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ICS - ENDODONTOLOGY > 1: Pulpal and Periradicular Pathology > Flashcards

1: Pulpal and Periradicular Pathology Flashcards

1
Q

tertiary dentine: each type formed by what kind of cells?

A

reactive: formed by pre-existing odontoblasts
reparative: formed by newly differentiated odontoblast like cells

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2
Q

what are the 4 layers of the pulp? what do the inner 2 layers contain?

A
  • odontoblast layer
  • cell free zone (of weil)
  • cell rich zone: fibroblasts, immune cells, undifferentiated mesenchymal cells
  • pulp core: CT, blood vessels, nerve fibres, fibroblasts
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3
Q

what are the cells of the pulp and what do they do?

A

progenitor cells: ability to form formative or defensive cells

formative cells: odontoblasts and fibroblasts

defensive cells: macrophages, lymphocytes, eosinophils, mast cells, plasma cells

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4
Q

innervation of the pulp - sensory nerve supply: which nerve to which type of tooth?

A

general innervation: CN V

maxilla: all CN V2
mandible: CN V3
- premolars: mylohyoid nerve of CN V3
- molars: C2 and C3

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5
Q

sensory nerves:

  1. myelinated a-delta and a-beta axons - stimulated by? result?
  2. unmyelinated c-axons: what type of pain results?
A
  1. stimulated by movement of dentinal fluid, resulting in a sharp pain
  2. dull, throbbing pain
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6
Q

motor nerve supply to the pulp:

  • activation results in?
  • sympathetic motor nerve supply by what nerve?
A
  • activation results in vasoconstriction, reduced pulpal blood flow
  • superior cervical ganglion: T1, C8, T2
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7
Q

what are the 3 causes of pulpal inflammation?

A
  • micro-organisms: bacteria, viruses
  • mechanical causes
  • chemical causes
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8
Q

microorganisms: what are the microbial irritants they produce?
pulp is infiltrated at the base of carious tubules by?

A
  • toxins and by-products

- chronic inflammatory cells, macrophages, lymphocytes, plasma cells

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9
Q

once pulp is exposed, it becomes infiltrated by ____ to form an _________ at the site of exposure.

A
  • PMN (polymorphonuclear lymphocytes)

- area of liquefaction necrosis

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10
Q

what are the two possibilities when pulp tissue is exposed?

A
  • remain inflamed for a long time

- undergo necrosis slowly or rapidly

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11
Q

pulp tissue inflammation/necrosis: depends on what factors? x5

A
  • bacterial virulence
  • inflammatory response
  • host resistance
  • amount of circulation
  • lymphatic drainage
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12
Q

mechanical factors of pulp damage: 3 main examples?

A
  • traumatic accident
  • iatrogenic damage during dental procedure: tooth prep, excessive orthodontics, sub-gingival scaling
  • attrition/abrasion
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13
Q

trauma to crown: 2 causes

A
  1. impact injury
  2. fracture of crown
    - can result in pulpal exposure
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14
Q

how does impact injury result in pulpal exposure?

A
  • crown remains intact
  • microcracks in enamel allow bacteria to reach pulp
  • blood flow damaged
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15
Q

chemical factors of pulp damage: examples?

A
  • chemical erosion

- inappropriate use of acidic materials

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16
Q

irritation of pulp results in?

what are the mediators?

A
  • inflammatory response

- inflammatory mediators: histamine, bradykinin, arachidonic acid, neuropeptides (CGRP)

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17
Q

immunological response: what are the immunocompetent cells and potential antigens?

A

immunocompetent cells:

  • T & B lymphocytes
  • macrophages
  • dentritic cells (antigen presenting cells)

potential antigens:
- bacterial toxins

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18
Q

lesion progression: how does it occur?

A
  • increased tissue pressure
    inability of pulp to expand
    lack of collateral circulation
  • pulpal necrosis
  • periradicular pathology
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19
Q

what is the term referring to the inflammation of the pulp

A

pulpitis

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20
Q

response of the pulp depends on? elaborate.

A

severity of the insult

  • mild: reversible pulpitis
  • severe/persistent: irreversible pulpitis
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21
Q

classification of the status of the pulp: what are the 7 classifications?

A
  • clinically normal pulp
  • reversible pulpitis
  • symptomatic irreversible pulpitis
  • asymptomatic irreversible pulpitis
  • necrosis
  • previously treated
  • previously initiated therapy
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22
Q

normal pulp: how does it appear?

A
  • symptom free
  • responds to sensibility testing: response subsides when stimulus is removed
  • histologically: no inflammatory change
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23
Q

dentine sensitivity:

  • pain occurs with? associated with?
  • what kind of pain?
  • what is the diagnosis when sensitivity is caused by a specific factor? what could the specific factors be?
A
  • thermal, chemical, tactile or osmotic stimuli, associated with exposed dentine
  • severe and sharp pain, does not linger when stimulus is removed
  • reversible pulpitis. specific factors can be caries, fractures, recent restorations etc.
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24
Q

reversible pulpitis:
symptoms?
causes?

A
    • pain: short and sharp, not spontaneous
    • stimulus: cold, sweet, sometimes hot
    • no significant radiographic changes apically
  2. caries into dentine, fractures, restorative procedures, trauma
25
Q

reversible pulpitis: treatment?

A
  • conservative pulp therapy + removal of the cause and pathway of irritation
  • consider diagnosis as provisional, review in 3 months
26
Q

irreversible pulpitis

  • occurs if?
  • what kind of pain?
  • sensibility tests?
A
  • occurs if inflammatory process continues
  • spontaneous pain, response to hot/cold lingers after stimulus is removed
  • sensibility tests responsive
27
Q

why is irreversible pulpitis difficult to diagnose?

A
  • may confuse whether pain is from maxillary or mandibular arches at early stages
  • tooth will not be TTP until periapical tissues are involved
  • no periapical changes radiographically
28
Q

irrerversible pulpitis: treatment?

A
  • once pain is located to the correct tooth,
    1. RCT: if tooth is restorable
    2. extraction
29
Q

advanced symptomatic irreversible pulpitis: symptoms and treatment?

A

symptoms:

  • excrutiating pain
  • moemntarily relieved by cold: pulp allodynia and hyperalgesic
  • tooth often TTP
  • reacts violently to heat

treatment:
- RCT
- pulpotomy
- extraction

30
Q

odontopaste: what is it? what does it contain? what are its purposes?

A
  • antibiotic: clindamycin hydrochloride
  • anti-inflammatory: triamcinolone
  • relieves pain until definitive root canal therapy can be carried out
31
Q

pulp canal classification:
occurs in response to?
leads to?
RCT not necessary unless ___?

A
  • trauma, irritants
  • eventual obliteration of pulp space
  • clinical signs of pulpal necrosis
32
Q

internal resorption: inflammatory

  • occurs at which point of pulp chamber?
  • activation of what cells?
  • symptoms? pulp becomes?
  • perforation will show on?
  • treatment?
A
  • occurs at any point within pulp chamber or root canal
  • activation of dentinoclasts within inflamed pulp tissue in contact with necrotic, infected coronal pulp tissue
  • asymptomatic, pulp will become necrotic
  • CBCT: cone beam computed tomography
  • RCT, depending on extent
33
Q

internal resorption: replacement

  • how common?
  • how does replacement occur?
  • not due to ____?
  • symptoms? what changes DO NOT usually occur?
A
  • uncommon
  • dentine is resorbed, replaced with bone-like hard tissue
  • not due to presence of bacteria in pulp
  • (asymptomatic), periapical changes do not occur
34
Q

pulpal necrosis:

  • breakdown of ___ which allows ____ to _____?
  • caused by?
A
  • pulpal tissue, bacteria, colonize root canal system

- direct exposure, dentinal tubules, cracks in dentine/enamel

35
Q

pulpal necrosis

  • no collateral circulation results in?
  • irrerversible pulpitis leads to?
  • traumatic injury causes? why?
A
  • collapse of venules and lymphatics under increased tissue pressure
  • liquefaction necrosis
  • ischaemic necrosis, due to the disruption of blood supply
36
Q

pulpal necrosis: symptoms?

A
  • usually asymptomatic, unless inflammation has progressed to periapical tissues
  • no response to sensibility testing
37
Q

previously treated: a clinical diagnostic category indicating what?

A
  • indicates that the tooth has been endodontically treated and the canals obturated with root canal filling material
38
Q

previously initiated therapy: indicates what?

A

tooth has been previously treated by partial endodontic therapy
- pulpotomy, pulpectomy

39
Q

periradicular/periapical conditions - occur when? what is the inflammatory/immunological response?

A
  • when microbes and by-products reach the peridradicular tissues
  • resorption of surrounding bone, epithelial cells proliferate to form granuloma or cyst
40
Q

normal periradicular tissue: how will they appear? (clinically and radiographically)

A
  • non-sensitive to percussion and palpation testing

- radiographically: tissues normal, lamina dura intact, uniform PDL space

41
Q

symptomatic peri-apical periodontitis - causes?

A

inflammation of periradicular tissues

  • bacterial toxis
  • chemicals
  • occlusal trauma
  • RCT over instrumentation
  • RCF beyond apex
42
Q

what is the pulpal status for symptomatic perirapical periodontitis?

A

irreversibly inflamed

necrotic

43
Q

symptomatic periapical periodontitis: signs and symptoms?

A
  • discomfort to biting/chewing
  • sensitivity to percussion
  • palpation may or may not produce a sensitive result
  • sensibility testing will depend on whether pulp is irreversibly inflamed or necrotic
44
Q

symptomatic periapical periodontitis: radiographically?
PDL appearance?
lamina dura?

A

PDL may appear normal

lamina dura either intact, widened, or have a distinct radiolucency

45
Q

symptomatic periapical periodontitis - treatment?

A

adjustment of occlusion

removal of canal irritants and necrotic pulp

46
Q

acute periapical abscess: causes?

A

bacteria progression into periradicular tissues, patient’s immune response cannot defend against invasion

47
Q

acute periapical abscess: signs and symptoms

A
  • rapid onset
  • PAIN: exquisitely tender to tooth
  • pus formation
  • mobility of tooth
  • systemic involvement
  • swelling: depending on location of apices and muscle attachments, can be localized or diffused
48
Q

acute periapical abscess: radiographically?

A

PDL space may be normal, slightly widened, or demonstrate distinct radiolucency

49
Q

acute periapical abscess: treatment?

A

drainage
RCT
extraction

50
Q

asymptomatic periapical periodontitis

  • occurs when?
  • clinically?
  • radiographically?
A
  • occurs when bacterial products from necrotic or pulpless tooth slowly ingress the periradicular tissues
  • mostly asymptomatic, percussion and palpation test produce non-sensitive response
  • radiolucency around apex of tooth
51
Q

chronic periapical abscess:
inflammatory reaction to?
characterized by?

A
  • to pulpal infection and necrosis

- characterized by gradual onset, little/no discomfort, intermittent discharge through an associated sinus tract

52
Q

chronic periapical abscess:
clinically?
radiographically?

A

clinically: usually asymptomatic, percussion and palpation tests produce non-sensitive result
sensibility tests are non-responsive

radiographically: radiolucent area on bone

53
Q

focal sclerosing osteomyelitis

  • associated with what condition?
  • tooth will have aetiological factor for?
  • symptoms depend on?
A
  • condensing osteitis: periapical inflammatory disease, resulting in more bone production than bone destruction in affected area
  • low-grade, chronic inflammation such as necrotic pulp, extensive restoration or crack
  • symptoms depend on whether or not pulp is inflamed or necrotic
54
Q

condensing osteitis:
radiographically?
treatment?

A
  • increased radiodenstiy and opacity in one or more roots

- RCT

55
Q

focal osteoporosis:

  • not a ____?
  • symptoms?
  • usually affects what kind of tooth?
  • radiographically?
  • treatment?
A
  • LEO: lesion of endodontic origin
  • asymptomatic
  • virgin tooth/normal pulp
  • increased radiodensity and opacity around one or more roots
  • no treatment necessary
56
Q

periradicular cyst:

  • mostly affects where?
  • patients usually how old?
  • which gender?
  • maxillary or mandibular teeth?
A
  • mostly human jaws
  • pts in third decade
  • affects men more than women
  • maxillary teeth more than mandibular
57
Q

periradicular cyst:

  • ____ cyst? of what origin?
  • arises from?
  • what bacteria commonly isolated?
A
  • odontogenic cyst, inflammatory origin
  • epithelial cells rests of Malassez in PDL
  • actinomyces
58
Q

histopathological features of radicular cysts:
epithelial lining?
cholesterol clefts - formed by?
what else is found?

A
  • usually stratified squamous epithelium
  • formed by degradation of inflammatory cells
  • fibrous capsule of collagen fibres
  • inflammatory cells
59
Q

periodontal abscess

  • symptoms?
  • pocket?
  • sensibility testing?
A
  • rapid onset, spontaneous pain, TTP, pus formation, swelling
  • deep periodontal pocket
  • sensibility testing normal response

ICS - ENDODONTOLOGY (3 decks)

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