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23 Endodontics > 4 - Classification of Pulpal Diseases > Flashcards

4 - Classification of Pulpal Diseases Flashcards

1
Q

does clinical diagnosis always correspond to histologic findings

A

no

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2
Q

pulpal diseases are classified according to what

A

clinical symptoms and findings

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3
Q

the pulp is either ___ or ___

A

vital or necrotic

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4
Q

what are the different pulpal diagnoses

A
  1. normal pulp
  2. reversible pulpitis
  3. irreversible pulpitis
  4. hyperplastic pulpitis
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5
Q

Why do we need to establish a baseline for comparison

A

determining what normal pulp is

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6
Q

does vital pulp mean it’s healthy?

A

NO! bital means the pulp is still alive

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7
Q

what pulp can recover without sacrificing pulp

A

reversible pulpitis

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8
Q

what pulp cannot recover without sacrificing pulp

A

irreversible

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9
Q

what is pulp death called

A

pulpal necrosis

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10
Q

T/F: determining what is normal in the pulp is subjective

A

TRUE

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11
Q

in normal pulp, are there symptoms reported in pt

A

no

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12
Q

in normal pulp, is there quick sharp response to cold application and immediate relief when removing from cold

A

yes

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13
Q

does normal pulp have sensitivity to percussion

A

NO

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14
Q

is there radiographic evidence of PA pathology in normal pulp

A

NO

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15
Q

in normal pulp, ___ and ___ should be in line with control teeth (what’s normal for one patient might not be normal for another)

A

cold, EPT

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16
Q

what does EPT stand for

A

electric pulp testing

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17
Q

what are subjective symptoms? example?

A

symptoms that are reported by the patient

e.g., “my tooth hurts when I chew”

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18
Q

what are objective symptoms? example?

A

something that is observable to the dentist

e.g., swelling or radiographic changes

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19
Q

are soft tissue diseases of the pulp visible on radiographs?

A

NO!! REMEMBER THIS!

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20
Q

what pulpitis:

inflammation is not severe. if the cause is eliminated, the pulp may return to normal

A

reversible pulpitis

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21
Q

what soft tissue disease?

A

SOFT TISSUE DISEASES OF PULP ARE NOT VISIBLE ON RADIOGRAPHS! must do pulp testing to diagnose

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22
Q

describe pain in reversible pulpitis

A

stimulated, sharp, and transient

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23
Q

does the removal of stimulus result in immediate relief in REVERSIBLE pulpitis?

A

YES

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24
Q

whats the difference between reversible pulpitis and normal pulp

A

Very similar but reversible pulpitis
stands out more
The tooth is more sensitive than the
surrounding teeth but pain does not
linger

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25
Q

what is severe inflammation that will not resolve even if the cause is removed

A

irreversible pulpitis

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26
Q

what are the types of irreversible pulpitis

A

Symptomatic Irreversible Pulpitis
Asymptomatic Irreversible Pulpitis

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27
Q

what pulpitis is associated with spontaneous pain (does not need to be stimulated)

A

symptomatic irreversible pulpitis

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28
Q

is the characteristic of pain in symptomatic irreversible pulpitis variable

A

yes

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29
Q

how long does symptomatic irreverisble pulpitis last

A

minutes to hours

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30
Q

can you locate pain of symptomatic irreversible pulpitis

A

yes but localization is difficult due to proprioceptive nerve fibers

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31
Q

what can prolong pain in symptomatic irreversible pulpitis

A

stimuli (cold, hot)

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32
Q

in advanced cases of symptomatic irreversible pulpitis, ___ provides relief and ___ worsens pain

A

cold = relief
heat = worsens

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33
Q

describe histology of symptomatic irreversible pulpitis

A
  1. dilated blood vessels
  2. intense infiltration by neutrophils (PMNs)
  3. sometimes confined areas of lysis
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34
Q

if patient complains of cold sensitivity, the first thing you think about is that pulp is ___

A

VITAL

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35
Q

what are 2 key symptoms that allow you to say that your pt has symptomatic ireversible pulpitis

A
  1. Spontaneous Pain
  2. Persistent pain after a stimulus has been removed
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36
Q

irreverible pulpitis is usually ___ or the patient only reports ___

A

asymptomatic; mild symptoms

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37
Q

in asymptomatic irreversible pulpitis, is the diagnosis presumptive?

A

yes

38
Q

what pulpitis is undiagnosed many times

A

asymptomatic irreversible pulpitis

39
Q

histology of asymptomatic irreversible pulpitis

A
  1. Lymphocytes
  2. Plasma Cells
  3. Macrophages
  4. Some PMN’s
  5. Less fibroblasts
  6. More Collagen Fibers
40
Q

what is an overgrowth of pulp tissue into open carious lesion

A

hyperplastic pulpitis (pulp polyp)

41
Q

hyperplastic pulpitis is [small or large] carious lesion

A

large (open caries allows for drainage)

42
Q

hyperplastic pulpitis occurs in [young or old] patients

A

young

43
Q

hyperplastic pulpitis is usually [symptomatic or asymptomatic]

A

asymptomatic -> open caries allows for draininge

44
Q

what is hyperplastic pulpitis also called

A

pulp polyp

45
Q

histology of hyperplastic pulpitis

A
  1. Connective tissue stroma
  2. Chronic inflammatory cells
  3. Very vascularized
  4. No nerve fibers
  5. Lined by stratified squamous epithelium
46
Q

hyperplastic pulpitis requires what tx

A

endodontic therapy

47
Q

what occurs when the pulp is transformed into vascularized inflammatory tissue with dentinoclastic activity

A

internal resorption

48
Q

is internal resorption a type of irrevresible pulpitis

A

yes

49
Q

is internal resorption symptomatic?

A

no! asymptomatic

50
Q

what has PINK TOOTH syndrome

A

internal resorption

51
Q

what has an irregular enlargement of canal space seen on radiographs BUT pulp tests are usually within normal range

A

internal resorption

52
Q

histology of internal resorption

A
  1. Chronic inflammatory cells
  2. Multinucleated Giant Cells (Dentinoclasts)
  3. Giant cells have brush like projections
  4. Giant cells secrete acid
  5. Howship’s lacunae
53
Q

what is the tx of internal resorption

A

IMMEDIATE removal of pulp tissue and institution of root canal treatment

54
Q

what is pulpal necrosis

A

dead pulp because pulp is encased in rigid walls and has poor collateral circulation

55
Q

when pulp is encased in rigid walls and has poor collateral circulation, the venules and lymphatic collapse under the increased tissue pressure leading to ___

A

pulp necrosis

56
Q

does pulp necrosis mainly look dry or liquid

A

dry

57
Q

if you seen bleeding, pulp is what

A

vital

58
Q

___ will inevitable lead to bacterial colonization of pulp space with or without PA involvement

A

pulpal necrosis

59
Q

what are the types of pulp tests

A
  1. cold test
  2. electric pulp test
  3. heat test (occasional with hard to find tooth)
60
Q

what do you do during pulp test

A
  1. test suspected tooth
  2. test other teeth for comparison (called control teeth)
61
Q

how to do cold test

A

apply cold directly to tooth with cotton pellet

62
Q

how to record response to cold test

A
  1. No response (-)
  2. Mild response (+)
  3. Moderate response (++)
  4. Severe response (+++)
63
Q

how to take electric pulp test

A
  1. Applies electrical current to tooth
  2. Simply record number when patient responds
  3. also use control teeth
  4. use toothpaste as conducting media
64
Q

is pulp test asymptomatic many times

A

yes

65
Q

if pain is present in pulpal necrosis, it’s usually from what?

A

periradicular tissues or partial necrosis

66
Q

is partial pulpal necrosis painful

A

YES! can be very painful

67
Q

what does pain from partial pulpal necrosis come from

A

from remaining pulp tissue

68
Q

what is the last tissue to die in partial pulpal necrosis

A

nerve tissue

69
Q

partial pulpal necrosis is diagnosed as what

A

pulpal necrosis

70
Q

once the pulp dies in pulpal necrosis, what does it become susceptible to

A

bacterial invasion

71
Q

with pulpal necrosis, bacteria and byproducts have an effect on what tissues

A

surrounding periapical tissues

72
Q

is pulp calcification the same as a disease

A

no, it’s a physiological thing

73
Q

what are types of pulpal calcifications

A
  1. pulp stones
  2. difuse calcificaiton (denticle)
  3. calcific metamorphosis
74
Q

what pulp stone resembles dentin

A

true

75
Q

what pulp stone is concentric rings of amorphous mass of calcified tissue

A

false

76
Q

are pulp stones attached or free?

A

BOTH! attached or free

77
Q

where are pulp stones present

A

pulp chamber/ coronal pulp

78
Q

most pulp stones are true or false

A

false

79
Q

diffuse calcification are present where

A

radicular pulp; root canal

80
Q

what can be an obstruction to root canal treatment

A

diffuse calcifications

81
Q

what is a partial or complete RADIOGRAPHIC obliteration of pulp space

A

calcific metamorphosis

82
Q

histologically, there is always a canal present where

A

calcific metamorphosis

83
Q

what is a yellowish coloration of teeth

A

calcific metamorphosis

84
Q

response to what is delayed or sometimes absent in calcific metamorphosis

A

response to cold/electrical sitmulus

85
Q

is calcific metamorphosis pathologic? does it require RCT?

A

NOT pathologic; does NOT require RCT

86
Q

tooth discoloration can occur with what

A
  1. pulpal necrosis
  2. internal resorption
  3. calcific metamoprhosis
87
Q

what is this

A

pulpal necrosis

88
Q

what is this

A

internal resorption

89
Q

what is this

A

calcific metamorphosis

90
Q

always make 2 diagnoses: what are they

A
  1. pulp
  2. PA tissue

23 Endodontics (12 decks)

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