Dental Pulp Diagnostic

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Dental Pulp Diagnostic
Dr. Csaba Dobó Nagy Department of Oral
Diagnostics
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Pulp conditions

• normal when there is a response to the stimulus
  provided be the sensibility test and this
  response is not pronunced or exaggerated,and it
  does not linger
• Pulpitis is present when tehere is an exaggerated
  response that produse pain. Pulpitis can be
  considered as reversible or irreversible,
  depending on the severity of pain and whether the
  pain lingers or not.
• Pulp necrosis the tooth is pulpless or has had
  previous root canal therapy

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Diagnostic objectives of pulp testing

• Assesment of pulp health based on its qualitative
  sensory response
• Prior to restorative, endodontic and orthodontic
  procedures
• As a follow-up and for monitoring the pulp after
  trauma of the theeth
• In different diagnosis, such as excluding
  periapical pathosis of pulp origin
• Replication of sympthoms and triggers of pain
  diagnostic purposes
• To localise the source of pain
• As an aid in excluding nonodontogenic orofacial
  pain

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Definition

• Pulp Vitality Testing Assesment of the pulps
  blood supply
• Pulp Sensibility Testing assesment of the pulps
  sensory response
• Pulp Sensitivity condition of th pulp being
  very responsive to a stimulus

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Pulp Testing Techniques/Pulp Senibility Testing

• Thermal Tests
• Cold tests
• Ice
• Refrigeant Spray (chlor-etil, dichlor-difluorometa
  ne-DDM, tetrafluoro-etane TFE)
• Carbon-dioxide snow
• Heat test
• Warm gutta-percha
• Touch and heat
• Electric pulp test
• Test cavity preparation

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Pulp Vitality Testing 3.

• Other
• Photoplethysmography to improve pulse oximetry
  , by adding a light with a shorter wavelength
• Spectrophotometry dual wavelength lights
• Transmitted Laser Light (TLL) separated
  sending/receiving probes
• Transillumination colour changes that may
  indicate pulp pathosis
• Ultraviolet light photography fluoresens
  patterns
• Surface temperature measurment (breathing)

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Comparison of pulp testing

• Cold tests
• Rate of temperature decrease CO2 in 5 sec. 2C,
• Heat tests
• melting point of Guttapercha between 78C -150C,
  but 11C increase cause damage in the pulp
• Electric pulp tests
• In recently erupted teeth it takes 5 years
  myelinated (Ad) fibres reach DEJ
• Orthodontic movement sensory functions may be
  disturbed up to 9 months
• 2-6 weeks recovery following trauma
• Contamination (ginigva, metal restauration)

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Types of Nerve Fibres and their distribution
inside the dental pulp

• Dental pulp is a highly innervated tissue that
  contains sensory trigeminal afferent axons
• N trigeminal sensory nerve fibers
• 90 of A fibres are A delta fibres , which are
  located at the pulp-dentin border in the coronal
  portion of the pulp and concentrated in the pulp
  horns
• C fibres are located in the core of the pulp and
  extend into the cell free zone underneath the
  odontoblastic layer
• Symphatetic efferent fibres regulate the blood
  flow

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Pulp tests and innervation

• Electric current simulates Ad-fibres, but not the
  C-fibres, because their high treshold.
• Cold simuli produce stronger response than cold
  stimuli, because of the outward flow of fluid.
• Repeated application of cold will reduce the
  displacement of fluid less painful.
• Ad-fibres are more affected by the reduction of
  blood flow than C-fibres, because they more
  sensitive to hypoxia.
• Uncontrolled heat can injure pulp release
  mediators that affect the C-fibres.

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Positive/negative hydrostatic pressure
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Neuro-parakrin inflammation
normal pulp - -
inflamed pulp - -
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Comparison of pulp tests
Etil-chloride warm guttapercha Electric test
senzitivity 0,83 0,86 0,72
specificity 0,93 0,41 0,93
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Recovery of traumatic teeth function
Test 0. day 28. day 2 month 3 month
pulzus oximetry 100 100 100 100
Electric test 0 29,4 82,35 94,11
Heat test 0 29,4 82,35 94,11
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Faults of electric pulp test

• False-negative
• False-pozitive
• Localization
• Incizal third
• Molars, premolars neck
• EKG gel

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Determination of pulp circulation

• Yet no available clinical test
• Senzibility tests 84-90 reliable for pulp
  vitality.
• Fals-pozitive remaining C-fibres
• Fals-negative
• Calcification
• recent trauma
• developing tooth

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Differentiation of reverzibilis/irreverzibilis
pulpitis
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Small area dentin-recording
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microdialysis
bradikin ?10x gyulladt pulpában JOE, 200026744
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Special clinical cases

• Dentin hypersensitivity
• Pulpitis chronica
• Pulp-perio

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irreversibilis pulpitis?
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Pulpitis chronica