How deep is too deep?

[cbizzle7994]

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Was doing my first operative prep today, removing an overhanging class 2 composite restoration with a class 2 amalgam, when I came across darkening of the dentin. The original prep was pretty deep (3mm or so in the distal) and was afraid I was getting close to the pulp. I called over faculty and they assured me it was sclerotic dentin and not the pulp.

My question is, how can you differentiate between the two and how deep do you actually have to go until you pulp out?

 

[diasIItema]

Why didn't you ask the faculty? (to clarify, I'm not being a dick b/c I don't know the answer. Just wondering why you didn't ask at the time).

 

[TJNova2011]

Was doing my first operative prep today, removing an overhanging class 2 composite restoration with a class 2 amalgam, when I came across darkening of the dentin. The original prep was pretty deep (3mm or so in the distal) and was afraid I was getting close to the pulp. I called over faculty and they assured me it was sclerotic dentin and not the pulp.

My question is, how can you differentiate between the two and how deep do you actually have to go until you pulp out?

Get out a perio probe, measure it against the xray to see the distance away from the pulp chamber. This gives you a guesstimate as one should realize there's distortion... After a few preps you will become more aware of different shades.

 

[MatthewLeeDDS]

In my experience, when you're getting close to the pulp, you'll see a little bit of a brownish shadow where you would expect the pulp to be. As you continue to approach it, it will become redder. If you expose you'll get a bright red pinpoint, typically with very slight bleeding. Having radiographs handy is the key to knowing what to expect. You'll learn pulp anatomy and this helps a lot of where to expect the pulp. When prepping a tooth, you may see dentin discoloration but the key is for it to be caries-free. Staining does not equal caries; you should use your explorer to determine if the dentin is solid and it's ready to restore.

 

[DrJeff]

It's pretty simple, get the caries out of the tooth and if they reach the pulp, they reach the pulp, and if they don't they don't.

Unless you've got a 3-D Cat scan of the tooth, standard radiographs just show you a 2-D picture of a 3-D object so i've had many a time where on the 2-D radiograph the extent of the caries look ominious with respect to the pulp, but when I start removing the caries I find that the caries is located say primarily buccally or lingually and actually isn't too close to the pulp. The flipside also holds true where the caries may not look to ominious on the radiograph, but when you start removing it, you find that the extent of the carious dentin is far greater than you're anticipating and a pulp exposure does happen. You just have to chase the caries and go from there!

 

[djeffreyt]

sclerotic dentin is hard as a rock, just like stained but non-carious dentin. There is no reason to cut it out. So if you reach a dark brown area of dentin and wonder if it's the pulp and it's hard as a rock, then either way, you don't have to cut any further, so problem solved.

All the other suggestions above hold true also.

 

[txaggie03]

You just have to chase the caries and go from there!

Exactly. It is what it is. Now fix it.