Endo Dx, Treatment Planning, etc. (19)

Question 1

The pulp contains nerve, blood vessels, and ___________.

Answer 1

Connective tissue

Question 2

What are the three factors that make the pulp unique in its ability to fight off infection?

Answer 2

1. Completely surrounded by hard tissue - cannot expand w/ edema
2. Lacks collateral circulation
3. Osteoblasts form secondary dentin

Question 3

Which nerve fibers are found in the pulp?

Answer 3

A-delta and C

Question 4

What is found in the pulpodentinal complex?

Answer 4

A-delta fibers and odontoblasts

Question 5

Which nerve fiber in the pulp transmits sharp pain to cold stimulus?

Answer 5

A-delta (large, myelinated)

Question 6

_________ are small unmyelinated fibers that transmit dull, aching pain.

Answer 6

C fibers

Question 7

T/F: C fibers are found in the pulpodentinal complex.

Answer 7

False

Question 8

T/F: Reversible pulpitis is a disease.

Answer 8

False

Reversible pulpitis is a symptom. Remove the irritant and the pulp returns to normal state.

Question 9

What is often the crossover point from reversible to irreversible pulpitis?

Answer 9

Penetration of bacteria into the pulp

Question 10

What are the histological features of SIP?

Answer 10

Microabscesses in the pulp. Intact nerves may be observed. Inflammatory cells present throughout.

Question 11

What can cause necrosis of the pulp?

Answer 11

1. Untreated irreversible pulpitis
2. Traumatic injury
3. Long-term loss of blood supply

Question 12

T/F: Bacteria are able to penetrate the dental tubules from the pulp chamber.

Answer 12

True.

This is why you clean and shape the walls of the canal.

Question 13

What is hyperplastic pulpitis?

Answer 13

Reddish, cauliflower like growth of pulp tissue through carious exposure.

Question 14

What are the histological features of internal resorption?

Answer 14

1. Chronic inflammatory cells
2. Giant cells
3. Necrotic pulp coronal to defect

Question 15

T/F: Endo treated teeth can undergo internal resorption.

Answer 15

False

Early recognition and prompt endo treatment can halt internal resorption.

Question 16

What is the most indicative sign of apical inflammatory lesions?

Answer 16

Radiographic resorption of bone. However, this is not always seen.

Question 17

T/F: The terms acute and chronic can be applied to the histology of apical lesions.

Answer 17

False.

Acute and chronic apply only to the symptoms

Question 18

T/F: All SAP cases require endo on the associated tooth.

Answer 18

False

Pulp testing must be done to determine pulpal diagnosis

Question 19

What are the three potential causes of SAP?

Answer 19

1. Pulpal disease
2. Canal overinstrumentation/overfill
3. Occlusal trauma

Question 20

What are the three diagnostic factors for Asymptomatic apical periodontitis?

Answer 20

1. Absence of symptoms
2. Apical radiolucency
3. Necrotic pulp

Question 21

If left untreated, symptomatic apical periodontitis will lead to an __________.

Answer 21

Acute apical abscess

Question 22

What are the signs and symptoms of an acute apical abscess?

Answer 22

1. Swelling
2. Moderate-severe pain
3. Pain w/ percussion
4. Increase in mobility
5. Swelling may spread

Question 23

T/F: Chronic apical abscesses are painful to the patient.

Answer 23

False

They are continuously draining so there is minimal swelling and pressure buildup

Question 24

T/F: Condensing osteitis requires endo treatment.

Answer 24

False

Tooth is typically vital and asymptomatic

Question 25

What are some characteristics of non-odontogenic facial pain?

Answer 25

1. Episodic pain
2. Trigger points
3. Pain crosses the midline
4. Increases with stress
5. Seasonal
6. Parasthesia

Question 26

What are the only contraindications for endo therapy?

Answer 26

Uncontrolled diabetes and MI within 6 months

Question 27

T/F: Inflammation in the pulp will transmit location so the patient will be able to localize the pain easily.

Answer 27

False

Pulp - pain only
PDL - pain and location

Question 28

What are common referred pain areas for maxillary and mandibular molars?

Answer 28

Max - zygomatic, parietal, and occipital regions

Mand - ear, angle of jaw, posterior neck

Question 29

T/F: Sometimes it is necessary to wait for treatment until vague symptoms can localize.

Answer 29

True

Question 30

T/F: EPT testing can be done in place of thermal testing.

Answer 30

False

Thermal testing must be done for proper diagnosis.

Question 31

Describe the SLOB rule.

Answer 31

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.

Question 32

Which teeth are most commonly associated with cracked tooth syndrome?

Answer 32

Mandibular molars, esp 1st molars

Question 33

How can you treat cracked tooth syndrome?

Answer 33

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)

Question 34

What are some diagnostic considerations for a vertical root fracture?

Answer 34

1. Isolated perio pocket

2. J-shaped/teardrop radiolucency

Question 35

T/F: Perio disease will often lead to endo disease.

Answer 35

False

More likely that endo disease will lead to perio disease.

Question 36

Regarding endo/perio relationships, how would you diagnose and treat a primary endo lesion?

Answer 36

Diagnose - Narrow deep pocket and necrotic tooth.

Treat - RCT and monitor perio for healing

Question 37

How would you diagnose and treat a perio/endo lesion that is primary perio w/ secondary endo?

Answer 37

Diagnose - hx of periodontitis, broad pocket, vital tooth

Treat - RCT first, perio treatment second.