BOOK QUESTIONS Flashcards
what does the dental pulp form as a defensive response?
Tertiary dentin
what cell in an antigen recognition cell in the dental pulp
odontoblasts
what is the most prominent antigen presenting cell in the dental pulp?
dendritic cell
what type of collagen most prominent in the dental pulp?
type I
What is NOT a type of pulp stone:
free, attached, embedded, or floating?
FLOATING
what are free pulp stones?
surrounded by pulp
what are attached stones?
continuous with the dentin
what are embedded pulp stones?
surrounded entirely by DENTIN and mostly of the TERTIARY type
Describe a pulp cap?
capping of exposed vital pulp tissue by placing a layer of MTA
this will stimulate reparative dentin and maintain pulp vitality
what is the effect of blood flow to the pulp when anesthtics with vasoconstriction are sued during restorative procedures?
blood flow is reduced to less than HALF of its normal rate.
what is dentin blushing?
vascular injury (hemorrhage) of pulp tissue often during crown preps. Thought to be due to the frictional heat
why are deeper carious lesions more injurious to the dental pulp?
increased dentin permeability in deeper areas, and greater cellular injury to the odontoblasts.
what depth of dentin shield is often sufficent to sheild pulp
at least 1 mm
why does a blast of compressed air directed at freshly exposed dentin create a sensation of pain?
causes a rapid outward movement of fluid in patent dentinal tubules and this stimulates nociceptors in the dentin pulp
what is the primary reason for the placement of a liner between biocompatible restorative materials and the dentin?
eliminate microleakage
what is the most significant determinant of the success of vital pulp therapy?
Pulp status before the procedure
what do you place at each visit with step wise evacuation of caries?
glas ionomer base
what is apexogenesis?
continued physiologic root formation… is a vital pulp therapy procedure performed to encourage continued physiologic development and formation of the root end.
What is Apexification?
induction of a calcific barrier across and open apex
you remove the necrotic pulp, depbride the canal, and place an antimicrobial medicament.
why is there greater dentin permeability near the pulp?
higher density of the dentinal tubules AND larger diameter
bacterial invasion of the dentinal tubules occurs more rapidly in which teeth?
non vital teeth
what is anachoresis?
microorganism transport from blood vessels into damaged tissue
PEOPLE are trying to research this topic to see if traumatized teeth with intact crowns are affected this way…
T/F
Root canals can become infected through anachoresis?
false
…research says the MAIN pathway of pulpal infection is from dentinal exposure due to enamel cracks
Which is NOT a category of Intraradiuclar infections?
tertiary?
Intraradiuclar are primary, secondary, or persistant
most common microorganisms in PRIMARY endo infections are?
Gram negative bacteria!
what microorganisms is commonly present in large percentages of root canal treated teeth that present with persistent apical periodontitis, indicaitve of failed treatment?
Enterococous Faecalis
It’s faculative anerobic gram pos coccus that has been frequently found in root canal treated teeth.
more restrictive group compared to primary infection
describe gram positive bacteria and endo
they have a higher occurence in post instrumentation samples, MORE resitant to antimicrobial treatmetns, adapt ot harsh environmental conditions.
GRAM NEG bacteria are usually eliminated by ENDO treatment!
t/f
A direct pulp exposure of a carious lesion is necessary to have a pulpal response and inflammation?
FALSE!
cracks in the enamel can attract inflammatory cells to the pulp
what is necessary for pulp and periradicular pathosis to develop?
presence of bacteria
T/F
transient changes, such as aspiration of the odontoblasts into the dentinal tubules, are usually reversible in healthy pulps?
TRUE
what is NOT a hard tissue change from pulpal inflammation?
NOT thickening of periodontal ligamnet
but yes to calcification of pulp tissue space, resoprtion of opulp tissue spaces, formation of pulp stones
T/F
Acute apical abscess is always assoicated with necrotic pulp?
true
what is the risk of endo and bisphosphanate therapy
greater risk of osteonecrosis if IV bisphosphonate therapy. dont’ damage soft tissue if endo treatment
is selective anesthesia of individual teeth useful in the mandible?
no, marginally more effective in the maxilla
A narrow vertical probing defect associated with a tooth exhibiting pulp necrosis but no or mild periodontal disease is most likely a:
draining sinus tract
- The classification of periodontic-endodontic disease includes which of the following?
- The classification of periodontic-endodontic disease includes which of the following?
a. endodontic (pulpal) origin
b. periodontal origin
c. endodontic-periodontic origin (true combined lesion)
d. all of the above
D
The common etiologic factor in both periodontal and endodontic disease is the presence and effect of —- on the respective tissues.
MICROORGANISMS
What is the best means of differentiating endodontic from periodontal pathosis?
pulp vitality testing
- Treatment for primary endodontic disease with concurrent periodontal disease of pulpal origin is treated best by:
a. scaling and root planning followed by endodontic treatment
b. endodontic treatment followed by scaling and root planning
c. endodontic treatment followed by periodontal surgery
d. endodontic treatment followed by reevaluation of periodontal status in 2 to 3 months
d
- Fractures in cracked teeth most often extend in what direction?
a. mesiodistal
b. faciolingual
c. apical to coronal
d. horizontal
MD
- Calcifications encountered in the pulp space:
a. represent additional dentin formation
b. can always be detected by radiograph
c. are always attached to the chamber or canal walls
d. often prevent instruments from negotiating canals
a
- Accessory canals are more common in the apical third; they also are more common in posterior teeth. True or false?
a. The entire sentence is true.
b. The first part of the sentence is true, the second part is false.
c. The first part of the sentence is false, but the second part is true.
d. The entire sentence is false.
TRUE to btoh
- What is a major objective of the access opening?
a. to locate the primary or largest canal
b. to achieve unimpeded straight-line access of the instruments to the first canal curvature or apical one third
c. to expose the pulp horns
d. to remove all restorative materials
to acheive unimpeded straight line access
- Which statement best describes the outline form for access?
a. It mimics the shape of the canal or canals.
b. It is toward the distal on the occlusal surface in molars.
c. It is a projection of the internal tooth anatomy onto the external surface.
d. It is a constant and unchanging shape regardless of age.
c
- What is an advantage of caries removal during access?
a. It enhances the effectiveness of NaOCl.
b. It reduces interappointment pain.
c. It strengthens tooth structure.
d. It allows assessment of restorability prior to the endodontic treatment.
allows assessment of restorability prior
- Which of the following is not a general principle for endodontic access?
a. outline form
b. compensation form
c. caries removal
d. toilet of the cavity
NOT compensation form
- What is the outline shape of the access for a maxillary first molar?
a. round
b. triangular
c. trapezoidal
d. square
triangular
- What is the outline shape of the access for a mandibular first molar with four distinct separate roots?
a. round
b. triangular
c. trapezoidal
d. square
trapezoidal or rectangular
- What is the preferred method to evaluate whether a canal has been adequately cleaned?
a. The canal is three files sizes larger than the initial master apical file.
b. The canal walls are “glassy smooth” when explored with a file.
c. Dentin shavings obtained are clean and white.
d. Irrigant runs clear with no visible debris.
glassy smooth
- The degree of canal enlargement during shaping is dictated by which of the following?
a. method of obturation
b. anatomy of the root
c. restorative treatment plan
d. all of the above
all
- Which of the following is the most widely used irrigating solution?
a. sodium hypochlorite
b. ethylenediaminetetraacetic acid (EDTA)
c. citric acid
d. QMix
sodium hypochlorite
- What is the primary purpose of an irrigant such as sodium hypochlorite?
a. to kill bacteria
b. to dissolve tissue remnants
c. to flush out debris
d. to lubricate instruments
flush out debris
- Removal of the smear layer after cleaning and shaping does which of the following?
a. promotes coronal leakage
b. reduces dentin permeability
c. allows better adaptation of obturating materials to canal walls
d. forces bacteria into dentinal tubules
allows for better adaptation of obturating materials
- EDTA is most effective for which of the following?
a. decalcifying small canals to allow instruments to negotiate to length
b. lubricating canals to facilitate instrumentation
c. eliminating bacteria in the canals
d. removing the smear layer after cleaning and shaping
EDTA removes the smear layer after cleaning and shpaing
- Recapitulation is defined as:
a. the removal of accumulated debris using a small file at the corrected working length
b. confirmation of the working length after completion of cleaning and shaping
c. the last irrigation before drying of the canal
d. verification of the master apical file after cleaning and shaping
removal of accumulated debris using a small file at the corrected working length
- Which of the following results in the greatest loss of endodontically treated teeth?
a. inadequate cleaning and shaping of the canals
b. inadequate obturation
c. caries and periodontal disease
d. vertical root fracture
Caries and perio disease
inadequate restorations
- Dentin becomes more brittle after endodontic treatment due to loss of moisture content.
a. true
b. false
FALSE
- The most significant contributing factor to reduced cuspal stiffness (strength) that can predispose to fracture is:
a. occlusal access opening
b. loss of one or both marginal ridges
c. an amalgam restoration placed after root canal treatment
d. a bonded composite restoration placed after root canal treatment
Loss of one or both marginal ridges
- Which of the following is crucial to a definitive restoration after endodontic treatment?
a. It should be placed at the time of obturation.
b. It should allow cuspal flexure to absorb occlusal forces.
c. It should provide a coronal seal.
d. It should always be a full-coverage crown on posterior teeth.
it should provide a coronal seal. needs to prevent microleakage
- Which statement is most important with regard to exposure of obturating materials to oral fluids?
a. It is not a factor if a sealer is used during obturation.
b. It is a major cause of failure.
c. It leads to rapid failure.
d. It many cause pain with thermal changes.
major cause of failrue
- Which statement describes the ideal timing for placement of the definitive restoration?
a. It should be placed as soon as practical.
b. It should be placed at the 6-month recall visit to ensure that symptoms do not recur.
c. It should be placed when radiographic evidence of healing is present.
d. If should be delayed if there is a questionable prognosis.
ASAP
- The practical principles for function and durability when designing a definitive restoration include all the following except:
a. conservation of tooth structure
b. retention
c. placement of a post
d. protection of the remaining tooth structure
remember, POST IS ONLY FOR RETENTION!!!!
- Which of the following is an indication for placing only a direct restoration (amalgam or composite)?
a. Excessive loss of tooth structure is a factor.
b. The opposing arch has been restored with full-coverage crowns.
c. Esthetics is not a concern.
d. The marginal ridges are intact.
marginal ridges are intact
- What is a possible outcome with overfill of obturation materials?
a. decreased periapical inflammation
b. improved and rapid healing of periapical tissues
c. inadequate apical seal
d. decreased postobturation discomfort
Inadequate apical seal
- Which statement best describes lateral canals?
a. They connect adjacent canals within the same root.
b. They may allow bacterial and necrotic debris access to the periodontium.
c. They are débrided with copious irrigation.
d. They are significant determinants of the prognosis in endodontic outcomes.
B
overall remember that they have minimal impact on the prognosis
- What pulp/periapical diagnosis may result in completed treatment in a single visit?
a. symptomatic apical periodontitis
b. asymptomatic apical periodontitis
c. acute apical abscess
d. painful irreversible pulpitis
painful irreversible pulpitis
- Which of the following is a disadvantage of gutta-percha?
a. poor adaptation to irregularities of the canal with compaction
b. shrinkage if altered by heat or solvents
c. not easily managed and manipulated
d. difficult to partially remove from a canal
shrinkage if altered by heat or solvents
- Which of the following is an advantage of gutta-percha?
a. adhesiveness to dentin
b. slight elasticity and rebound effect
c. expansion on cooling when warmed
d. adaptation to canal irregularities with compaction
adaptation to canal irregularities with compaction
- What have recent studies shown regarding synthetic polyester resin–based polymers?
a. They are adhesive to canal walls throughout their length.
b. They are inflammatory to periapical tissues.
c. They are mutagenic.
d. There is no difference in resistance to leakage compared to gutta-percha.
no difference in resistance to leakage compared to gutta percha
- Which of the following describes lateral compaction of gutta-percha?
a. It is the technique of choice in cases involving internal resorption.
b. It involves multiple steps and an extensive armamentarium.
c. It provides good length control.
d. It is difficult to retreat.
LENGTH control!
- Which of the following would not be an early sign or indication of a perforation?
a. pain during access preparation
b. sudden appearance of hemorrhage
c. burning pain and a bad taste during irrigation with NaOCl
d. a malpositioned file as viewed on a radiograph
NOT pain
- What are the ideal time and material for nonsurgical repair of a furcation perforation?
a. immediate repair with amalgam
b. immediate repair with MTA
c. delayed repair with amalgam
d. delayed repair with MTA
REPAIR with MTA
- What is a common cause of ledge formation during cleaning and shaping?
a. straight-line access into the canal
b. excess irrigating solution
c. overenlargement of a curved canal using files
d. constant recapitulation and irrigation into the apical portion of the canal
overenlargement of a curved canal using files
- What is a possible etiology for an apical root perforation?
a. inability to negotiate canals with ledges
b. working length determination with radiographs only
c. trying to locate canals in a small chamber
d. failure to adjust the working length after curved canals have been straightened during cleaning and shaping
failure to adjust the working legnth after cruved canals have been straightened during cleaning and shaping
- Which type of perforation has the poorest long-term prognosis?
a. apical root perforation
b. stripping perforation in the apical third of the root
c. stripping perforation in the coronal third of the root below the crest of bone
d. direct floor to furcation perforation in a multirooted tooth
strippin gperofration inthe CORNAL third of the root below the crest. this can lead to serious attachment loss
- Which solvent has been shown to be the most efficient in softening gutta-percha?
a. chloroform
b. halothane
c. methylchloroform
d. xylene
chloroform
- What is the purpose of incision for drainage?
a. to evacuate inflammatory exudates from a soft tissue swelling
b. to obtain a biopsy specimen
c. to prevent a postoperative swelling
d. to avoid emergency cleaning and shaping of the root canals
evacuate inflammatory exudates from a soft tissue swelling
. What is the primary determinant of successful endodontic treatment?
a. selection of the proper obturation technique
b. effective elimination of microorganisms from the pulp space
c. use of rotary instruments to shape the canals
d. use of an effective irrigation regimen
elimination of microorgaisms from the pulp space
What are the major indicators of successful endodontic treatment?
a. lack of discoloration and absence of tenderness on biting
b. absence of swelling and redness of the gingiva
c. absence of symptoms and of apical radiolucency
d. a happy patient who has paid the bill
absence of symptoms and of apical radiolucency
- Which of the following is not a clinical criterion for evaluating treatment outcomes?
a. absence of a radiolucency
b. no evidence of a sinus tract
c. no swelling present
d. no response to percussion or palpation
absence of radiolucency
- Which of the following is not considered a predictor of success or failure?
a. the patient’s medical history
b. apical pathosis
c. the quality of the coronal restoration
d. the extent and quality of obturation
NOT patient’s medical history
- The most common postoperative cause of endodontic treatment failure is:
a. overextension of obturating material
b. a separated instrument
c. coronal leakage
d. placement of a post unnecessarily
CORONAL LEAKAGE
ich of the agents recommended for internal bleaching is preferred?
a. carbamide peroxide
b. sodium perborate
c. hydrogen peroxide
d. sodium peroxyborate monohydrate
sodium perborate
- Which statement is not true regarding calcifications in the pulp space?
a. Pulp stones are usually found in the coronal pulp.
b. Pulp stones can increase the incidence of odontogenic pain.
c. Calcifications increase with both age and irritation.
d. Diffuse calcifications are most commonly found in the radicular pulp.
pulp stones can increase the incidence of odontogenic pain. NOT TRUE
another name for a denticle?
pulp stone
pulp stones are found in ___ and diffuse in ___
pulp stones in the coronal area, and linear diffuse calficiations in the radicular pulp
- Which of the following occurs in the pulp chamber in molars with age?
a. decreases primarily in a mesiodistal dimension
b. decreases primarily in an occlusal-apical dimension
c. remains the same in volume
d. increases in size in response to irritation
decreases in an occlusal apical dimension
- The healing capacity of older patients is significantly less than that of younger patients because of a decrease in periapical vascularity. The vascularity of the periapical tissues is a critical determinant in healing.
a. The first statement is false; the second statement is true.
b. The first statement is true; the second statement is false.
c. Both statements are true.
d. Both statements are false.
first false, second true
PERIAPICAL blodo flow is NOT impaired with AGE
various types of pulp calcificaitons?
- Free—surrounded by pulp tissue
- Attached–continuous with dentin
- Embedded–surrounded by dentin (tertiary usually)
- Diffuse or linear deposits with neurovascular bundles.—usually seen in aged, traumatized or chronically inflamed pulps Are they pathologic? NO Do they cause symptoms? NO regardless of size
- Many people contain pulp stones and occur in normal, and chronically inflamed pulps. Not responsible for any symptoms reguardless of size. Large ones may block access to the canal or root apex during tx.
