Dental Pulp
Diagnostic
Dr. Csaba Dobó Nagy
Department of Oral Diagnostics
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
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
Definition
• Pulp Vitality Testing: Assesment of the pulp’s
blood supply
• Pulp Sensibility Testing: assesment of the
pulp’s sensory response
• Pulp Sensitivity : condition of th pulp being
very responsive to a stimulus
Pulp Testing Techniques/Pulp Senibility
Testing
• Thermal Tests
– Cold tests:
• Ice
• Refrigeant Spray (chlor-etil, dichlor-difluorometaneDDM, tetrafluoro-etane TFE)
• Carbon-dioxide snow
– Heat test
• Warm gutta-percha
• Touch and heat
• Electric pulp test
• Test cavity preparation
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)
Comparison of pulp testing
• Cold tests
– Rate of temperature decrease: CO2 in 5 sec. 2°C,
• Heat tests
– melting point of Guttapercha between 78°C -150°C, but
11°C increase cause damage in the pulp
• Electric pulp tests
– In recently erupted teeth it takes 5 years myelinated (Aδ)
fibres reach DEJ
– Orthodontic movement sensory functions may be
disturbed up to 9 months
– 2-6 weeks recovery following trauma
– Contamination (ginigva, metal restauration)
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
Pulp tests and innervation
• Electric current simulates Aδ-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.
• Aδ-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.
Positive/negative
hydrostatic pressure
+150 Hgmm
-150 Hgmm
Neuro-parakrin inflammation
normal pulp
+
-
-
inflamed pulp
++
-
-
Comparison of pulp tests
Etilchloride
warm
Electric test
guttapercha
senzitivity
0,83
0,86
0,72
specificity
0,93
0,41
0,93
Recovery of traumatic teeth function
Test
0. day
pulzus
oximetry
Electric test
100%
100%
0
29,4%
82,35% 94,11%
0
29,4%
82,35% 94,11%
Heat test
28. day 2 month 3 month
100%
100%
Faults of electric pulp test
• False-negative
• False-pozitive
• Localization:
– Incizal third
– Molars, premolars neck
– EKG gel
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
Differentiation of reverzibilis/irreverzibilis
pulpitis
Small area dentin-recording
microdialysis
bradikin ↑10x gyulladt pulpában JOE, 2000;26:744
Special clinical cases
• Dentin hypersensitivity
• Pulpitis chronica
• Pulp-perio
irreversibilis pulpitis?
Pulpitis chronica