Final Exam Flashcards
Root end anatomy of apical constriction is referred to as what?
Apical foramen
(Cemento-dentinal junction)
What does the S in SOAP mean?
Subjective
What is not an example of Subjective? (List the examples of subjectives)
- History of Pain
- Stimulus of Pain
- Frequency of Pain
- Severity of Pain
- Duration of Pain
- Spontaneity of Pain
- Location of Pain
- Character of Pain
What is not an example of Objective?
- Visual Exam
- Palpation
- Percussion
- Presence of Sinus Tract
- Caries/Tooth Fractures
- Fractured Restorations
- Extensive Restorations
- Periodontal Disease/Probing
- Mobility
- Exposed Dentin/Wear Facets
Which of the following is not a sign of irreversible pulpitis?
- Symptomatic IRREVERSIBLE PULPITIS: lingering thermal pain, Spontaneous pain, Referred pain
- ASYMPTOMATIC: no clinical symptoms, inflammation produced by caries, caries excavation , trauma
What is not indicative of a chronic periapical abscess?
Chronic periapical abscess: Inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little or no discomfort intermittent discharge of pus through a sinus tract.
Which is not a sign of acute apical periodontitis?
Acute periapical periodontitis:
- Symptomatic periapical periodontitis: Inflammation, usually of the apical periodontium, producing clinical symptoms including a painful response to biting and/or percussion or palpation. It might or might not be associated with an apical radiolucent area.
- Asymptomatic periapical periodontitis: Inflammation and destruction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area, and does not produce clinical symptoms.
What are the signs of a necrotic pulp?
- Death of dental pulp.
- Nonresponsive to pulp testing. May response to HOT ONLY and relieved by COLD.
- Electric pulp test negative.
- Asymptomatic to intense
- May or may not have periradicular lesion
- Can be percussive sensitive with onset of periradicular inflammation.
Periapical or periradicular pathosis is a consequence of … (or can have or maybe)?
Pulp necrosis
Internal resorption is always symptomatic (T/F)
False, internal root resorption is usually asymptomatic and is first recognized clinically through routine radiographs.
Teeth with internal resorption may respond normally to pulp tests (T/F)
True -
Internal root resorption usually occurs in teeth with vital pulps and responses to sensitivity testing. However, it is common to register a no-response to sensitivity testing, since often the coronal pulp has been removed or is necrotic, and the active resorbing cells are more apical in the canal. Also, the pulp might have become necrotic after active resorption took place (Hargreaves 645).
If you discover a resorption, you should treat it as fast as possible?
IMMEDIATELY! OR IT WILL DIE FOREVER
Teeth with intracanal resorptive lesions usually respond within normal limits to pulpal and periapical tests. Radiographs reveal presence of radiolucency with irregular enlargement of the root canal compartment
Immediate removal of the inflamed tissue and completion of root canal treatment are recommended; these lesions tend to be progressive and eventually perforate to the lateral periodontium. When this occurs, pulp necrosis ensues and treatment of the tooth becomes more difficult.(Torabinejad 56)
Non-odontogenic pain can result from…?
- Heterotropic pain - pain felt in an area other than its true source
- Referred pain
- Central pain - CNS
- Projected pain - peripheral of same nerve (shingles)
- Myofascial sources (most common)
- Masseter, temporalis, medial & lateral pterygoid, anterior digastric muscles
- Sinus/nasal mucosal sources
- Neurovascular sources
- Neuropathic pain disorders
- Neuralgia
- Neuroma
- Neuritis
- Neuropathy
- Cardiac sources
- Psychogenic pain
Which of the following statements regarding internal resorption is accurate?
- Initiated within the root canal system
- Etiology - caries, trauma, crown prep, cracked tooth, abrasion, erosion, idiopathic
- Can occur at any location
- Usually asymptomatic often found on routine exam
- Tooth usually tests positive or vital
- Prompt endo treatment necessary
Perforating a tooth during endodontics is always below the standard of care.
True
If you separate a file, bypass it, and seal it in a canal you don’t need to tell the patient (T/F)
False
Which of the following is the closest percentage of maxillary molars that have four canals?
90-95%
What is the closest percentage of mandibular anteriors that have two canals?
40% (Lower central laterals)
Max first bicuspids commonly have how many canals?
2 roots & 2 canals
Max second bicuspid commonly have how many canals?
1 root & 1 canal
Which tooth has most varied morphology?
Max 1st molar
Mand first premolar freq have two canals (T/F)?
False, 1 canal. 20-30% have 2 canals
Which tooth frequently presents with C shaped root canal system?
mandibular second molar
Which of the following most frequently likely indicates pain that is not of pulpal origin?
There are several indicators that a toothache may be non-odontogenic in origin.
- Red flags for non-odontogenic pain include:
- toothaches that have no apparent etiology for pulpal or periradicular pathosis;
- pain that is spontaneous, poorly localized, or migratory;
- pain that is constant and non-variable.
- pain that is described as burning, pricking, or “shocklike” is less likely to be pulpal or periradicular in origin.
- If pain of suspected periradicular origin is non-responsive to local anesthetic, it is a strong indication that the pain may be non-odontogenic in origin.
- Referred pain from a tooth is usually provoked by an intense stimulation of pulpal C fibers, the slow conducting nerves that when stimulated cause an intense, slow, dull pain.
When a patient complains of severe pain that cannot be localized, A, B or C?
Non-odontogenic pain
Percussion is a definitive test for what?
Pain to percussion does not indicate that the tooth is vital or non-vital but is rather an indication of inflammation of the periodontal ligament à perio diagnosis.
Acute apical abscess is best differentiated from acute apical periodontitis by which of the following?
An abscess must have pus formation and/or a sinus tract.
Which of the following is most likely to have referred pain?
Although any deep somatic tissue type in the head and neck has the propensity to induce central excitatory effects and therefore cause referral of pains to teeth, pains of muscular origin appear to be the most common.
Which is true about a necrotic tooth?
- It is usually non-responsive to stimulus (Hot bad, cold good)
- Non-vital
- Asymptomatic to intense feeling
- May or may not have an apical lesion
- May or may not be percussion sensitive
Reversible pulpitis - which statement is true?
- Non-lingering (thermal tests)
- Not spontaneous
- “A clinical diagnosis based on subjective and objective findings indicating that the inflammation should resolve and the pulp return to normal”
Loss of lamina dura can be a sign of Irreversible pulpitis?
A widening or break in the lamina dura is the most consistent radiographic finding of NOT a nonvital tooth. Most likely occlusal trauma, thus a periapical issue.
Chronic apical periodontitis is always symptomatic (T/F) ?
FALSE, it is always asymptomatic.
Percussion testing indicates the health and integrity of the pulp?
No. Percussion does not indicate health or integrity of pulp. Reveals inflammation of PDL.
Radiolucent lesion at the apex of a lower central incisor is ALWAYS an indication that the nerve is necrotic (T/F)?
False
A patient presents with a new three unit bridge with full coverage of the abutments. The bridge was done last week in your office. Which of the following is not relevant to locating the problem?
Will give four answers (hard question)
What you can or cannot do with crown testings
Cold? Electric? Percussion? Bite on it? Some may not work
For teeth with PFM crowns cold test by individually isolating teeth with a rubber dam, electric may not work.
Endo file length - DO to D1-6, what does that represent?*
length of cutting file (length from tip to top of flutes)
02 04.06 refers to what?
Taper
Gutta percha alone can seal a case (T/F)?
False - (need sealer also)
Coronal seal is equally as important as the quality of the obturation (T/F)?
True
As you instrument a canal does it get longer or shorter?
Gets shorter (gets less curved)
Know the Buccal object rule - the lingual or palatal canal moves in the opposite direction of the cone head (T/F) ?
FALSE
SLOB -
Same side - lingual
Opposite side - buccal
If taking an angled x-ray, the slob rule refers to where the film is placed***
SLOB = Same Lingual Opposite Buccal
As the cone position moves from parallel, whether toward the horizontal or toward the vertical, the objects on the film shift away from the direction of the cone (or in the direction of the central beam).
In other words, when two objects and the film are in a fixed position and the radiation source (cone) is moved, images of both objects move in the opposite direction
The facial (buccal) object shifts farthest away; the lingual object shifts less. The resulting radiograph
shows a lingual object that moved relatively in the same direction as the cone and a buccal object that moved in the opposite direction
- What is the property of sodium hypochloride?
- Which is not a property of NAOCl?
- Superior antibacterial action
- No difference in efficacy between 0.5 & 5%
- Irrigation + mechanical instrumentation = eliminated bacteria in 50% of cases
- Dissolves tissue
- Not a chelating agent, does not remove smear layer
Blowing air on a tooth is a diagnostic test for what?
sensitivity?
You CANNOT make a diagnosis of a tooth by blowing air on it
Posterior teeth must have prost coverage after endodontics (T/F)?
True
Pt presents to your office on a full day with a toothache. Extremely sensitive to temperatures. Can’t start treatment though. Appropriate to give him what? (three answers)
?
Mandibular 1st premolars frequently have 2 canals (T/F)?
False - Mand second premolars have two canals frequently
The apical third of maxillary lateral incisors always take a mesial bend?
False…distal curve
The exit of a pulp is always at the apical terminus of a root (T/F)?
False. It can also exit laterally
During a consultation, if you see a separated file in a tooth from another dentist it is okay to not tell the patient (T/F) ?
False. Not telling patient about broken files is considered fraudulent concealment.
Over filled canals are below the standard of care here at this school (T/F)?
False
What’s the color sequence of the files from 15 to 45?
- white
- yellow
- red
- blue
- green
- black
- white
Min. size of a 02 tapered hand file for a glide path is what?
25
All except one of the following are factors that can be used to determine an endpoint in cleaning and shaping the endpoint of a root canal system: What is not relevant?
Width of root canal and its apical constriction
Radiographic width of the root thickness
Anatomic configuration of the root
Type of tooth being treated***
Non-vital response in the following conditions: acute apical abscess, chronic apical periodontitis, and phoenix abscess (arises from chronic situation) share a common clinical diagnosis of what?
Pulpal infection, necrosis and pus?
When two canals are detected in the same root, a reliable method for determining apical termination is by what?
- pre-op radiograph in a parallel manner
- measure the tooth and subtract 1mm for the apical constriction for “estimated working length”
The observation on a periapical film of a root canal space that abruptly terminates in the middle of a root is indicative of what?
Radiographic of canal splitting mid root is seen by decrease in density (radiolucent decreases - so it is radiopaque)
“Fast break” usually indicates canal bifurcation.
If the canal appears to disappear, look for bifurcations.
History of pain, stimulus of pain, severity of pain, and frequency of pain are objective findings by principle (T/F)?
False; these are subjective findings
Ice test, thermal test, electric test, and cavity test are subjective findings (T/F) ?
False - objective
Mechanoreceptors in the pulp can help isolate a tooth that is causing pain?
C-fibers - majority of dental nerves are c-fibers that innervate central pulp
Toothaches of myofascial origin can arise (A/B/C)?
- Muscular origin (masseter, temporalis, medial & lateral pterygoid, anterior digastric)
- Sinus/nasal mucosal sources
- Neurovascular sources
- Neuropathic pain disorders
- Neuralgia
- Neuroma
- Neuritis
- Neuropathy
- Cardiac sources
- Psychogenic pain
Neuralgia normally causes dull diffuse ache that lasts a considerate amount of time (T/F)?
- False
- Intense, sharp shooting pain usually unilateral
- Pain subside in relative short period of time until again stimulated
The radiographic differentiation of canals splitting mid-root on a radiograph is seen by a decrease in the density or it’s more radiolucent in the mid-root area. True or False?
False, it is radiopaque
If a patient is in myofascial pain, an IA block will eliminate symptoms (T/F)?
False
But anesthesia to trigger points (in muscles) could alleviate symptoms
