Caries Pathophysiology and reaction to cavity preparation Pathophysiology and reaction to... ·...
Transcript of Caries Pathophysiology and reaction to cavity preparation Pathophysiology and reaction to... ·...
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Caries Pathophysiology and Tissue
Reaction to Cavity Preparation
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Study Objectives
• To discuss the pathophysiology of caries and
its impact on enamel, dentine and pulp.
• To discuss about the reaction of dentine and
the pulp to cavity preparation.
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Introduction
• Caries is a multifactorial infectious disease
with significant morbidity and in extreme
cases, mortality for the child.
• Understanding the irreversible though
arrestable destruction process of caries helps
the dentist plan better for its management.
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• When the caries progresses from the enamel into
the dentin, sclerotic dentin is formed by the
deposition of minerals into and between the tubules
(intratubular and intertubular dentin)
• Reparative and tertiary dentine is also secreted by
other mesenchymal type cell of the pulp that
differentiate into new odontoblasts.
Caries Pathophysiology
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• The quality and amount of tertiary dentine depends
on the depth and rate of progression of the carious
lesion. The faster the lesion progresses, the poorer
and more irregular is the reparative dentine.
• If the noxious stimulus is too intense, the
cytoplasmic processes of the odontoblasts
degenerate and “dead tracts “are formed.
Caries Pathophysiology - 2
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• When the caries process advances more rapidly
than the elaboration of reparative dentine, the
blood vessels of the pulp dilate, and scattered
inflammatory cells become evident, particularly
subadjacent to the areas of the involved dentinal
tubules (transition stage).
Caries Pathophysiology - 3
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• If the carious lesion remains untreated, a frank
exposure eventually occurs.
• The pulp reacts with an infiltration of acute
inflammatory cells, and the chronic pulpitis
becomes acute.
Caries Pathophysiology - 4
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• A small abscess may develop under the region of
the exposure, and the chronic inflammatory cells
may be formed further away from the central area
of the irritation.
Caries Pathophysiology - 5
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• The remainder of the pulp may be uninflammed
(chronic partial pulpitis with acute exacerbation).
• As the exposure progresses, the pulp may undergo
partial necrosis, followed in some instance by total
necrosis.
Caries Pathophysiology - 6
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• Drainage is the factor determining whether or not
partial or total necrosis will occur.
• If the pulp is open and drainage can occur, the apical
tissue may remain uninflammed or chronically
inflamed.
Caries Pathophysiology - 7
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• If the drainage is impeded by food impaction or
restoration, the entire pulp may become necrotic
more rapidly.
Caries Pathophysiology - 8
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• The factors affecting the dentine pulp complex
during operative procedures (cavity or crown
preparation) are mainly the cutting of dentin per se,
the generation of heat, and the desiccation the
tissues.
Reaction to operative procedures
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• When uninvolved dentine undergoes operation, as
in extension for prevention, tubules that are not
protected by reparative dentine are cut.
• The tissue reaction that occurs is similar to that
occurring with caries: intratubular and intertubular
mineralization takes place resulting in sclerotic
dentine formed by the formation of tertiary dentin.
Reaction to operative procedures - 2
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• The amount and regularity of tertiary dentin are
related to the depth of the cavity preparation. As
the depth is increased, production of reparative
dentine is enhanced but its regularity and quality is
compromised. Also, dead tracts may result in
damage done to odontoblastic processes.
Reaction to operative procedures - 3
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• Pulp reaction to operative procedure can be mild or
severe, depending on the technique used. When the
technique is gentle, the reaction is mild, and minor
alterations in the odontoblastic layers can be
observed as a result of fluid accumulation.
• A gentle technique implies using appropriate cooling
and minimal pressure.
Reaction to operative procedures - 4
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• In a severe reaction, the nuclei of the odontoblasts
may be aspirated into the dentinal tubules,
hemorrhage may be present, and inflammation is
extensive, sometimes resulting in cell necrosis.
Reaction to operative procedures - 5
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• Cutting a cavity without using water cooling might
led to irreversible changes in the pulp owing to the
heat generated at the tip of the bur.
• The application of pressure increases the damage.
• Prolonged air blasts also deleterious to the pulp.
Reaction to operative procedures - 6
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• A blast of air on dentine for 10 seconds is enough to
produce displacement of odontoblastic nuclei.
• In order to prevent the generation of heat and
damage to the pulp, there are measures that should
be taken.
Reaction to operative procedures - 7
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Measures to be taken
• The cavity should be prepared as shallowly as
possible, respecting the principle of cavity
preparation
• Small and sharp burs should be used
• Appropriate cooling should be employed and
minimal pressure exerted
• Excessive drying of dentin by air syringe should
be avoided
Reaction to operative procedures - 7
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When the caries process advances rapidly:
• There is elaboration of reparative dentine
• The blood vessels of the pulp dilate
• Scattered inflammatory cells become evident
• The inflammatory cells are found within the dentinal
tubules
Quiz 1
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Reactions to operative procedures:
• Cutting a cavity without using water cooling might
led to irreversible changes in the pulp.
• The application of pressure increases the damage.
• Prolonged air blasts cools the pulp.
• A blast of air on dentine for 10 seconds is enough
cool the odontoblastic nuclei.
Quiz 2
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• Slides were developed by Morenike Ukpong of the
Department of Child Dental Health, Obafemi
Awolowo University Ile-Ife.
• The slides were developed and updated from
multiple materials over the years.
• We hereby acknowledge that many of the materials
are not primary quotes of the group.
• We also acknowledge all those that were involved
with the review of the slides.
Acknowledgement