P

PAD (photo-activated disinfection), 838–840
pain
absence of, 818
aggravating factors in, 64
alleviating factors of, 64
associated factors of, 64
cardiac/thoracic, 61
causes of, 40
classification of, 55
craniofacial, 62
definition, 53
diffuse, of vague origin, 869
duration of, 6
effects of, 49–50
elicitation with bite or percussion tests, 19
emergencies, 40
emotional variables affecting response to, 955–956 See also (anxiety/fear)
endogenous abatement of, 52
food-impaction related, 818f
history and characteristics of (children), 817–818
inflammation-associated, 483
intensity of, 6
intracranial lesions, 61
localization of, 6
locating pulpal, 31
musculoskeletal, 55–56
neuropathic, 57–61
neurovascular, 56–57
nonodontogenic See (nonodontogenic toothaches)
odontogenic See (odontogenic toothaches)
onset of, 6, 58, 64
in orofacial region, 55
patient descriptors, 673
aching pain, 54–55, 64t
burning pain, 58, 64t
constant pain, 60
crushing pain, 61
deep pain, 63–64
diffuse pain, 63–64
dull aches, 47, 58
dull pain, 54–55, 64t
electric pain, 58–59
myofascial area, 55–56
pulsatile pain, 56–57, 64t
radiating pain, 52
sharp pain, 58–59
shocking pain, 64t
shooting pain, 58
throbbing pain, 54–55, 64t
transient pain, 52
to percussion, 14
periradicular, 55
postendodontic, 686f
posttreatment, 80–81
provoked, 817
psychogenic, 61
pulpal
difficulty of localizing, 55
nature of, 54
referred See (referred pain)
salivary gland, 56
sinus/nasal mucosal, 56
somatic, 55–56
spontaneous, 817–818
trephination for, 42
trigeminal neuralgia, 5–6
trigeminal pain system, 671–676
types of, 53b
with vital pulps, 861
voltage-gated sodium channels and, 692t
with/without tissue injury, 52
pain management strategies, 98 See also analgesia
flexible plan for prescribing, 685–687, 686f
future directions for, 687
local anesthesia
long-acting, 685
when endodontic treatment is impossible, 714
postendodontic, 676–679, 686f
pretreatment, 676, 685
prophylactic antibiotics for, 684–685
three-D pain control, 685, 685b
in vital teeth, 80–81
when endodontic treatment is impossible, 714
pain perception
diagram of perception and modulation of orofacial pain, 675f
gender differences in, 695
higher-order perceptual processes in, 676
mechanisms contributing to, 673b
nociceptive information transmission, 672f
predictors of postoperative, 676–679
prepain sensations, 671–672
trigeminal pain system
detection, 671–674
perception of stimulus, 676
processing, 674–676
palatal-anterior superior alveolar (P-ASA) nerve blocks, 704
palatal roots, 731–732, 817
palate
sloughing of, 422f
swelling of, 11
palatogingival grooves, 656, 661–662, 663f
palpation, 14, 65, 818
PAMPs (pathogen-associated molecular patterns), 506–507, 532
papillary-based incisions, 742
paracrine effects, 675f
parafunctional habits, and pulpal reaction, 523–524
paralleling (right-angle) technique, 100f–101f
parapharyngeal space, 593
paresthesia, 425–426, 694, 698–699, 768
paresthesia, 430f
partial abutments, 872f
partial pulpotomies, 842, 844
partial restorations, 793t, 794, 872f, 896–897
parulis, 11f
P-ASA (palatal-anterior superior alveolar) nerve blocks, 704
passive posts, 783–784
passive ultrasonic activation, 255–256
paste delivery systems, 608–609, 615f–616f
paste retreatment, 919–921
pastes, 350
filling materials, 919f–920f
length control with paste root fillings, 432f
obturation, 381
Sargenti (N2) paste treatment, 358f, 362f, 431–432
toxic ingredients of, 919
triple antibiotic paste, 255, 494f, 608–609, 612f–613f
patency establishment, 880–881
patency files, 318, 336
pathfinding and gauging files, 322f
pathogen-associated molecular patterns (PAMPs), 506–507, 532
pathogenicity, 562–565, 567
pathogens, 588–589 See also infections See also microorganisms
pathophysiology of endodontic disease, 283–285
pathosis
acute endodontic, 78f
interradicular, 285f
periapical, 819
pulpal
periodontal disease and, 522–523, 656–657
signs of, 818
Patient Account Information for, 391f
patient age
aging populations and dental care, 858–860
canal shapes of elderly patients, 148
cementum apposition with, 146
dentin changes related to, 497
diagnosis and treatment planning, 870–873
longevity of dentition, 858
normal processes of aging, 863
pulpal reaction to restorative procedures and, 516
success and failure according to, 882
tissue changes and, 778
tooth retention in elderly, 864–865
patient data, 397
patient loop tracking, 973–994
patient preparation
premedication options, 734–737
patient preparation/education, 967
antianxiety regimens, 97–98
case presentation, 92–95
digital displays for, 989f
explanations of treatments, 92–95
alternatives to root canal therapy, 92
causes of pulpal death/disease, 92
endodontic (root canal) treatment, 92
need for crown (cap) after treatment, 92
process of root canal treatment, 92–95
risk of tooth discoloration, 92
success rates of root canal therapy, 92
symptoms of pulpal death/disease, 92
information forms for, 390
informed consent See (informed consent)
pamphlets for, 406
for periradicular surgery, 734–737
publications for, 92–95
stress and understanding of, 85
systems for, 967
for treatment planning, 91–98
patient records See documentation/records
pattern recognition receptors (PRRs)
in host defense, 506–507
in innate immune response, 531–532
Payr, Erwin, 258
PD (predentin), 457, 459, 477f, 492f
PDGF (platelet-derived growth factor), 603
PDL See periodontal ligament (PDL)
PDUFA (Prescription Drug User Fee Act), 404
Pearson silver impregnation method, 471f
pediatric endodontic treatment
apexification, 847–851
artificial apical barrier techniques, 850–851
restoration after, 851
apexogenesis, 845–847
diagnostic process in children, 817–821
morphology of primary and permanent teeth, 813–817
nonvital pulp therapy on primary teeth, 831–838
outcomes studies, 833
permanent teeth, 838–842
preservation of arch space in, 809
principles of, 821
pulpal necrosis of, 382
pulp-dentin complex
dentinogenic response to injury, 809–810
histology of, 809
reactions to dental caries, 810–811
pulp-dentin complex in young teeth, 809–813
pulp therapy for primary teeth
direct pulp capping, 822
indirect, 821–822
peer reviews, 444
Peeso drills, 834
penetration instruments, 163, 168–169, 173f
penicillin, 684–685, 714
perceived pain See localization of pain; pain entries
percussion testing, 14, 14f, 19, 65, 818
perforations, 170f
apical, 943–944
avoiding, 834, 835f
examples of, 879f
furcal, 170f
furcation, 176f
indications of, 876, 878f
internal nonsurgical repairs, 939–941
labial, 176f
of mandibular canal, 416f
mid-root, 944f–945f
multiple, 298f
nonsurgical repairs, 939–942
pain with, 708–709
post, 438, 439f, 908f
during post removal, 907–909
by posts, 909f–910f, 940f
during preparation, 318f
prevention of, 118–120, 438
repair of, 116–118, 169f, 174f, 382f, 939–944, 941f
root, 85f, 656
sinus, 429–430
treatment referrals after, 879f
perforin, in adaptive immune response, 533
periapex, anatomy of, 529
periapical bone loss, 1012
periapical cemental dysplasia (cementoma), 20f, 106f
periapical debridement, 241–242
periapical infections/diseases, 833
with associated sinus tracts, 13
clinical classification of, 36–38
response to treatment, 85f
periapical lesions, 20f, 84f
pericytes, 492f
periimplantitis, 896f
periodontal cysts, 662, 664f–665f
periodontal disease, 655
of pulpal origin, 657
pulpal pathology and, 522–523, 656–657
in senior patients, 864–865
terminal, 897–898
periodontal evaluation, 30, 227
periodontal inflammation, influence on pulp of, 657
periodontal lesions
around longstanding defects, 939–941
concomitant with pulpal, 661f
primary, 659, 660f
with secondary endodontic involvement, 660
secondary to primary endodontic, 660f
periodontal ligament (PDL), 55
damage to, 934
described, 529–530
in geriatric patients, 875
injections to, 699
sensitivity after root canal treatment, 58–59
periodontal probing, 15
periodontal tissue, 656
periodontal treatment
complications of, 865–866
methods of, 662–667
pulpal reaction to, 522–523, 522f
for rubber dam placement problems, 120–122
periodontitis
apical See (apical periodontitis)
marginal, 656–657
prognosis with, 659
retrograde, 656–657
periodontium
influence of pulpal disease on condition of, 656–657
regeneration of attachment apparatus by, 657
safety of ligamental anesthesia to, 706
periorbital space, 594
peripheral nerve endings, 674
peripheral nerve paresthesia, 694
peripheral nervous system (PNS), 41
peripheral neuropathies, 60
peripheral nociceptors, analgesia for, 674
peripheral sensitization, 53, 60, 672, 675–676
periradicular curettage, 898
periradicular destruction, 287f
periradicular diseases, 12f, 736f
abscesses, 9f, 42–45
development of, 290f
etiology of, 721–722
lesions, 320f, 736f, 744–745, 866f
osteitis, 74
periradicular pain, 42, 55
periradicular radiolucencies, 172f, 713
periradicular surgery, 666f
anatomic considerations, 730–732, 730f, 732f
anterior maxilla and mandible, 732
posterior mandible, 730–731
posterior maxilla, 731–732
bone graft materials, 764t
clinical decision making for, 722–723
closure of surgical site, 756–757
complications, 766–768
curettage and biopsies, 744–745
exploratory, 725f
hemostatic materials, 746f
indications for, 721–723, 722f–724f
instruments and operatory setup, 727–728, 737, 738f–739f, 741, 744f
intentional replantation, 762–765
local anesthesia for, 713, 737–741
localized hemostasis during, 745–747
membrane materials, 764t
patient preparation for, 734–737
postoperative care, 761f, 766
pre- and postoperative examples, 757f–760f, 762f–763f, 765f–766f
preoperative evaluation, 728–730, 730f, 745
radiography for, 732–734
rationale for, 722
root-end cavity preparation, 750–752
root-end filling materials, 752–756
root end management, 747–750
angle of resection, 748
determining need for resection/filling, 747
resected root-end surface topography, 749
root-end conditioning, 749–750
root-end resection, 747–748
surface preparation, 748–749
surgical access, 741–744
wound healing
biologic principles of, 723
hard tissue, 726–727
soft tissue, 723–726
systemic medications for, 727–728
periradicular tissue, 529–530
periradicular tissues, 530
peritubular dentin, 459, 460f
permanent restorations, 162, 651–652
permanent teeth, 809–813
morphology of, 813–817
pediatric endodontic treatment in, indirect pulp therapy, 838–840
primary teeth compared to, 813f
permanent tooth buds, 832
permeability of dentin, 461–462, 516, 517f
persistent infections, 569–571, 580–584, 893f
persistent microorganisms, 891
personal protective gear, 89
personnel See staff issues
PGs See prostaglandins (PGs)
Pharmaceutical Research and Manufacturers Association, 402
pharmacogenomics, 687
phenolic preparations, 253
phenotypes, changes in neuronal, 673
phentolamine mesylate, 697
PHI (protected health information), 91
phobias See anxiety/fear
phosphoric acid methacrylates, 787
phot-activated disinfection (PAD), 838–840
photoactivation disinfection, 259
photography, digital, 966–967
physical properties of sealers, 269
physical status classification system, 72b
physiologic root development, 608
PI (povidone iodine), 248, 251
PIDs (position-indicating devices), 95
pilot holes, 909f–910f
pink spot, 647f
pins, removal of, 170f
placement of sealers, 362, 363f
plaques, 662
plastic carriers, 916–918
plastic deformation, 230b
plasticity of intradental nerve fibers, 481–482
plastic limit, 230b
platelet aggregation, 672–673
platelet-derived growth factor (PDGF), 603
platelets, in response to apical periodontitis, 538
plexus of Raschkow, 475
PLGA (resorbable polylactic-coglycolic acid), 606f
pliers, 901f, 938f
pluggers, 372f–373f, 375f, 919f
+ sign (excitatory action), 675f
PMNs (polymorphonuclear neutrophilic leukocytes), 533, 537
PMNs (polymorphonuclear neutrophils), 724–725
pneumomediastinum (air embolus), 440
pocket cysts, 261–262, 892
pockets
probing, 15, 203f, 413, 657, 866f See also (probes/probing)
prurulent, 658–659
points, silver See silver points/cones
polyglactic acid, 764t
polyglycolic acid, 764t
polymers, 266
polymorphonuclear neutrophilic leukocytes (PMNs), 533, 537
polymorphonuclear neutrophils (PMNs), 724–725
polytetrafluoroethylene, 764t
poorly fitting restorations, 26f
populations, microbial, 565
porcelain-fused-to-metal crowns, 15–16, 899–900
porcelain jacket crowns, 15–16, 899–900
porcelain restorations, 168–169
POs (preodontoblasts), 456f, 492f
position-indicating devices (PIDs), 95
positive rack angles, 229–245
postcapillary venules, 486f
post cementation, 804f
posterior access cavity preparation, 162–165
identification of canal orifices, 163–164
individual teeth, 165
initial external outline form, 162–163
inspection of pulp chamber floor, 164
primary teeth, 833
pulp chamber
inspection of, 164
penetration of, 163
roof removal, 163
refinement of restorative margins, 164
removal of caries and permanent restorations, 162
removal of cervical dentin bulges, orifice, and coronal flaring, 164
straight-line access determination, 164
posterior superior alveolar (PSA) nerve blocks, 704, 704f
postexposure actions, 133b
post fractures, 887f
postnatal (adult) stem cells, 603
postoperative care, 406, 406f, 761f, 763–766
postoperative complications, 766–768
Post Puller, 905
post space formation, 794
posts/post materials
avoiding, with permanent restorations, 651
broken, 887f, 903f–905f
cast post/core system, 785
clinical features of, 781–782
color of, 789
custom cap, 947f
design/shape of posts, 901–902
dislodging, 934
fiber, 784
fractured, 906f, 909f–910f
gold post material, 790f–791f
length parameters, 794
light-transmitting, 851
materials for, 783–784
overheating of posts, 414f
perforations by, 439f, 908f–910f, 940f
prefabricated metallic, 783–785
preparation of, 804f
radiopacities of, 902f
removal/retrieval of, 427, 901–909, 904f, 906f–908f, 911f, 946f
broken, 905f
complications of, 907–909
inability to remove, 909
retention of, 783–786
role of, 781
screw, 425
separation of, 909
stress distribution within, 783f
techniques for, 903–905
threaded, 783–784
titanium, 783
zirconia, 784
posttrauma therapy, 442
posttreatment diseases/infections, 124, 317, 684 See also retreatment
clinical presentations of, 891f
diagnosis of, 892–894
etiology of, 890–892
persistent symptoms versus, 895
treatment planning for, 895–898
potassium iodide, 253
potency (differentiation) of stem cells, 603
povidone iodine (PI), 248, 251
practice management See also staff issues
central information store (CIS), 971
customer service, 1023–1024
emergencies, 1023
fees/payment procedures, 437–438
front desk, 976–977
front-desklessness, 972
goal setting, 1021–1022
hardware for, 977–978
imaging equipment, 978–993
IT infrastructure, 971
key performance indicators, 1021
keys to successful, 1020f, 1024
leadership, 1024–1026
management systems, 1019–1020
marketing, 972, 1024
mission statements, 1021
office design, 874f
office insurance, 972
office policies, 967, 972
online forms, 976
operatory design, 977–993
organization and quality control, 130
patient loop, 973–994
principles of, 1026f
referrals, 1024, 1025f
safety See (safety issues)
software for, 976–977
therapeutic index (TI)ers of, 970–971
tiers of, 970
time management, 1022, 1024
ideal day, 1022–1023
procedural time studies, 1022
scheduling, 1022–1023
unhurried visits, 437
use of technology, 963–964
vision statement, 1020–1021
precipitate, 250
precurved stiff files, 935–936
predentin (PD), 457, 459, 477f, 492f
prefabricated metallic posts, 783–785
pregnancy, 74, 74b, 695
premedication with antibiotics, 96–97
premises liability, 964 See also malpractice See also negligence
premolars, anesthetizing, 699
preodontoblasts (POs), 456f, 492f
preoperative evaluation, 728–730, 730f, 745
preoperative pain, 676–679
Prescription Drug User Fee Act (PDUFA), 404
pressure impulses, 484f
pretracheal space, 593
pretreatment evaluations, for restorative procedures, 787–789
biomechanical status, 779f, 788
endodontic, 787
esthetic requirements, 788–789
periodontal, 787–788
tooth position, occlusal forces, parafunctions, 788
pretreatment of posts, 784
pretrigeminal neuralgia, 58
prevention of infections, 643
prevertebral space, 593
Prevotella species, 594–595
prilocaine, 693t, 697–698, 703
prilocaine/epinephrine solutions, 703
primary afferent fibers, 50, 674
primary afferent neurons, 41–42
primary dentin, 458, 489
primary infections, 569–571
geographic influence on, 573–574
intraradicular, 572–580
microbial composition and diversity, 572–573, 572f, 574f–576f
microbial ecology and, 577–579, 581f
nonbacterial microorganisms, 579–580
spatial distribution of microbiota, 574–577, 577f–580f
symptomatic infections, 573, 577f
primary pathogens, 562–563
primary teeth, 82 See also pediatric endodontic treatment
anterior, 814–816
molars, 816–817
morphology of, 813–817
nonvital pulp therapy on, 831–838
permanent teeth compared to, 813f
preservation of, 809
pulp-dentin complex in, 809–813
root canal anatomy, 814
safety of ligamental anesthesia to, 707
prions, 134
privacy
communication protocols for, 966
computer use protocols, 966
database security, 972
with electronic communication systems, 1004
Privacy Rule See Health Insurance Portability and Accountability Act (HIPAA)
probes/probing, 227f
flexible, 227f
locating/evaluating cracks/fractures, 27
periodontal, 15, 227, 866f
pocket depth, 15
pulpal floor, 173f
routine probing, 413
procollagen, 473
product labeling, 680
ProFile, 295–297, 326, 328f–329f
Profile GT obturators, 378–380
ProFile instruments, 296–297, 299f–300f, 328f–329f
Profile thermoplasticizing, 914f
progenitor cells, 810
prognosis See also specific injury or process
for apical periodontitis, 286–287
for cracks/fractures, 29
crown fractures, 620
for extractions, 897f
factors in determining, 77
healing after replantation, 763–765
indications for extraction, 79f
with MTA for perforation repairs, 941
for perforation repairs, 941
with periodontitis, 659
pulpotomies, 628–629
revascularization with open apex, 651
with separated instruments, 926–928
single-tooth implants, 722
vertical root fractures, 30–31
progression of pain, 64
progress notes, 393, 400f–401f
proinflammatory mediators, 673
projection neurons, 675f
projection (second-order) neurons, 42–45, 51–52, 674
proliferative phase of healing, 725–726
endothelial cells/angiogenesis, 725–726
epithelium, 726
fibroblasts/fibroplasia, 725
properties of sealers, 359b
prophylactic endodontic practice See also legal responsibilities/issues See also malpractice
absorbable hemostatic agents, 440
alcohol use/abuse by patients, 438
bleach injuries, 438–439
broken needles, 440–441
continuing education, 442–443
core choice, 439–440
dental fear, 435–436
digital radiography, 433–435
disclosure errors, 433
documentation See (documentation/records)
errors See (errors)
examination process, 433
fees/payment procedures, 437–438
infective endocarditis, 445
inferior alveolar nerve canal avoidance, 441–442
malpractice related to prophylaxis, 408–425, 432–445
medication errors, 442
mental nerve avoidance, 442
off-the-cuff diagnoses, 437
other clinicians’ substandard treatment, 444
patients with HIV, 444–445
peer reviews, 444
perforations See (perforations)
pneumomediastinum (air embolus), 440
posttrauma therapy, 442
preoperative/postoperative radiography, 433
professional communication, 437
rapport/relationship with patients, 436–437
statistical research, 443–444
sterilization guidelines, 441
technologic advances, 443
temporomandibular disorders (TMDs), 433
treatment for infections, 684–685
prophylactic treatment
antibiotics before procedures, 96–97, 684–685, 737
for patient infections, 685
for staff exposure to infection, 89
proprioceptors, in dental pulp, 14
ProRoot MTA, 382f, 941f
prostaglandins (PGs), 692
decreasing production of, 676
mechanism of, 672–673
release of, 675f
prosthetic foundations, failure of, 788f
prosthetic implants, 76–77
prosthodontic treatment, and pulpal pathology, 523
ProTaper, 299–302, 301f, 326–327, 327f, 329f, 331f–333f, 378–380, 914, 915f
protected health information (PHI), 91
protection of dentin, 521
protective clothing for staff, 89
proteoglycans, 472
prothrombic adverse effects, 680
protocols
clinician and staff initials log, 406f
communication (office)
e-mail protocols, 967b
interoffice, 967
protocols for privacy during, 966
computer use, 966, 982b
disinfection, 609
documentation entries, 406
endocrown, 790f–791f
interview, 957–958
restorations for nonvital teeth, 793t
revascularization, 608, 614, 615f–616f
PRRs (pattern recognition receptors)
in host defense, 506–507
in innate immune response, 531–532
prudent care (ordinary care), 412
PSA (posterior superior alveolar) nerve blocks, 704, 704f
Pseudomonas aeruginosa, 567
psychogenic pain, 57–58, 61
psychologic stress, 954–955
psychosocial evaluations, 77
pterygomandibular space, 593
pulmonary conditions, 5b
pulp
anatomy, A-delta fibers, 50–51
apical, 473f
connective tissue fibers of, 472–473
environment of aged, 867
fibrosis of, 494f
inflamed, 488–489
influence of periodontal inflammation on, 657
metabolism of, 469–471
morphologic zones of, 463–466, 464f
safety of ligamental anesthesia to, 706–707
structure of, 453
vascular supply to, 483–489
blood vessels in pulp horn, 485f
configuration of, 484f
lymphatic capillaries, 487f
lymphatic system, 487f
postcapillary venules, 486f
regulation of pulpal blood flow, 484–488
subodontoblastic terminal capillary network (TCN), 485f
transcapillary fluid transport, 488f
pulpal anesthesia, determining, 695–696
pulpal blood flow, 477, 488f
anesthesia and, 510–512, 511f–512f
clinical aspects of, 489
humoral control of, 486
in inflamed pulp, 488–489
local control of, 486
lymphatic vasculature, 486–487
regulation of, 484–488
transcapillary fluid exchange, 487–488
vascular permeability, 489
pulpal calcifications, 171–172, 494–497, 868f
after traumatic luxation, 497f
diffuse, 495f
dystrophic, 639f
pulp stones, 495f–496f
pulpal cells, 466–469
dendritic, 469, 469f–471f, 507–508, 507f
fibroblasts, 468–469
HLA-DR+ matured macrophage in, 469f
lymphocytes, 469
macrophages, 469
mast cells, 469
MHC class II molecule-expressing cells, 471f
odontoblast layer of, 464f, 467f–468f
odontoblasts, 465f, 466–467
relationship of odontoblast structure to secretory function, 467–468
pulpal collagen fibers, 471f
pulpal dendritic cells, 469, 469f–471f, 507–508, 507f
pulpal diseases/infections, 28f, 36–37
apical/periapical disease, 37–38
clinical classification of, 36–38
concomitant with periodontal lesions, 661, 661f
inflammatory, 673
influence on condition of periodontium of, 656–657
irreversible pulpitis See (irreversible pulpitis; reversible pulpitis)
locating pain, 31
normal pulp, 36
periodontal diseases and, 655
prevention of, 602
progression of, 290f
pulpalgia, 673–674
pulpal necrosis See (pulpal necrosis (nonvital pulp))
restorative procedures with infections, 28f
reversible pulpitis, 36, 41
pulpal exposure, 820, 862f
pulpal innervation, 473–483
calcitonin gene-related peptide(CGRP), 476f, 482f
A and C fibers, 475f
characteristics of sensory fibers, 475t
convergence of sensory information, 473f
dentin sensitivity, 478–480
distribution of nerve fibers, 477f
hydrostatic stimulation pulses, 483f
hyperalgesia See (hyperalgesia)
myelinated nerve axons, 476f
neuropeptides, 480–481
plasticity of intradental nerve fibers, 481–482
pressure impulses, 484f
substance P-positive nerve fibers, 484f
testing, 478
tissue injury/deafferentiation, 478
pulpal interstitium and ground substance, 471–472
elastic fibers, 472
hyaluronan, 472
inflamed interstitium, 472
pulpal necrosis (nonvital pulp), 37, 355f, 607f, 611f See also pulp testing methods See also pulp/pulpal entries
with acute periradicular abscess, 37, 40, 42–45
with no swelling, 42
single-visit treatment, 42
with swelling, 42–45
after traumatic injuries, 641
anesthesia for teeth with, 713
and apical periodontitis, 536
bacterial colonization of, 563
caries-related, 508, 508f, 612f
diagnosis of, 509, 847
factors in development of, 641
fatigue failure of, 782–783
immature teeth with, 852f
infected, 46f
infections with, 37, 46f, 562
necrotic pulp space revascularization, 608
with pain, 45
pre-op/post-op, 494f
in primary teeth, 840–841
prophylactic penicillin for, 684
protocols for nonvital teeth with full prosthetic restorations, 793t
recommended treatment for, 790f–791f
regenerative treatment for, 851 See also (regenerative dentistry/endodontics)
and resorption, 355f
restorative procedures on, 804f
structure/properties in, 777–778
symptomatic, 81
timing of obturation with, 353
trauma-related, 613f, 625f, 821
pulpal pathosis
etiology of primary, 350
periodontal disease and, 522–523, 656–657
signs of, 818
pulpal reactions
to air abrasion for cavity preparation, 521
to biomechanical irritation, 523–524
to calcium hydroxide, 517–518
to caries, 504–508, 810–811
chemokine production, 507, 507f
clinical symptoms, correlation of, 509–510
dentin sclerosis, 505
and dentin sclerosis, 505f
fibrodentin, 505–506
inflammatory response, 506–507, 506f
neurogenic mediators, 508–509
prevention, diagnosis, and treatment, 519–521, 520f–521f
pulpal dendritic cells aggregation with, 507–508, 507f
reactionary dentin, 505–506
and reactionary dentin, 506f
reparative dentin, 505–506
and reparative dentin, 506f
tertiary dentinogenesis, 505
and tertiary dentinogenesis, 504–505
conditions for favorable, 822
correlation of clinical symptoms, 509f
to crown preparations, 516, 516f
to cuspal flexure, 523–524
to dental materials, 811–813
dentin hypersensitivity and, 510, 511f
to direct pulp capping, 519
with mineral trioxide aggregate, 518
to hemostatic agents and disinfectants on direct pulp exposures, 519
to implant placement and function, 524
to intrapulpal anesthesia, 512
to laser procedures, 519–521, 519f
dentin hypersensitivity treatment, 521
dentin protective measures, 521
local anesthetics and, 510–512, 511f–512f
to mechanical irritants, 523
to MTA capping, 813f
neurogenic mediators of, 508f
to orthodontic surgery, 523, 524f
to periodontal procedures, 522–523, 522f
permeability of dentin and, 516
to restorations/restorative procedures, 512–518, 518f
materials, 516–518, 518f
patient age and, 516
permeability of dentin/odontoblastic layer and, 517f
physical irritation from procedure and, 513–515, 513f–514f
pretreatment pulp inflammation and, 512–513
pulp proximity and surface area of exposed dentin and, 515–516, 515f
to restorative procedures, 811
to vital bleaching, 521–522
to zinc oxide and eugenol (ZOE), 518
pulpal repair, 489–494
pulpal tissue
apical versus coronal, 603–604
intercommunication with periodontal tissue, 656
pulp canal obliteration (calcification), 641, 641f
pulp capping, 382f, 812
agents for, 811
with calcium hydroxide, 517–518, 518f
direct, 841f
follow-up care for, 844
hemostatic agents and disinfectants, pulpal reaction to, 519
with mineral trioxide aggregate, pulpal reaction to, 518
pulp chamber, 875
depth, 870
floor, 140f, 144–145
calcific deposits on, 159
inspection of, 164
probing, 173f
types of, 217f
laws (guidelines) of anatomy of, 151–152
receded, 155
roof
failure to remove, 175f
penetration of, 158–159, 163
removal of, 159, 165f, 825f, 835f
pulp degeneration, 655
pulp-dentin complex, 453–458, 463, 603 See also See also dentin entries
cell-poor zone, 464
cell-rich zone, 464–466
clinical relevance of, 809b
development of, 453–458
accessory canals in roots, 457–458
bell stage, 454f, 456f
diagrammatic representation of, 454f
epithelial rest cells, 457f
molecular control of trigeminal axon navigation, 455–456
odontoblast differentiation, 456–457, 456f
root development, 457, 457f
sensory trigeminal axons, 455f
stages, 454–455
tooth nerve supply, 455
odontoblast layer, 463–464
pulp proper, 466
pulp dressing materials, 626
pulpectomies, 629, 629f
in mature teeth, 624–625
in primary teeth
access openings for, 833–836
contraindications for, 833, 833b
controversies over, 832–833
follow-up care, 838
stages of, 835f
pulp exposure, 561
avoiding, 838–840
direct bonding of, 812
managing, 840–842
traumatic, 845f
pulp horn removal, 165f
pulp innervation
calcitonin gene-related peptide(CGRP), 476f, 482f
A and C fibers, 475f
characteristics of sensory fibers, 475t
convergence of sensory information, 473f
dentin sensitivity, 478–480
distribution of nerve fibers, 477f
hydrostatic stimulation pulses, 483f
hyperalgesia See (hyperalgesia)
myelinated nerve axons, 476f
neuropeptides, 480–481
plasticity of intradental nerve fibers, 481–482
pressure impulses, 484f
substance P-positive nerve fibers, 484f
testing, 478
tissue injury/deafferentiation, 478
pulpitis
and apical periodontitis, 536, 536f
diagnosis of, 509–510
hyperplastic/proliferative, 508–509, 508f
painful, 483, 509
painless, 509
pulpotomies
definition, 842
failures, 819f
with glutaraldehyde, 827
lasers for, 520–521
local anesthesia for, 714
partial, 627f–629f
on primary teeth, 822–824
contraindications for, 823b
electrosurgical, 831
with ferric sulfate, 827–830
with formocresol, 824–827
with glutaraldehyde, 827
indications/contraindications for, 823
with mineral trioxide aggregate (MTA), 830–831
outcomes, 829–830
prospective studies on, 828–829
retrospective studies on, 829
radiographic examples, 630f
stages of vital, 825f
on young permanent teeth, 842–845
follow-up care, 844
with formocresol, 845
partial, 844
pulp polyps, 508–509, 508f
pulp proper, 466
pulp provocation tests, 817
pulp recession, 870
pulp regeneration, 603, 606f, 851–852, 852f
pulp revascularization, 493–494
pulp space
disinfecting the, 245–260
infections of, 641–642
pulp stones (denticles), 494, 1015f
pulp testing methods, 15–20, 31, 650–651, 869f See also testing/assessment methods
bite test, 19
with children, 818
electric pulp test (EPT), 17, 225
electronic, 18f, 225f
for geriatric patients, 866–869
infections, 28f
for pulpal anesthesia, 696f
pulpal innervation, 478
pulp degeneration, 658
pulp provocation tests, 817
pulp vitality, 650–651
pulse oximetry, 19
responsiveness of pulpal sensory neurons, 15
retreatment after, 83f
selective anesthesia, 19–20
staining and transillumination, 19
test cavity method, 19
thermal, 15–17, 36–37
cold tests, 15–16, 223–224
pulp therapy, evidence of successful, 823b
pulp tissue
cellularity of older, 868f
congealed, 152–153
pulp vitality, 20f See also pulp testing methods
blood supply and, 17
with cold and sweet sensitivity, 172f
confirmation with retreatment, 81f
in geriatric patients, 874
indications of, 14
nonvital pulp See (pulpal necrosis (nonvital pulp))
reestablishment of, 642–643
symptomatic, 30f
testing for See (testing/assessment methods)
tissue modification following loss of, 795f
vital pulp See (vital pulp)
pulp volume, 865f
pulse oximetry, 18–19, 18f, 226