ENDO Pulpal and Periradicular Diseases Flashcards
what are the three components of the pulp?
nerves, blood vessels, and connective tissue
can the pulp respond to edema (i.e. expand)?
no because it is surrounded by dentin (hard tissue), which limits ability to expand
pulp lacks collateral circulation, which severely limits its ability to respond to what 3 things?
bacteria, necrotic tissue, and inflammation
what cells are contained in the pulp?
odontoblasts and mesenchymal cells (differentiate into osteoblasts)
which two nerve fibers are responsible for sensing pulpal pain?
A-delta and C fibers
which nerve fiber pain is sensed as quick, sharp, and dissipates quickly on removal of the stimulus?
A-delta
which nerve fiber is large and myelinated?
A-delta
what is the pulpodentinal complex?
A-delta fibers and odontoblast layer
which nerve fiber pain is sensed as a dull, throbbing ache?
C fibers
which nerve fiber is small and unmyelinated?
C fibers
are C fibers involved in the pulpodentinal complex?
no
T or F:
pain sensed from C fibers signifies irreversible tissue damage
true
___ fibers sense dentinal pain, whereas ___ fibers sense pulpitis pain
A-delta
C fibers
C fiber pain occurs with tissue injury and is mediated by ___, ___, and ___
inflammatory mediators, vascular changes in blood volume/flow, and increase in tissue pressure
C fiber pain eventually results in ___
tissue necrosis
___ can raise intrapulpal pressure to levels that excite C fibers
hot beverages and foods
pain from which fiber is diffuse and can be referred to a distant site or to other teeth?
C fiber
which pulpal disease is signified as asymptomatic, mild-moderate response to thermal/electrical stimuli?
within normal limits
which pulpal disease is signified by thermal (usually cold) stimulus that causes quick, sharp, hypersensitive response?
reversible pulpitis not actually a disease, but a symptom – goes away with removal of stimulus
what 3 things can reversible pulpitis be caused by?
early caries/rampant decay, SRP, deep restorations without a base
which 2 ways is reversible pulpitis distinguished from symptomatic irreversible pulpitis?
painful response to thermal stimulus is longer after removal in symptomatic irreversible pulpitis, and reversible pulpitis does not involve unprovoked (spontaneous) pain
which pulpal disease must involve penetration of bacteria into the pulp and is damaged beyond repair?
irreversible pulpitis
what is the end result of irreversible pulpitis?
pulpal necrosis (could be quick or take years), and is often asymptomatic
what are 2 consequences of asymptomatic irreversible pulpitis?
hyperplastic pulpitis and internal resorption
what are the histological findings of internal resorption?
chronic inflammatory cells, multinucleated giant cells, and necrotic pulp
postural changes can sometimes induce pain in which pulpal disease?
symptomatic irreversible pulpitis
T or F:
radiographs are sufficient to diagnose irreversible pulpitis
false
electric pulp tests are also of little value
pulpal necrosis is a pulpal disease described as the death of the pulp as a result of one of which 3 causes?
untreated irreversible pulpitis, traumatic injury, or long-term interruption of blood supply
T or F:
necrosis can be partial or total necrosis
true
for example, a tw-canaled tooth can have inflammation in one canal and necrosis in the other
what are the symptoms of pulpal necrosis?
tenderness to percussion/chewing with thickening of the PDL
what is the progression of inflammation/necrosis?
- inflammation progresses to liquefaction necrosis
- insufficient drainage due to dentinal walls and lack of collateral circulation
- causes increase in pressure and eventual necrotic pulp
- bacteria penetrate dentinal tubules (this is why we remove superficial layers during cleaning/shaping)
periradicular diseases of pulpal origin are a response from ___
irritants from the root canal system
what are the range of symptoms of periradicular diseases of pulpal origin?
range from asymptomatic to slight sensitivity to chewing, feeling of tooth elongation, intense pain, swelling, high fever, and malaise
what is the most indicative sign of a periradicular inflammatory lesion?
radiographic bone resorption, although periradicular lesions are frequently not seen radiographically
diagnosis of periradicular lesions is based on ___ and ___
clinical signs/symptoms and radiographic findings
what are the 5 periradicular disease diagnoses?
acute periradicular periodontitis, acute periradicular abscess (acute apical abscess), chronic periradicular periodontitis, suppurative periradicular periodontitis (chronic periradicular abscess), and chronic focal sclerosing osteomyelitis (condensing osteitis)
which periradicular disease is described as a painful localized inflammation of the PDL around the apex?
acute periradicular periodontitis
what are 3 possible causes of acute periradicular periodontitis?
extension of the pulpal disease into periradicular tissue, canal overinstrumentation or overfill, or occlusal trauma
what is the only way to determine the need for RCT in cases of acute periradicular periodontitis?
pulp tests
T or F:
acute periradicular periodontitis only occurs around nonvital teeth
false, can be both
what is the histology of acute periradicular periodontitis?
localized inflammatory infiltrate within the PDL
which periradicular disease is a painful, purulent exudate around the apex?
acute periradicular abscess (acute apical abscess)
acute periradicular abscess is a result of the exacerbation of ___ from ___
acute apical periodontitis from necrotic pulp
what might you find radiographically on tooth with acute periradicular abscess?
possible slight thickening of the lamina dura
what is always present in acute periradicular abscess?
swelling
what is a phoenix abscess, and how does it differ from an acute periradicular abscess?
phoenix abscess has the same symptoms as an acute periradicular abscess (acute apical abscess) but with an obvious radiographic perirapical radiolucency
what is the histopathology of acute periradicular abscess?
central area of liquefaction necrosis containing neutrophils and cellular debris, surrounded by macrophages, lymphocytes, and plasma cells
T or F:
bacteria are always found in the apical tissues or within the abscess in acute periradicular abscesses
false, bacteria is not always found in these areas
what are the 4 signs and symptoms of an acute periradicular abscess?
rapid onset swelling, mod-severe pain, pain w/percussion and palpation, and slight increase in tooth mobility
describe the swelling associated with acute periradicular abscess
usually remains localized, but is determined by the location of the apex and muscle attachments. may become diffuse and spread (cellulitis)
how is an acute periradicular abscess differentiated from a lateral periodontal abscess?
pulp vitality testing and sometimes periodontal probing
which periradicular disease is a long-standing, asymptomatic or mildly-symptomatic lesion?
chronic periradicular periodontitis
what is the radiographic presentation of chronic periradicular periodontitis?
visible apical bone resorption that results from extensive demineralization of cancellous and cortical bone due to bacteria and endotoxins
is tenderness to percussion and palpation indicative of chronic periradicular periodontitis
slight tenderness is possible
what is the diagnosis of chronic periradicular periodontitis confirmed by?
general absence of symptoms, radiographic presence of periradicular radiolucency, and confirmation of pulpal necrosis
a totally necrotic pulp primarily has aerobic or anaerobic microorganisms?
anaerobic (no vascularity, no defense cells)
chronic periradicular periodontitis has been classified histologically as ___ or ___. how do you distinguish between the two classifications?
periradicular granuloma or periradicular cyst
distinguished via histopathological examination
which periradicular disease is associated with either a continuously or intermittently draining sinus tract without discomfort?
suppurative periradicular periodontitis (chronic periradicular abscess)
how can suppurative periradicular periodontitis (chronic periradicular abscess) mimic a periodontal lesion with a pocket?
the exudate from the abscess can sometimes drain though the gingival sulcus
what are the pulp test results of suppurative periradicular periodontitis?
negative because the pulp is necrotic
what is the radiographic presentation of suppurative periradicular periodontitis?
presence of bone loss at the periradicular area
what is the treatment for suppurative periradicular periodontitis?
the sinus tract sresolve spontaneously with nonsurgical endodontic treatment
which periradicular disease has excessive bone mineralization around the apex of an asymptomatic, vital tooth?
chronic focal osteomyelitis (condensing osteitis)