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Theory

1) Dentine sensation has many theories of how it works as dentine is a non-vital part of
the tooth, yet it can feel sensation. The classical theory explains how there may be
afferent nerve fibres situated in the dentine which could detect certain stimuli.
These stimuli will be detected by there afferent fibres to be able to feel sensation.
Another theory is that there are odontoblast processes that extend through the
dentine tubules and that a cell on the apical side synapses with a nerve. This means
that at the apical area of the dentine, at the lowest part of the tubule there is a
synapse with a nerve, so sensation can be felt through movement of these tubules.
The last theory is that the dentine tubules are filled with fluid, and that movement of
these fluids activates certain nerve fibres to be able to detect sensation.
2) The fluid in the dentine tubule will move towards the tooth’s surface. This is because
there is contraction of the dentinal fluid
3) Usually uses endo-frost, which is a propane-butane mixture which is around the
temperature of -50 degrees celcius
4) Use a positive control first so the patient knows what the test feels like, apply a small
pellet of endofrost onto the enamel of the tooth. Ask patient to let you know when it
feels cold and to let you know when it goes away, any lingering sesnations should be
noted.
5) Electrical pulp testing is done to test the vitality of the pulp. The pulp is innervated
and has blood vessels so it is hence called a vital organ. Electric pulp testing uses an
electrical probe through a conductive media such as toothpaste to investigate if
there is any electrical activity inside of the pulp. A dental dam is used as saliva
conducts electricity also. The voltage of the pulp will be different with different
teeth.

Practical

1) Pulpal diagnosis is reversible pulpitis, apical diagnosis is normal apical

2) The patient must know the procedure of this treatment and the alternatives around
it. This tooth has undergone extensive deep caries which has invaded through the
dentine into the pulp, the patient must be aware of the diagnoses. The patient must
be asked if they would like to keep this tooth for a deep restoration and further
potential complication of a RCT or if they’d rather an extraction then potentially an
implant
3) The procedure that will be performed is the restoration of deep caries. As well as
removal of the pulp through a This will include selective removal of dentine,
removing the soft dentine as it is carious. As we have extended deep into the
dentine, it is important that we line the pulp with resin modified glass ionomer. This
seals dentinal tubules so prevent movement of carious material. If there is pulp
exposure from the removal of soft dentine, we must clean the pup with NaOCl and
cap the pulp with bioceramic putty cement. Then we will fill the restoration with a
seal to visit back to see if there is any progress in the caries further into the pulp
which would need a futher RCT.