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  Discussion on Research Summary: Pulp exposure during dental procedures
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Moderator:
DrO

Posted on Thursday, May 26, 2011 - 7:42 am:

Here is a careful look at possible adverse consequences of two dental procedures that remove tooth enamel: bit seating and diastemata correction. Exposure of the pulp with predispose the tooth to infection descending to the roots.

Diastemata correction is an important health procedure (for more on this see article associated with this discussion topic) that runs a risk of exposing the pulp of the tooth the procedure is trying to preserve. This study found that removing enamel from the front of the cheek tooth runs less risk of exposing the pulp than removing it from the back side.

On the other hand bit seating is a elective procedure of uncertain significance on a horse's ridability. Some of these cheek teeth have a pulp 1.6 mm below the occlusal surface which would be invaded by a routine bit seat. We continue to advise against this practice.
DrO

Equine Vet J. 2011 Mar;43(2):163-9.
An anatomical study to evaluate the risk of pulpar exposure during mechanical widening of equine cheek teeth diastemata and 'bit seating'.

Bettiol N, Dixon PM.
Source
Division of Veterinary Clinical Studies, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush Veterinary Centre, UK.

Abstract
Reasons for performing study: Cheek teeth (CT) diastemata are a major equine dental disorder that can be treated by mechanically widening the diastemata. There is limited anatomical knowledge of the spatial relationships of the individual pulps to the adjacent interproximal surfaces; on the risks of exposing the 6th pulp horn when performing the clinically unproven 'bit seating' procedure on Triadan 06s. Objectives: To describe the anatomical relationships between the occlusal and interproximal surfaces of CT and the adjacent pulp horns; and between the 6th pulp horn and the occlusal and rostral surfaces of Triadan 06s. Methods: The CT from 30 skulls of horses subjected to euthanasia for non-dental reasons were sectioned to expose the rostrally and caudally situated pulp horns to allow the anatomical relationships between the pulp horns and the occlusal and interproximal aspects of the CT to be assessed. Results: Pulp horns were mean ± s.d. of 5.74 ± 1.45 (range 1.3-10.8 mm) from the nearest interproximal surface, with 5.3% of pulp horns being <3.5 mm from the interproximal surface. In contrast to expectations, pulps tended to became closer to the interproximal surface (and also to the occlusal surface) with increasing age. Teeth with physiologically tall clinical crowns, and also those in the Triadan 09 position had pulps that were closer to the interproximal surfaces than the remaining CT. The more caudally situated pulp horns, i.e. in particular, the 4th maxillary and 5th mandibular pulp horns were closer to the interproximal surfaces than the remaining pulp horns and these pulp horns also had the thinnest sub-occlusal secondary dentine. Pulps that were close to the interproximal surface were also found to be close to the occlusal surface of the CT. Conclusions and potential relevance: While diastema widening is theoretically safe between the majority of CT, a small proportion of pulp horns are only 1.3 mm from an interproximal surface and others lie just 1.6 mm beneath the occlusal surface, and such pulps are at risk of pulpar exposure and to thermal injury during this procedure. The risk of pulpar exposure increases when dental tissue is removed from the caudal aspects of CT.
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