Endo Dx, Treatment Planning, etc. (19) Flashcards
The pulp contains nerve, blood vessels, and ___________.
Connective tissue
What are the three factors that make the pulp unique in its ability to fight off infection?
- Completely surrounded by hard tissue - cannot expand w/ edema
- Lacks collateral circulation
- Osteoblasts form secondary dentin
Which nerve fibers are found in the pulp?
A-delta and C
What is found in the pulpodentinal complex?
A-delta fibers and odontoblasts
Which nerve fiber in the pulp transmits sharp pain to cold stimulus?
A-delta (large, myelinated)
_________ are small unmyelinated fibers that transmit dull, aching pain.
C fibers
T/F: C fibers are found in the pulpodentinal complex.
False
T/F: Reversible pulpitis is a disease.
False
Reversible pulpitis is a symptom. Remove the irritant and the pulp returns to normal state.
What is often the crossover point from reversible to irreversible pulpitis?
Penetration of bacteria into the pulp
What are the histological features of SIP?
Microabscesses in the pulp. Intact nerves may be observed. Inflammatory cells present throughout.
What can cause necrosis of the pulp?
- Untreated irreversible pulpitis
- Traumatic injury
- Long-term loss of blood supply
T/F: Bacteria are able to penetrate the dental tubules from the pulp chamber.
True.
This is why you clean and shape the walls of the canal.
What is hyperplastic pulpitis?
Reddish, cauliflower like growth of pulp tissue through carious exposure.
What are the histological features of internal resorption?
- Chronic inflammatory cells
- Giant cells
- Necrotic pulp coronal to defect
T/F: Endo treated teeth can undergo internal resorption.
False
Early recognition and prompt endo treatment can halt internal resorption.
What is the most indicative sign of apical inflammatory lesions?
Radiographic resorption of bone. However, this is not always seen.
T/F: The terms acute and chronic can be applied to the histology of apical lesions.
False.
Acute and chronic apply only to the symptoms
T/F: All SAP cases require endo on the associated tooth.
False
Pulp testing must be done to determine pulpal diagnosis
What are the three potential causes of SAP?
- Pulpal disease
- Canal overinstrumentation/overfill
- Occlusal trauma
What are the three diagnostic factors for Asymptomatic apical periodontitis?
- Absence of symptoms
- Apical radiolucency
- Necrotic pulp
If left untreated, symptomatic apical periodontitis will lead to an __________.
Acute apical abscess
What are the signs and symptoms of an acute apical abscess?
- Swelling
- Moderate-severe pain
- Pain w/ percussion
- Increase in mobility
- Swelling may spread
T/F: Chronic apical abscesses are painful to the patient.
False
They are continuously draining so there is minimal swelling and pressure buildup
T/F: Condensing osteitis requires endo treatment.
False
Tooth is typically vital and asymptomatic
What are some characteristics of non-odontogenic facial pain?
- Episodic pain
- Trigger points
- Pain crosses the midline
- Increases with stress
- Seasonal
- Parasthesia
What are the only contraindications for endo therapy?
Uncontrolled diabetes and MI within 6 months
T/F: Inflammation in the pulp will transmit location so the patient will be able to localize the pain easily.
False
Pulp - pain only
PDL - pain and location
What are common referred pain areas for maxillary and mandibular molars?
Max - zygomatic, parietal, and occipital regions
Mand - ear, angle of jaw, posterior neck
T/F: Sometimes it is necessary to wait for treatment until vague symptoms can localize.
True
T/F: EPT testing can be done in place of thermal testing.
False
Thermal testing must be done for proper diagnosis.
Describe the SLOB rule.
Same lingual, opposite buccal.
If the source of radiation is moved left, the object that is lingual will also appear to move left in the new image.
Which teeth are most commonly associated with cracked tooth syndrome?
Mandibular molars, esp 1st molars
How can you treat cracked tooth syndrome?
Healthy pulp - place ortho band or temp crown and observe. If this helps plan for permanent crown
SIP or Necrotic - RCT and crown (guarded prognosis)
What are some diagnostic considerations for a vertical root fracture?
- Isolated perio pocket
2. J-shaped/teardrop radiolucency
T/F: Perio disease will often lead to endo disease.
False
More likely that endo disease will lead to perio disease.
Regarding endo/perio relationships, how would you diagnose and treat a primary endo lesion?
Diagnose - Narrow deep pocket and necrotic tooth.
Treat - RCT and monitor perio for healing
How would you diagnose and treat a perio/endo lesion that is primary perio w/ secondary endo?
Diagnose - hx of periodontitis, broad pocket, vital tooth
Treat - RCT first, perio treatment second.
