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d) using the text above and the picture speak on the structure of a tooth and the
main sites of caries formation.
e) Find in the information on etiology of caries, risk factors, symptoms and
signs, diagnosis and treatment. Give a short summary of your own.
Ex. 9. Read the text and answer the questions:
Treating Caries: A Guide for Dental Students
Treating dental caries requires understanding the stage and extent of the lesion
to determine the appropriate intervention. The first step is accurate diagnosis using
clinical examination, sometimes aided by radiographs or advanced tools like laser
fluorescence. Early lesions such as enamel caries may be managed non-invasively
with remineralization therapies. These often involve the application of fluoride,
calcium, and phosphate to restore enamel hardness and prevent progression.
When caries has progressed beyond the enamel into dentin, treatment usually
involves removing the decayed tissues. Two main strategies exist for caries removal:
nonselective and selective removal. Nonselective removal, or complete excavation,
aims to eliminate all softened and affected dentin, reaching hard dentin. While this
approach ensures removal of all infected tissue, it risks pulp exposure and may
sacrifice healthy tooth structure.
Selective caries removal is a more conservative method that preserves some
affected dentin near the pulp to avoid exposure and promote pulp healing. It can be
performed in one or two steps; the two-step method involves partial removal
followed by reassessment and further removal if needed. This approach aligns with
minimally invasive dentistry principles, aiming to maximize tooth vitality.
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Atraumatic Restorative Treatment (ART) is a minimally invasive technique
especially useful in resource-limited settings. It involves manual removal of soft
decayed tissue using hand instruments without anesthesia, followed by restoration
with glass ionomer cement. ART preserves tooth structure and reduces patient
discomfort.
Preventive Resin Restoration (PRR) is another conservative method targeting
small pit and fissure lesions. It entails removing caries only in affected areas and
sealing remaining fissures with a composite resin or sealant to prevent further decay.
After caries removal, the cavity is restored with appropriate materials like
composite resins or glass ionomer cements to restore function and seal the site from
bacterial invasion. Proper isolation of the treatment field during restoration is
essential to ensure lasting adhesion and seal.
Pain control is important during treatment. Local anesthesia or topical gels may
be used depending on lesion depth and patient comfort. Maintaining patient comfort
reduces treatment anxiety and improves outcomes.
Following treatment, patient education on oral hygiene, diet, and regular dental
visits is vital to prevent recurrence. Early intervention and continuous monitoring
allow management of caries at a stage when less invasive treatments are effective.
In summary, treating caries today emphasizes early diagnosis, minimal
invasive removal, preserving pulp vitality, and long-term prevention. Dental students
should master these principles to provide patient-centered, evidence-based care that
maintains natural dentition as long as possible.
Questions:
1. What is the first step in determining the treatment approach for dental caries?
2. How can early enamel lesions (C1) be managed without invasive procedures?
3. What are the two main strategies for removing carious dentin?
4. Describe the difference between nonselective and selective caries removal.
5. Why might selective caries removal be preferred near the dental pulp?
6. What is the Atraumatic Restorative Treatment (ART) technique, and when is it
particularly useful?
7. How does Preventive Resin Restoration (PRR) help in managing early caries?
8. Why is maintaining proper isolation important during restorative treatment after
caries removal?
9. What role does patient education play after caries treatment?
10. How does modern caries treatment reflect the principles of minimally invasive
dentistry?
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PULPITIS
Ex. 10. Translate the word-combinations:
Proper stimulus, multiple invasive procedures, dental tartar, maxillary teeth,
caries ache, mandibular arch, pulpal necrosis, reversible pulpitis, apical foramen,
physical examination, clinical evaluation, dental sensitivity, dental radiographs,
limited inflammation, endodontic therapy, gutta percha, root apex, alternative
diagnoses, a high-speed air turbine dental drill, prophylactic antibiotics, simple
filling, infectious sequelae, periapical abscess, purulent sinusitis, mandibular teeth,
untreated caries, clinical findings, pulp vitality test, damaged tooth, root canal
therapy, blood supply.
Ex. 11. Find the synonyms:
stimulus
sequelae
dental tartar
restoration
necrosis
maxillary teeth
pain
examination
caries
cease
ache
impulse
test
cells death
complications
stop
dental calculus
tooth decay
filling
upper jaw teeth
Ex. 12. Find the antonyms:
alive
to worsen
irreversible
to exclude
sensitive
acute
hot
to cease
rarely
multiple
to include
single
dead
dull
to improve
reversible
to continue
unperceptive
cold
frequently
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Ex. 13. Mind the different types of pulpitis and tooth problems. Read and
translate.
Acute pulpitis — sudden, intense inflammation of the pulp, with sharp,
throbbing pain.
Chronic pulpitis — long‑lasting, low‑grade inflammation of the pulp, often
with less severe pain.
Reversible pulpitis — mild inflammation of the pulp that can be cured by
removing the cause (e.g. decay) and restoring the tooth; the pulp remains vital.
Irreversible pulpitis — severe, progressive inflammation of the pulp that
cannot heal; the pulp will eventually die and requires root canal treatment or
extraction.
Pulp polyp (hypertrophic pulpitis) — a reddish, granulation‑tissue mass
growing from the pulp into a large carious cavity, common in young patients.
Pulp necrosis — death of the dental pulp due to severe inflammation, infection,
or trauma.
Periapical inflammation — inflammation of the tissues around the apex (tip) of
the tooth root, often a complication of pulpitis.
Periapical abscess — a collection of pus at the root tip, caused by bacterial
spread from necrotic pulp.
Examples:
1. Untreated pulpitis can lead to periapical inflammation and abscess.
2. When pulp necrosis occurs, the tooth no longer responds to cold or sweet stimuli.
3. Acute pulpitis is characterized by severe, spontaneous pain.
4. A periapical abscess causes severe pain, swelling, and tooth mobility.
5. In irreversible pulpitis, pain is spontaneous and lingers after the stimulus is
removed.
6. Chronic pulpitis may cause dull, intermittent pain and sometimes a pulp polyp.
7. A pulp polyp is often seen in chronic, open pulpitis with a large carious exposure.
8. In reversible pulpitis, pain disappears quickly after removing the stimulus
(e.g. cold).
Ex. 14. Mind the different types of pain and sensitivity in tooth problems. Read
and translate.
Toothache — pain in a tooth, typically sharp, throbbing, or constant; the main
symptom of pulpitis.
Dental pain — a kind of pain originating from a tooth, often aggravated by
stimuli.
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Sensitivity — pain or discomfort when the tooth contacts cold or hot
food/drink.
Hypersensitivity — increased sensitivity of the tooth to stimuli such as cold,
heat, sweets, or touch.
Spontaneous pain — pain that occurs without any obvious trigger (e.g., not
only when chewing or touching the tooth).
Pain on biting / on chewing — pain that increases when the tooth is under
pressure during biting or chewing.
Night pain — toothache that worsens when lying down, commonly seen in
pulpitis.
Radiating pain — pain that spreads from the affected tooth to the jaw, ear, or
temple.
Examples:
1. Spontaneous, throbbing pain often indicates irreversible pulpitis.
2. The young man describes radiating pain to the temple, which is common in case
of pulp involvement, as severe.
3. The patient’s main complaint reported to the dentist is a severe toothache,
aggravating especially at night.
4. The patient reports pain on biting, suggesting pulpal or periapical involvement.
5. Dental pain in pulpitis is often getting worse when lying down.
6. Night pain is a typical feature of different forms of pulpitis.
7. Hypersensitivity to cold and sweet foods is common in pulpitis.
8. Sensitivity to cold is a classic sign of reversible pulpitis.
Ex. 15. Match the term and its definition.
Tartar, periapical abscess, percussion test, caries, root canal treatment (RCT),
pulpitis, dentin, radiograph, antibiotic, tooth extraction, analgesic (painkiller), cold
test, local anesthesia.
• a hard yellowish deposit on teeth that can contribute to tooth decay and bad
breath.
• a test using cold (e.g., ice, ethyl chloride) to assess pulp vitality; sharp, short
pain is typical of reversible pulpitis.
• refers to the gradual decay of a tooth.
• a medicine used to relieve pain (e.g., paracetamol, ibuprofen).
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• an X‑ray image used to evaluate the tooth structure, caries depth, and
periapical changes.
• inflammation of the dental pulp, usually resulting from untreated cavities or
trauma to the tooth.
• a collection of pus at the root tip, caused by bacterial spread from necrotic
pulp.
• a medicine used to treat bacterial infection (e.g., in cases of abscess or
spreading infection).
• complete removal of the pulp followed by cleaning, shaping, and filling of
the root canal.
• numbing of a specific area (e.g., around a tooth) using an injection.
• the hard tissue beneath the enamel that surrounds the pulp chamber.
• tapping on the tooth to check for pain, which may indicate periapical
inflammation or abscess.
• removal of the tooth when it cannot be restored (e.g., severely damaged or
non‑restorable).
Ex. 16. Read the text. Mind the information about pulpitis, render it shortly in
English.
Pulpitis
Pulpitis is inflammation of the dental pulp resulting from untreated caries,
trauma, or multiple restorations. Its principal symptom is pain. Diagnosis is based on
clinical findings, radiographs, and pulp vitality tests. Treatment involves removing
decay, restoring the damaged tooth, and sometimes doing root canal therapy or
extracting the tooth.
Pulpitis can occur when
1. Caries progresses deeply into the dentin.
2. A tooth requires multiple invasive procedures.
3. Trauma disrupts the lymphatic and blood supply to the pulp.
Pulpitis is usually designated as
1. Reversible: There is limited inflammation; the tooth can be saved with a
simple filling.
2. Irreversible: Swelling inside the rigid encasement of the dentin compromises
circulation, making the pulp necrotic, which predisposes to infection.
Complications
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Infectious sequelae of pulpitis include apical periodontitis, periapical abscess,
cellulitis, and (rarely) osteomyelitis of the jaw. Infection extension from maxillary
teeth may cause purulent sinusitis, meningitis, brain abscess, orbital cellulitis, and
cavernous sinus thrombosis.
Spread from mandibular teeth may cause Ludwig angina (cellulitis of the floor
of the mouth), parapharyngeal abscess, pericarditis, empyema, and jugular
thrombophlebitis.
Symptoms and Signs of Pulpitis
In reversible pulpitis, pain occurs when a stimulus (usually cold or sweet) is
applied to the tooth. When the stimulus is removed, the pain ceases within 1 to 2
seconds.
In irreversible pulpitis, pain occurs spontaneously or lingers minutes after the
stimulus (usually heat, less frequently cold) is removed. A patient may have difficulty
locating the tooth from which the pain originates, even confusing the maxillary and
mandibular arches (but not the left and right sides of the mouth). The pain may then
cease for several days because of pulpal necrosis. When pulpal necrosis is complete,
the pulp no longer responds to hot or cold but often responds to percussion. As
infection develops and extends through the apical foramen, the tooth becomes
exquisitely sensitive to pressure and percussion. A periapical (dento-alveolar) abscess
elevates the tooth from its socket, and the tooth feels “high” when the patient bites
down.
Diagnosis of Pulpitis
1. Clinical evaluation.
2. Sometimes dental radiographs.
3. Testing for dental sensitivity and/or pulp vitality.
Diagnosis is based on the history and physical examination, which includes
provoking stimuli (application of heat, cold, and/or percussion). Dentists may also
use an electric pulp tester, which indicates whether the pulp is alive but not whether it
is healthy. If the patient feels the small electrical charge delivered to the tooth, the
pulp is alive.
The use of dental radiographs can help determine whether inflammation has
extended beyond the tooth apex and help exclude other conditions.
Treatment of Pulpitis
1. Caries removal and restoration placement for reversible pulpitis.
2. Root canal and crown or extraction for irreversible pulpitis.
Antibiotics (e.g, amoxicillin for patients who are not allergic to penicillin) for
systemic infection (e.g, fever) that cannot be resolved with local measures.
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In reversible pulpitis, pulp vitality can be maintained if the tooth is treated,
usually by caries removal, and then restored.
In irreversible pulpitis, the pulpitis and its sequelae require endodontic (root
canal) therapy or tooth extraction. In endodontic therapy, an opening is made in the
tooth and the pulp is removed. The root canal system is thoroughly debrided, shaped,
and then filled with gutta percha. After root canal therapy, adequate healing is
manifested clinically by resolution of symptoms and radiographically by bone filling
in the radiolucent area at the root apex over a period of months. If patients have
systemic signs of infection (eg, fever), an oral antibiotic is prescribed (amoxicillin;
alternatives for patients allergic to penicillin include cephalexin or another first- or
second-generation cephalosporin, azithromycin, clarithromycin, or doxycycline). If
symptoms persist or worsen, root canal therapy is usually repeated in case a root
canal was missed, but alternative diagnoses (eg, temporomandibular disorder, hidden
tooth fracture, neurologic disorder) should be considered.
Very rarely, subcutaneous or mediastinal emphysema develops after
compressed air or a high-speed air turbine dental drill has been used during root canal
therapy or extraction. These devices can force air into the tissues around the tooth
socket that dissects along fascial planes. Acute onset of jaw and cervical swelling
with characteristic crepitus of the swollen skin on palpation is diagnostic. Treatment
usually is not required, although prophylactic antibiotics are sometimes given.
TASKS:
1) Match the term (A) with the correct definition (B). Write down into your
notebook.
A — Terms
B — Definitions
1) Pulpitis
2) Reversible pulpitis
3) Irreversible pulpitis
4) Pulp necrosis
5) Spontaneous pain
6) Radiating pain
a) A severe, spontaneous pain that spreads to the
jaw, ear, or temple.
b) Pain that occurs without any apparent trigger,
common in pulpitis.
c) Inflammation of the dental pulp inside the
tooth.
d) A test using cold to check pulp vitality;
sharp, short pain is typical of reversible pulpitis.
e) Inflammation that cannot heal; the pulp will
die unless treated.
f) Inflammation mild enough that the pulp can
recover if the cause is removed.
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7) Cold test
8) Pulpotomy
9) Root canal treatment (RCT)
10) Periapical abscess
g) Death of the dental pulp tissue.
h) Surgical removal of the coronal pulp, often in
primary teeth.
i) A collection of pus around the root tip of the
tooth.
j) Complete removal of pulp, cleaning, and
filling of the root canals.
2) Fill in the Gaps (with key terms from the text). Write down into your
notebook.
Complete the sentences using these terms: pulpitis, reversible pulpitis, irreversible
pulpitis, pulp necrosis, radiating pain, spontaneous pain, percussion test, cold test,
root canal treatment, tooth extraction.
1. The patient complains of severe ________, especially at night, with no obvious
stimulus.
2. In ________, pain disappears quickly after removing the cold stimulus.
3. ________ is characterized by throbbing, lingering pain even after the stimulus is
removed.
4. When the pulp is dead, we speak of ________.
5. The patient describes ________ to the jaw and ear, which is typical of pulpitis.
6. On the ________, the tooth is painful to tapping, suggesting periapical
inflammation.
7. The ________ shows sharp, short pain, indicating reversible pulpitis.
8. For irreversible pulpitis, we usually perform ________.
9. If the tooth is severely damaged and cannot be restored, ________ is the
treatment of choice.
10. Untreated deep caries may lead to ________.
3) Decide if the statement is true (T) or false (F). Correct the false ones.
1. Pulpitis is inflammation of the gum tissue.
2. Reversible pulpitis means the pulp can recover if the cause is removed.
3. In irreversible pulpitis, pain disappears immediately after removing the stimulus.
4. A cold test is used to check pulp vitality.
5. Pulp necrosis always causes severe pain.
6. Radiating pain is a common symptom of pulpitis.
7. Periapical abscess is a complication of pulpitis.
8. Root canal treatment is used for pulp polyp.
40
9. Antibiotics are the first-line treatment for all cases of pulpitis.
10. Night pain is typical of pulpitis.
4) Answer the questions in 1–2 full sentences in English.
1) What is pulpitis?
2) What is the main cause of pulpitis?
3) What is the difference between reversible and irreversible pulpitis?
4) List three symptoms of pulpitis.
5) Describe what happens in a root canal treatment.
6) When is tooth extraction indicated in pulpitis?
7) What is the purpose of a cold test in pulpitis?
8) What is pulp polyp, and in which type of pulpitis does it occur?
9) Why is night pain typical in pulpitis?
10) When are antibiotics prescribed in pulpitis?
5) Mini‑Dialogues (Speaking Practice). Work in pairs. Read the dialogues and
fill in the missing parts using the terms (in notebook): root, tooth extraction,
irreversible, spontaneous, treatment, radiates, indirect / direct.
Dialogue 1: History taking
— Patient: I have a bad toothache, especially at night.
— Dentist: Does the pain occur by itself or only when you eat something hot?
— Patient: Yes, it hurts even when I’m not eating.
— Dentist: So you have ________ pain. Does it go to your ear or jaw?
— Patient: Yes, it ________ to my ear.
— Dentist: That sounds like ________ pulpitis. We need to check the tooth with a
cold test.
Dialogue 2: Explaining treatment
— Patient: What is the treatment for my pulpitis?
— Dentist: If the pulp is still alive, we can do ________ pulp capping.
— Patient: What if the pulp is dead?
— Dentist: Then we need ________ canal _________: remove the pulp, clean the
canals, and fill them.
— Patient: Can I save the tooth?
— Dentist: Yes, but if the tooth is too damaged, we may have to do a _______.
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