Academic literature on the topic 'Dental pulp - Anatomy'

The radiographs most frequently taken in general dental practice are of the teeth and their immidiate supporting tissues for detection of dental caries or assessment of bone loss in periodontal disease. Intraoral radiographs are taken by placing the X-ray-sensitive film or receptor in the mouth close to the teeth being investigated. Extraoral radiographs use larger films or receptors positioned externally and produce a view of the entire dentition and its supporting structures on a single film; they are used to ascertain the state of development of the dentitions prior to orthodontic treatment, for example. Dental panoramic tomographs (DPTs) are the most frequent extraoral radiographs. A radiograph is a negative photographic record. Dense structures such as bone are designated as radio-opaque; they absorb some X-rays and appear white on radiographs. More X-rays pass through less dense radiolucent structures such as air-filled cavities which show up as black areas. The contrast between different tissues of the structures which the X-ray beam passes through is determined by their radiodensity which, in turn, is largely due to their content of metallic elements. Calcium and iron are the prevalent heavy metals in the body. Calcium is combined with phosphate to form hydroxyapatite crystals in bones and mineralized tissues in teeth. Iron is present in haemoglobin in blood, but only large concentrations of blood, such as those found within the heart chambers, show up on X-rays. In sequence from densest to most lucent, the radiodensity of the dental and periodontal tissues are: enamel, dentine, cementum, compact bone, cancellous bone, demineralized carious enamel and dentine, dental soft tissues such as pulp and periodontal ligament, and air; gold and silver–mercury amalgam metallic restorative materials are even denser than enamel. A radiograph is a two-dimensional representation of a three-dimensional situation. The orientation of anatomical structures relative to the X-ray beam is a major factor determining their appearance on the film. For example, a beam travelling through the long axis of a radiodense structure will produce a whiter image on the film than one passing through its shorter axis because more X-rays are absorbed; the structure will also have a different shape.

The child patient can be a challenging and daunting proposition for the junior dentist and dental student. Whilst children can be anxious, unco­operative, and unpredictable, they also present an extremely rewarding opportunity, which, if managed correctly, may go on to influence their healthcare experiences for the rest of their lives. Excellent behavioural management of the child patient (and their parents!) is fundamental to a successful clinical and patient- reported outcome. Aside from possible behavioural issues, paediatric patients may pre­sent with a series of unique clinical presentations that require additional skills and knowledge above and beyond those required for adult pa­tients. Differences in the micro- and macro- structures of primary and permanent teeth, coupled with variations in eruption dates, lead to an evolving mixed dentition that can lead to some difficult diagnostic and treatment planning scenarios. Furthermore, dental anxiety and the pre­ponderance for dento- alveolar trauma in children and young adults may exacerbate the patient management of an already complex situation. Prevention is central to paediatric dentistry. However, whilst signifi­cant progression has occurred in some areas, poor dietary habits and suboptimal oral hygiene regimes remain significant concerns for the pro­fession, with large numbers of dental extractions still performed under general anaesthesia each year. Key topics include: ● Tooth anatomy and eruption patterns ● Abnormalities of structure and form ● Prevention and management of dental caries, including pulp therapy ● Dental trauma ● Dental extractions and space management ● Behavioural management ● Safeguarding ● Pharmacological management.

Contents. Principal sources and further reading. The child patient. Treatment planning for children. The anxious child. The child with toothache. Abnormalities of tooth eruption and exfoliation. Abnormalities of tooth number. Abnormalities of tooth structure. Abnormalities of tooth form. Abnormalities of tooth colour. Anatomy of primary teeth (& relevance to cavity design). Extraction versus restoration of primary teeth. Local analgesia for children. Restoration of carious primary teeth. Plastic restoration in primary molars. Stainless steel crowns. Class III, IV, and V in primary teeth. Severe early childhood caries. Primary molar pulp therapy. Pulp therapy techniques. Dental trauma. Safeguarding children. Injuries to primary teeth. Injuries to permanent teeth—crown fractures. Root fractures. Luxation, subluxation, intrusion, and extrusion. Splinting. Management of the avulsed tooth. Pulpal sequelae following trauma. Management of missing incisors. Common childhood ailments affecting the mouth. Sugar-free medications.

Endodontics remains a rapidly advancing branch of restorative dentistry. It is highly likely that, by the time this book is published, several new or updated endodontic file systems will have been released. Despite the fairly rapid technological advances that the profession has seen, the key principles of endodontic treatment remain the same: 1. Eliminate microorganisms from the root canal system 2. Prevent reinfection of the root canal system 3. Retain a functional natural tooth. Whilst these principles are easy to discuss, they are consistently diffi­cult to perform, due, in large part, to the complexity of the root canal system. Multiple theories, principles, and approaches have been discussed to help achieve an optimal technical and clinical outcome. However, evi­dence to favour one specific stage or system over another is lacking, and as such, a large degree of operator preference and experience will ultimately influence the treatment planning and technical strategy. Much like baking a cake, endodontic treatment relies upon a series of proced­ural steps to achieve a desirable outcome, which, for the patient, often equates to a functional, pain-free natural tooth. Good- quality magnification remains a key component of an endodontist’s armamentarium, and dental loupes or a dental operating microscope could not be recommended more highly. Key topics include: ● Endodontic case assessment, including root canal anatomy ● Pain management, including local anaesthesia ● Access and canal identification ● Vital pulp therapy, including caries management ● Canal negotiation and instrumentation ● Root canal irrigation ● Root canal obturation ● Restoration of the endodontically treated tooth.

The circulatory system has two interrelated, but distinct parts, the cardiovascular system which circulates blood around the body and the lymphatic system which returns excess fluid from the tissues to the cardiovascular system. The function of the cardiovascular system is to oxygenate blood in the lungs and distribute the oxygenated blood to the tissues of the body. At the same time, carbon dioxide that accumulates as a result of metabolism of oxygen within the tissues is removed from the tissues and transported to the lungs where it is released from the blood and exhaled. The cardiovascular system comprises the heart, a muscular pump, and blood vessels. Arteries convey blood to thin-walled capillaries where gaseous exchange takes place and veins return blood to the heart. The cardiovascular system is often described as two parallel systems; the pulmonary circulation moves blood through the lungs and the systemic circulation circulates blood through the body. Trace the circulation of blood through the two systems in Figure 4.1 by following the arrows from the side of the heart coloured red. It follows a figure-of-eight (8) pattern with the two systems interlinked at the heart, the upper loop representing the pulmonary circulation and the lower loop the systemic circulation. The heart is a muscular pump driving blood at considerable pressure through arteries that get progressively smaller in both circulations until capillaries are reached. Arteries are sometimes dismissed as mere plumbing, but they play a vital role in regulating the blood flow through organs and tissues. Capillary walls are only one cell thick, allowing for the efficient diffusion of gases and small nutrient molecules to and from tissues. Waste gases and metabolites are also returned to the circulatory system through capillaries and these unite to form veins carrying blood under comparatively low pressure back to the heart. The heart comprises two muscular pumps arranged in parallel and beating in unison. As you can see in Figure 4.1, these two pumps are designated as the right and left sides of the heart. Each pump consists of two chambers, a thin-walled atrium that receives blood from one or other circulation and a thick-walled ventricle that ejects blood into the circulations.