaneous severe pain, especially at night  Persistent throbbing pain  Loss of sleep  Need analgesics The Scream by Munch (1893) Image source: National Gallery of Norway Nerve ? 23  PROVISIONAL DIAGNOSIS OF PULP STATUS WILL DETERMINE THE APPROPRIATE Pulp Vitality TREATMENT Rodd et al. (2006) 24 Diagnosis History Clinical Examination Special Test Radiological Examination Gopikrishna et al. (2009) 25 Diagnosis Specific to pulpitis: History 1. Which tooth/location? 2. What elicit symptoms? 3. What relieve symptoms? Clinical Examination 4. When -Time of day it occurs or goes away? 5. Short, sharp & goes away Special Test quickly vs dull and lingering? 6. Taking analgesics? Radiological Examination 26 Diagnosis Specific to pulpitis: History Clinical Examination Special Test Radiological Examination 27 Table source: Wikipedia Diagnosis History Specific to pulpitis: 1. Identify which tooth 2. Colour of tooth 3. Cavitated? Fracture? Clinical Examination 4. Margins of existing restoration? 5. Depth of existing Special Test restoration? 6. Marginal ridge intact? 7. Pulp exposure? Radiological Examination 8. Surrounding tissues? 28 Diagnosis History Specific to pulpitis: 1. Thermal – cold & hot Gutta Purcha Endo-Frost Clinical Examination Ethyl Chloride Special Test 2. Electric pulp test Radiological Examination 29 Diagnosis History Specific to pulpitis: Sensibility Test = Thermal & Electrical True ‘Vitality’ Test = Clinical Examination Pulp blood flow using Laser Doppler Flowmetry (LDF) Special Test Radiological Examination Image source: Onlinelibrary. Wiley.com 30 Diagnosis History Specific to pulpitis: 1. Bitewing Clinical Examination Image source: J. Khaw 2. Periapical Special Test Radiological Examination 31  Causes Signs Pulpitis Summary Diagnosis Symptoms Link to: History Taking Decision on care options Local Anaesthetic Adaptation of diagram by S.Balian (2021) 32 Bibliography for this presentation: 1. Abd-Elmeguid, A & Yu, D. (2009) Dental Pulp Neurophysiology: Part 1. Clinical and Diagnostic Implications, J Can Dent Assoc, 75 (1), pp. 55 – 59. Available at: http://www.cda-adc.ca/jcda/vol-75/issue-1/55.pdf (Accessed: 7 January 2025). 2. Abd-Elmeguid, A & Yu, D. (2009) Dental Pulp Neurophysiology: Part 2. Current Diagnostic Tests to Assess Pulp Vitality, J Can Dent Assoc, 75 (2), pp. 139 – 143. Available at: http://www.cda-adc.ca/jcda/vol-75/issue-2/139.pdf (Accessed: 7 January 2025). 3. Donnermeyer, D., Dammaschke, T., Lipski, M. and Schafer, E. (2022) Effectiveness of diagnosing pulpitis: A systematic review, Int Endo J, 56 (Suppl.3), pp. 296 – 325. DOI: 10.1111/iej.13762 4. Gopikrishna, V., Pradeep, G. & Venkateshbabu, N. (2009) Assessment of pulp vitality: a review, Int J Paed Dent, 19, pp. 3-15. DOI: 10.1111/j.1365-263X.2008.00955.x 5. International Caries Detection and Assessment System (ICDAS) Coordinating Committee. (2009) Criteria Manual: International Caries Detection and Assessment System II, Hungary: ICCMS. Available at: https://www.iccms-web.com/uploads/asset/5ccb149905404942610729.pdf (Accessed: 7 January 2025). 6. Rodd, H., Waterhouse, P.J., Fuks, A.B., Fayle, S.A. & Moffat, M.A. (2006) UK National Clinical Guideline for Paediatric Dentistry: Pulp therapy for primary molars, Int J Paed Dent, 16 (Suppl. 1), pp. 15-23. DOI: 10.1111/j.1365-263X.2006.00774.x 33