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BDS3 > Endo > Flashcards

Endo Flashcards

1
Q

According to Dr. Seet, what is the definition of Endodontics?

A

Prevention and/or elimination of apical periodontitis

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2
Q

What are the TWO types of nerve fibres for nociception

A
  1. A-delta fibres
    - Myelinated, lower threshold
    - Sharp pain
  2. C-fibres
    - Unmyelinated, higher threshold
    - dull, aching, throbbing pain
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3
Q

True or false: Pulpal pain never crosses midline.

A

True

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4
Q

Describe the THREE main aspects of the diagnostic process

A
  1. History taking (MHx, DHx, HISTORY OF CC -> DDx)
  2. Clinical examination
  3. Radiographic examination
    THEN, correlate all findings -> definitive diagnosis
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5
Q

Why might patients have trouble specifically locating where (pulpal) pain is coming from?

A

Pulp has nerves but not proprioception. Pt can only report pain coming from a region, not a single tooth.

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6
Q

True or false: People usually wake up if dental pain is caused by bruxing

A

False

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7
Q

What are the THREE P’s of periodontal diagnostic testing? (according to Dr. Sarbin)

A

Percussion
Palpation
Periodontal probing

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8
Q

What is an example of a vitality test and what does it do?

A

Laser doppler test - detects blood flow to the pulp

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9
Q

What nerve fibres does a cold and electric test stimulate respectively?

A

Both A-delta fibres

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10
Q

What is SLOB and what does it mean?

A

Same Lingual Opposite Buccal
- the lingual root will always move in the same direction as the shift (e.g. lingual root will move mesially in a mesial shift)

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11
Q

Other than the THREE P’s and radiographs, name a few other clinical tests used in periodontal diagnostic testing.

A
  • Mobility
  • Colour change
  • Draining sinus tracing (with GP point)
  • FracFinder/Tooth Slooth (pain on biting = perio, pain on release = cracked cusp)
  • Transillumination
  • Removal of restorations
  • LA test (mainly only useful for upper teeth)
  • Test cavity (done with no LA)
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12
Q

What are FIVE pathways through which bacteria can get to the pulp?

A
  • Caries
  • Cracked cusp
  • Severe tooth wear (mild toothwear is protected from bacterial entry by positive pressure from dentinal fluid)
  • Defective restorations
  • Developmental abnormalities (e.g. dens invaginatus, but also dens evaginatus -> predisposed to toothwear)
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13
Q

What is the healthy pulp response to sensibility testing?

A
  • React to cold and EPT with mild pain, pain shouldn’t last longer than 1-2 secs
  • No or mild reaction to heat testing
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14
Q

True or false: Teeth that have dentinal sensitivity have a lower EPT threshold.

A

False, they will have normal EPT results.

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15
Q

True or false: Reversible pulpitis lowers the threshold for a-delta fibres.

A

True

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16
Q

Reversible pulpitis should always be a “provisional diagnosis” because you can’t be sure that it’s not going to turn irreversible. How soon should the recall be after making such a provisional diagnosis?

A 
3 months (Dr. Seet)
1 month (Dr. Fedele-Rossi)
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17
Q

True or false: Irreversible pulp is still vital.

A

True, only necrotic pulp is non-vital. But recovery from irreversible pulp is not likely due to extensive inflammation.

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18
Q

Name SEVEN symptoms that differentiate irreversible pulpitis from reversible pulpitis.

A
  • Spontaneous pain
  • Wakes patient from sleep
  • Postural changes can trigger pain (increased blood pressure to pulp)
  • Pain from heat stimuli (dull, throbbing, ache)
  • Pain lingers
  • Analgesics may or may not work
  • Can have delayed response to EPT
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19
Q

Why is it not recommended to perform RCT without RD?

A

The purpose of RCT is to prevent bacteria from infiltrating the root canal. RD will help make this happen.

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20
Q

What are TWO reasons why LA might not work as effectively in pulpitis?

A
  • Inflammation causes lower pH -> less RN -> less diffusion

- Inflammation causes calcium channels to stay open, so LA cannot close them (Dr. Seet)

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21
Q

What is another name for necrobiosis?

A

Partial necrosis

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22
Q

How can there be sterile necrotic pulp?

A

Trauma may displace tooth and sever the neurovascular bundle travelling through the apical foramen.

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23
Q

What are TWO signs/symptoms of periapical periodontitis? (ie. NOT pulpal signs and NOT PA abscess)

A
  • TTP++

- Slight widening of PDL space on radiograph (if past acute phase)

24
Q

True of false: Periapical periodontitis can only occur after caries reaches the pulp.

A

False, it can be caused by occlusal trauma (e.g. subluxation) or parafunction or even idiopathic (inflammatory) means.

25
Q

What is one possibility through which a periapical abscess may be assymptomatic?

A

If there is drainage through a sinus tract (may drain intra or extraorally)
- Intraoral sinus tract may also be through the PDL, and will cause a deep narrow perio pocket (NOT to be confused with vertical root fracture - which would be more common with endodontically treated teeth)

26
Q

What are THREE materials that can be used for pulp capping?

A
  • CaOH
  • MTA (mineral trioxide aggregate)
  • Biodentine (fast setting calcium silicate)
27
Q

True or false: Pulp capping is not indicated for carious pulp exposures in mature teeth with inflamed pulp.

A

True

28
Q

How do you differentiate inflamed pulp from non-inflamed pulp during a partial pulpotomy?

A

In non-inflamed pulp, haemostasis can be achieved.

29
Q

What are THREE indications for partial pulpotomy?

A
  • Traumatic exposure
  • Immature permanent tooth or mature permanent tooth with simple restorative needs
  • Patients who cannot afford RCT
30
Q

What are the 9 steps to partial pulpotomy?

A
  1. LA
  2. Rubber dam isolation
  3. Disinfect tooth (NaOCl or CHX)
  4. Remove 1-2mm of superficial pulp tissue (sterile diamond bur, copious water spray)
  5. If excessive bleeding observed (inflammed pulp), extend prep apically
  6. Haemostasis (NaOCl or pressure)
  7. CaOH liner or MTA
  8. Restore tooth
  9. Recall at 1, 3, 6 and 12 mnths
31
Q

What is the average age of onset for chronic non-aggressive periodontitis?

A

35yo (if presenting younger than this, suspect aggressive periodontitis)

32
Q

What are the THREE main differences between gingivitis and periodontitis?

A

Gingivitis:

  • No attachment loss
  • No bone loss
  • Reversible
33
Q

What are FOUR modifying factors of periodontitis?

A
  • Smoking
  • Diabetes
  • HIV
  • Emotional stress
34
Q

What are THREE signs of aggressive periodontitis?

A
  • Amount of microbial deposits inconsistent with severity of periodontal destruction
  • Younger than 30yo
  • Familial aggregation (“Do you have a family history of gum disease?)
35
Q

What is condensing osteitis?

A

Seen as a radioopacity, it occurs when there is slow, long term irritation to the pulp.

36
Q

Did you know…

A

You should always provide a DUAL diagnosis (ie. pulp and periapical diagnosis - Vinczer)

37
Q

True of false: You can still have TTP after RCT.

A

True, the nerves in the PDL will feel it.

38
Q

What are TWO types of dental swellings?

A
  • Localised and fluctuant

- Diffuse and firm (spreading along muscular or fascial planes e.g. cellulitis)

39
Q

True or false: Roots of upper lateral incisors tend to curve labially rather than palatally, making labial abscesses more likely.

A

False, then tend to curve palatally = palatal abscesses from laterals more common.

40
Q

How long does the acute phase of apical periodontitis last? (ie. when would a radiolucency show up?)

A

6-8 weeks

41
Q

Why can we not call all apical radiolucencies PA abscesses?

A

Apical radiolucencies can be:
- PA abscess (inflammatory tissue with pus in centre)
- Granuloma (inflammatory tissue)
- Cyst (inflammatory tissue with fluid in centre, whole thing lined with epithelium)\
NOTE: only way of differentiating is histologically (not radiographically)

42
Q

Why does the body break down bone to set up an abscess?

A

There is a poor immune response from the bone (immune cells cannot get a good position).

43
Q

What is the difference between a symptom vs. a clinical sign?

A

Symptom is what the pt experiences under normal activity.
Clinical sign is a response we can ellicit artificially.
(e.g. pain on biting = symptom, TTP = clinical sign)

44
Q

What can we diagnose about an apical radiolucency?

A

Apical radiolucency = apical periodontitis.

If there is a draining sinus or swelling = abscess.

If not, it could be a granuloma or cyst.

45
Q

Why might we remove coronal pulp and reappoint before commencing RCT?

A

Inflammed pulp bleeds a lot and makes it hard to find canals.
We can perform pulpotomy of coronal pulp then reappoint next day or in 1-2 months (waiting will give the advantage of seeing if there is improvement in any periapical radiolucencies)

46
Q

If we perform pulpotomy of the coronal pulp then seal and reappoint for RCT, why can’t we just seal permanently without RCT?

A

RCT is more predictable vs. leaving necrotic root canal pulp in terms of preventing/eliminating apical periodontitis.

47
Q

What is the difference between pocket depth and probing depth?

A

Probing depth is physiological (1-2mm = normal sulcus.

Pocket depth is pathological (3mm or more)

48
Q

What TWO things make up attachment loss?

A

Pocket depth and recession.

NOTE: either can exist without the presence of the other.

49
Q

True of false: BOP is predictive of periodontitis.

A

False, although BOP is an indicator of gingivitis.

50
Q

From where to where is CAL calculated?

A

CEJ to base of sulcus.

51
Q

What THREE things can a localised sharp dip in pocket depth indicate?

A
  • Vertical root fracture
  • Draining sinus through PDL
  • Surface defect (e.g. enamel pearl, overhang, developmental concavity)
52
Q

How many root canals can an upper molar have?

A

Up to 5.

53
Q

What are the TEN things we check during a perio exam?

A
  • Plaque levels
  • Pocket depth
  • Recession
  • Calculus
  • BOP
  • Suppuration
  • Tooth mobility
  • Furcation involvement
  • Overhang
  • Marginal bleeding

NOTE: marginal bleeding is an optional recording and is automatically calculated when perio chart is saved.

54
Q

Where are enamel pearls most commonly found?

A

Furcations of molars and premolars.

55
Q

True of false: DPRs tend to overestimate alveolar bone loss.

A

False, they tend to underestimate bone loss.

56
Q

What are the TWO types of alveolar bone loss?

A
  • Horizontal

- Vertical/Angular

57
Q

In terms of alveolar bone loss, what is worse: one-wall defect or three-wall defect?

A

One-walled defect (it means 3 out of 4 bony walls that hold the tooth in the socket are gone)

BDS3 (22 decks)

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