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Endo > Final Exam > Flashcards

Final Exam Flashcards

1
Q 
Circulation of the Pulp
Lacks?
Type of Circulatory system
Largest Vessels are \_\_\_ and \_\_\_
Vessels of the pulp
A

ture arteries and viens
microcirculatory system
arterioles and venules
arterioles, capillaries, venules, lymphatic vessels

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2
Q

What two aspects of the pulp inhibit its ability to heal?

A

it is encased within an unyielding chamber

lacks a collateral circulation

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3
Q

Most effects from restorative dentistry have what kind of effect on the pulp

A

indirect

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4
Q

Cavity Preparation Pulp Injury

frictional heat
desiccation
exposure of dentinal tubules
direct damage to odontoblasts and processes 
chemical exposure of dentin tubules
A

Cavity Preparation Pulp Injury

frictional heat
desiccation
exposure of dentinal tubules
direct damage to odontoblasts and processes 
chemical exposure of dentin tubules
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5
Q

Restorative Material Pulp Injury

material Toxicity
insertion Pressures
thermal effects
induced Stresses

A

Restorative Material Pulp Injury

Material Toxicity
Insertion Pressures
Thermal effects
Induced Stresses

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6
Q

Subsequent to the Restoration Pulp Injury

Marginal Leakage
Cuspal Flexture

A

Subsequent to the Restoration Pulp Injury

Marginal Leakage
Cuspal Flexture

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7
Q

Coronal bacterial leakage has been shown to be an important fact in

A

pulpal inflammation

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8
Q

Pathway of Bacterial Invasion

dental caries
direct pulp exposure
microleakage
periodontal disease
dental anomalies
anachoresis-bacteria in blood infects tissue sepicemia
A

Pathway of Bacterial Invasion

dental caries
direct pulp exposure
microleakage
periodontal disease
dental anomalies
anachoresis-bacteria in blood infects tissue sepicemia
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9
Q

What Pulpal Cells Respond to Irritation

form dentin, decreasing dentin permeability to irritants?

A

odontoblasts

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10
Q

What Pulpal Cells Respond to Irritation

form collagen to wall of irritants, become secondary odontoblasts?

A

fibroblasts

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11
Q

What Pulpal Cells Respond to Irritation

neutralize irritants, destroy bacteria, release mediators involved in repair?

A

inflammatory cells

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12
Q

Pressure in a confined spaces alters the pulpal structure depresses the function of the pulpal tissues and cell death results in edema and increased pressure is known as?

A

Compartment syndrome

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13
Q

Sequence of Pulpal Inflammation Secondary to Caries

A

Chronic Inflammation
Hyperemia
Acute Inflammation
Repair or Necrosis

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14
Q

Chronic Inflammation Phase 1

definition

A

Lymphocytes and plasma cells localize adjacent involved dentinal tubules in an immune response to bacterial toxins penetrating the tubules

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15
Q

Chronic Inflammation Phase 2
Active Hyperemia
Passive Hyperemia

A
  • an increase in the inflow of blood due to chemical mediators causes vasodilation and capillary permeability
  • a decrease in the outflow of blood
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16
Q

Acute Inflammation Phase 3

cell type and what they do

A

PMN, destroy bacteria and pulpal tissue

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17
Q

Acute Inflammation Phase 4

Irreversible vs Reversible

A
  • if bacterial assault and pulpal destruction continues, acute inflammation leads to necrosis
  • if bacterial assault and pulpal destruction ceases repair can occur
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18
Q

Four Stages of Irreversible Pupal Necrosis

A

1.microabscess formation
2.ulceration
3.partial necrosis
4.Total Necrosis
MUPeTs

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19
Q

Localized abscess adjacent to the dentin containing the invading bacteria which leads to a dense infiltration of PMNs surrounding the abscess is known as?

A

Microabscess Formation

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20
Q

Carious exposure allow exudate to escape decreasing the intrapulpal pressure

A

Ulceration

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21
Q

Define Partial Necrosis, why is it important?

A

the coral pulp can be totally necrotic what the apical pulp is vital, thus we must anesthetizing teeth even if they test negative to pulp testing

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22
Q 
Two Types of Necrosis
Liquefaction Necrosis
-tissue
-intrapulpal pressure
-sensitivity
A
  • structureless tissue mass
  • may have elevated intrapulpal pressure
  • may still be sensitive to heat
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23
Q 
Two Types of Necrosis
Dry Necrosis
-tissue
-debris
response to thermal EPT testing
A
  • no fluid, no mass
  • dry necrotic debris
  • none
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24
Q

Pulp tissue damage leads to ____in regards to blood flow

A

cut of pulp blood circulation

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25
Q

Oxygen Tension

_____ bacteria predominate early followed by____ then _____ in necrotic pulp

A

facultative
anaerobic
strict anaerobes

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26
Q

Types of Pulp Infections

mixed polymicrobial infection of 10-30 bacterial species and 10^3-10^8 bacterial cell counts per canal that predominately contains anaerobic with some facultative bacteria

A

Primary Intraradicular infection

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27
Q

Types of Pulp Infections

microorganisms not present in primary infection, introduced after access opening

A

Secondary Intraradicular infection

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28
Q

Types of Pulp Infections

microorganisms that resist treatment, 1-3gram positive facultative anaerobes

A

Persistance Intraradicular infection

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29
Q

Types of Pulp Infections

outside of the roots

A

Extraradicular infection

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30
Q

Chronic Hyperplastic Pulpitis

  • caused by
  • pathophysiology
  • symptoms
A
  • large exposures of the pulp
  • pulp proliferates out from the chamber and the epithelium from saliva seeds onto the pulp tissue, proliferates to form keratinized stratified squamous epithelial lining
  • may be asymptomatic
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31
Q

Hyperplastic Pulpitis

  • pathology
  • symptoms
A
  • overgrowth of a chronic inflamed young pulp onto the occlusal surface
  • often asymptomatic
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32
Q

Teeth with caries into dentin have pulp_____

A

pulpal inflammation

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33
Q

Neural Structure of the Pulp

  • thermal receptors? types
  • pressure receptors?types
  • pain receptors?types
A
  • none
  • none
  • 2, a delta fibers and C fibers
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34
Q

A Delta Fibers

  • endings lie
  • concentration
  • responsible for___ pain
  • type of pain
  • localization of pain
  • threshold
  • effected by inflammation?
  • Fluid movement process works via
A
  • pulp dentin boarder
  • pulpal horn
  • dentinal pain
  • sharp
  • well localized
  • low threshold
  • none
  • fluid movement within the dentinal tubules caused by thermal or osmotic changes stimulates
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35
Q

C Fibers

  • speed of conduction
  • type of pain
  • response to dentinal stimulation
  • concentration
  • localization
  • threshold
  • effected by inflammation?
  • Can fire spontaneously as a result of _____
A
  • slow
  • dull throbbing for long duration
  • not found
  • deeply seated in the pulp
  • poorly localized
  • inflammatory mediators stimulate them
  • irreversible pulpitis
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36
Q

True or False

There is a correlation between symptoms and the histological status of the pulp

A

False

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37
Q

What % of teeth with caries were asymptomatic

What % of patients with pulp inflammation are asymtomatic?

A

36%

60%

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38
Q

True or False

Pain occurs during times of inflammation and after damage is done as pulp is in a necrotic state

A

First statement is true, second is false because necrotic tissue will have a limited impulse conduction capacity

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39
Q

Severe pulpal pain indicated ____ necrosis with _____ intrapulpal pressure of ____mm Hg

A

liquefaction necrosis

34.5

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40
Q

What is the normal intrapulpal pressure

A

10 mm Hg

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41
Q

Crown fractures cause ____ pulp irritation

A

direct

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42
Q

the superficial ___mm of an exposed pulp is inflamed one week after crown fracture

A

2mm

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43
Q

After one month ____% of injured teeth with non exposed pulps and ____% of teeth with exposed pulps have irreversible inflammation

A

50%

100%

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44
Q

Disruption of Apical Blood Supply
internal Resorption occurs in ___% of cases and
calcific metamorphosis occurs in ___% of the cases

A

2%

24%

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45
Q

Tenderness to percussion with no mobility or displacement

A

concussion

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46
Q

Loosening with no displacement

A

subluxation

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47
Q

Central displacement into alveolar bone

A

intrusive

48
Q

Peripheral displacement out of alveolar bone

A

extrusive

49
Q

Peripheral displacement

A

lateral

50
Q

Necrosis Prognosis of Luxated Teeth

  • subluxation
  • extrusive luxation
  • intrusive luxation
A
  • 26%
  • 64%
  • 96%
51
Q

Calcific Metamorphosis

  • loses regulatory mechanisms and continues to produce dentin
  • pulp chamber and root canal appearance radiographically
  • color of tooth
  • time for occurrence
  • more___ and less___
  • pulp inflammation
A
  • odontoblasts
  • totally calcified
  • yellow
  • rapidly
  • fibrous and cellular
  • rare
52
Q

a condition associated with either a physiologic or pathologic process resulting in a loss of dentin cementum and bone

A

resorption

53
Q

Internal Resorption

  • initiation location
  • loss of
  • invasion of
  • may or may not perforate____
A
  • within the pulp
  • dentin
  • cementum
  • the external root surface
54
Q

Internal Resorption

  • pulp undergoes ___ changes
  • becomes___
  • macrophage giant cells differentiate into___
  • ____resorb the internal dentinal wall
  • pulp tissue is
  • ____requried to halt the resorption process
A
  • metaplastic changes
  • vascular granulation tissue
  • dentinoclasts
  • irreversibly inflamed
  • RCT
55
Q

External Resorption

  • initiation location
  • initially only affects______
  • more or less common than internal
  • may or may not invade_____
A
  • periodontium
  • external root surfaces
  • more
  • pulp
56
Q

Three types of External Resorption

A

inflammatory
replacement
surface

57
Q

A pathologic loss of cementum, dentin and bone

A

inflammatory resorption

58
Q

Replacement Resorption

  • result from
  • pathology
  • fusion of
  • loss of
  • lack of clinically
A
  • inflammatory resorption
  • loss of cementum, dentin and periodontal ligament with subsequent ingrowth of bone into the defect
  • bone to cementum and or dentin
  • physiologic mobility
  • radiolucency
59
Q

Surface Resorption

  • type of process
  • part of normal _____
A
  • physiologic not pathologic

- dentin/cementum disposition

60
Q

Two primary types of necrosis from dental trauma

A

infection and ischemic infarction

61
Q

Ischemic Infarction

  • type of necrosis
  • do bacteria invade pulp
  • type of necrosis cells undergo
  • what remains
  • macrophages/lysosomal enzymes present
  • resulting color
A
  • sterile necrosis
  • no
  • coagulation necrosis
  • collagen skeleton
  • no
  • red crystals discolor pulp and tooth
62
Q

Atropic Pulp

  • odontoblasts
  • fibroblasts
  • increased volume of____
  • type of calcification
A
  • none
  • few
  • collagen
  • dystrophic
63
Q

Why are root canals of necrotic pulp a safe haven for bacteria

A

no circulation of blood to carry antibacterial cells or antibiotics to infection

64
Q

The periapical lesions clinical presentation is dependent upon what?

A

the pathogenicity of the invading microorganisms

65
Q

4 portals of exit of the root canal and pulp

A

furcal canals
lateral canals
accessory canals
apical foramen

66
Q

Types Of Endodontic Infection

Intra-radicular (3 types)
-initial colonization of canal
-invade canal during treatment, not present to start but from contamination
- lasting after ^^
Extra-radicular
-invation of peri-radicular tissues from ______

A
  • primary
  • secondary
  • persisting
  • intra-radicular infection
67
Q

Type of bacteria in dental carries

Type of bacteria in root canals

A
  • Gram + cocci

- Facultative cocci and anaerobic rods and endotoxin

68
Q

True or False

Bacteria are present in PA lesions and cause focal infections

A

First is true, second is false

69
Q

2 Patterns of Microbial Colonization

How are biofilms formed

A

Suspended (planktonic state) and Adhered (Sessile state)
Planktonic organisms enter the root canal, pulpal inflammatory lesion moves vertically providing a fluid vehicle and allowing multiplication and adherence

70
Q

Biofilm is only found on roots of teeth with ____ ____

A

chronic infection

71
Q

Cellular Composition of Asymptomatic Apical Periodontitis Lesions
-most prominent cell

A

-fibroblasts

72
Q

Periapical pathology is _____

A

multifactorial

73
Q

Apical periodontitis is a _____ ______ infection where

_____ is required

A

polymicrobial opportunistic infection no single or unique pathogen is required

74
Q

Cell that plays the leading role in forming the first line of defense in apical periodontitis

A

neutrophil

75
Q

To provide sufficient space for the inflammatory lesion the _____ and ____ are broken down

A

PDL and alveolar bone

76
Q

Process of Bone Resorption

  • carried out by
  • what stimulates the bone resorbing osteoclasts: 3
  • in early phase of apical periodontitis ____ are abundant and outnumber ____ resulting in bone ____
  • Bone loss results in ____ on a radiograph
A
  • osteoclasts
  • cytokines, Interleukin-1 and prostaglandins
  • osteoclasts, osteoblasts, resorption
  • radiolucency
77
Q

Zones of Infection

  • microorganisms and PMNs
  • toxins, Lymphocytes and plasma cells
  • histiocytes and osteocytes
  • fibroblasts, osteoblasts and collagen fibers
A
  • Zone of Infection
  • Zone of contamination
  • Zone of irritation
  • Zone of stimulation
78
Q

Zones of Infection

  • bacteria do not penetrate beyond the zone of _____
  • repair occurs form the zone of ___ in the ___ direction
A
  • contamination
  • stimulation
  • inward
79
Q

Zones of Infection (order them)

necrotic zone
exudative zone
granulomatous zone
fibrous zone

A 
Bone
fibrous zone
exudative zone
granulomatous zone
necrotic zone
apex
80
Q

Over time the neutrophil decreases while ____ and ___ increasingly predominate

A

macrophages and T/B cells

81
Q

Fibrovascular elements mix with inflammatory mediators in an attempt at repair in the _____ zone

A

exudative zone

82
Q

fibroblastic activity increases with distance as well as formation of new vessels in the ____ zone

A

granulation

83
Q

FYI

Due to continual invasion, repair and healing cannot occur so the lesion enters the chronic phase

A

FYI

Due to continual invasion, repair and healing cannot occur so the lesion enters the chronic phase

84
Q

Histological term used to describe tissue formed adjacent to the apex of a tooth with pulp pathosis

A

periapical granuloma

85
Q

An odontogenic cyst associated with a necrotic pulp that develops within a peri-radicular inflammatory lesion.
This cyst derives its epithelium form_____

A

Radicular cyst

cell rests of malassez

86
Q

3 Types of Cysts

A

Epithelial granuloma
Bay Cyst
True Cyst

87
Q

cyst with a proliferating epithelium which does not form a cavity

A

epithelial granuloma

88
Q

cyst with epithelium attached to the root

A

Bay or Pocket cyst

89
Q

cyst with unbroken epithelial lining

A

True cyst (10%)

90
Q

What % of periapical lesion attached to extracted roots were cysts?

A

15%

91
Q

what % of cysts identified by electrophoresis healed following NSRCT?

A

70-80%

92
Q

What causes facial swelling with acute apical abscesses

A

anaerobes inhibit PMN phagocytosis and produce enzymes and endotoxin (lipopolysaccharide or LPS)

93
Q

Inflammation of bone marrow and adjacent bone. Inflammation may remain localized or spread to the marrow, cortex, cancellous tissue and periosteum

A

Osteomyelitis

94
Q

Why is palpation necessary in diagnosing in endo?

A

indicates that inflammation has spread through the facial or lingual cortical plate involving the overlying mucoperiosteum

95
Q

True or False

Percussion indicates the health or integrity of the pulp and reveals inflammation in the PDL

A

first is false

second is true

96
Q

use of periodontal probing

A

assessment of PDL attachment

97
Q

Mobility

I
II
III

A

I: 1mm horizontal movement
III: >1mm horizontal movement with vertical depressibility

98
Q

Thermal Tests

must heat or cool the PDJ by ___ degrees C to get a response.

A

8

99
Q

How is a baseline established for thermal tests

A

test normal teeth

100
Q

Normal thermal response is feeling pain when stimulus is applied and pain subsiding ____ secs after stimuli removed

A

15-30secs

101
Q

Most accurate pulp tester

A

bipolar mode tester

102
Q

FYI- Reasons for False Negative EPT

inadequate contact
immature apical development
traumatic injuries
calcification
analgesics
A 
FYI- Reasons for False Negative EPT
inadequate contact
immature apical development
traumatic injuries
calcification
analgesics
103
Q

FYI- Reasons for False Positive EPT

gingival or periodontal stimulation
stimulation of adjacent teeth
multiple rooted tooth with partial necrosis
patient interpretation

A 
FYI- Reasons for False Positive EPT
gingival or periodontal stimulation
stimulation of adjacent teeth
multiple rooted tooth with partial necrosis 
patient interpretation
104
Q

Reversible Pulpal Injury

  • symptoms
  • radiographic
  • pulp tests
  • periapical tests
A
  • may have slight symptoms to thermal stimulus
  • none
  • responds normal
  • not sensitve
105
Q

Irreversible Asymptomatic Pulpal Injury

  • symptoms
  • radiographic
  • pulp tests
  • periapical tests
A
  • diagnosed by caries excavation to reveal exposure
  • none or very slight
  • responds normal
  • no pain
106
Q

Irreversible Symptomatic Pulpal Injury

  • symptoms
  • radiographic
  • pulp tests
  • periapical tests
A
  • severe pain to thermal stimulus, possible spontaneous pain
  • none or slight, exception=osteitis
  • severe pain with thermal, possible spontaneous pain
  • often painful
107
Q

Necrotic Pulpal Injury

  • symptoms
  • radiographic
  • pulp tests
  • periapical tests
A
  • none to thermal stimulus
  • radiolucent lesion
  • depends on periapical status
  • depends on periapical status
108
Q

Periapical Symptomatic apical periodontitis

  • symptoms
  • radiographic
  • pulp tests
  • periapical tests
A
  • significant pain with pressure/masticaiton
  • none, slight radiolucency
  • depends on pulp status
  • not sensitive
109
Q

Asymptomatic Apical Periodontitis and Apical Cyst

  • symptoms
  • radiographic
  • pulp tests
  • periapical tests
A
  • none to mild
  • apical radiolucency
  • none
  • none to mild on percussion/palpation
110
Q

Acute Apical Abscess

  • symptoms
  • radiographic
  • pulp tests
  • periapical tests
A
  • swelling and significant pain
  • radiolucency
  • none
  • pain on percussion or palpation
111
Q

Chronic Apical Abscess

  • symptoms
  • radiographic
  • pulp tests
  • periapical testsf
A
  • draining sinus tract or parulis
  • radiolucent lesion
  • none
  • not sensitive
112
Q

Condensing Ostelitis

  • symptoms
  • radiographic
  • pulp tests
  • periapical tests
A
  • depends on pulp status
  • increased trabecular bone density
  • depends on pulp status
  • depends on pulp status
113
Q

2 Periapical Lesions with Percussion Pain

which has swelling?

A

symptomatic apical peridontirtis and acute apical abscess

acute apical abscess

114
Q

Periapical lesion with sinus tract/draining/gum boil

A

chronic apical abscess

115
Q

Periapical lesion with radiolucency with NO symptoms

A

asymptomatic apical periodontitis

Endo (3 decks)

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