L13-ENDO

Question 1

What is the technical term for inflammation of the pulp that endodontists don’t use :) ?

Answer 1

pulpitis

Question 2

Can pulp inflammation occur from sources other then bacterial infection?

Answer 2

YES! Trauma, dental instruments, restorative materials)

Question 3

What is the chief unique characteristic that modifies the pulp inflammatory response?

Answer 3

Hard root canal walls that prevent increase in volume of the tissue during edema

Question 4

What are the two results of the pulp tissue not being able to expand during inflammation? (what is the “theory” for one of them?)

Answer 4

1. increase in pressure=PAIN 2. increase in pressure = less circulation “strangulation theory”

Question 5

Why is it that once a blood vessel becomes occluded locally by injury or insult (or the inflammatory response attempting to prevent spread of infection) in the pulp the cells fed by this vessel will very quickly die and necrosis sets in?

Answer 5

There is POOR or NONEXISTENT collateral circulation

Question 6

What is the most common way for plaque bacteria to reach the root canal?

Answer 6

carious lesions

Question 7

Severe ________ infections may progress down the periodontal ligament and gain access to the pulp via the apical foramen.

Answer 7

periodontal

Question 8

Enamel-dentin _______, or ______, also give plaque bacteria access to deep dentin tubules and eventually the pulp itself.

Answer 8

cracks, or breaks,

Question 9

In rare instances bacteria may enter a pulp chamber via the ________.

Answer 9

blood stream

Question 10

What is the role of viruses in pulpitis?

Answer 10

Unknown! (research opportunity?!)

Question 11

Inflammation of the dental pulp develops _______ as in any other tissue.

Answer 11

the same!

Question 12

What are the first leukocytes to infiltrate the pulp tissue?

Answer 12

PMNs (neutrophils!)

Question 13

_____’s in acute, and ______’s in chronic inflammation of the pulp.

Answer 13

PMN’s…..MØ’s

Question 14

Dental pulp, like all internal tissues, is normally ______.

Answer 14

sterile

Question 15

How did they determine that bacterial invasion caused pulpitis?

Answer 15

Experiments using germ-free animals where the pulp was exposed yet pulpitis did not develop as it always did in conventional animals.

Question 16

Even before plaque bacteria have infected the pulp, inflammation (usually _______ –> mononuclear inflammatory cells: Macrophages, T and B cells) and creation of reactionary or reparative _______ will occur in response to bacterial products that have diffused down the tubules.

Answer 16

chronic…..dentin

Question 17

What can act as a conduit for bacteria once a carious lesion reaches the dentin?

Answer 17

dentin tubules!

Question 18

Once plaque bacteria reach the pulp, _________ (with today’s treatment methods) inflammation (usually acute – polynuclear inflammatory cells: PMN’s) almost always sets in.

Answer 18

irreversible

Question 19

Dental pulp infections are almost always _________ infections.

Answer 19

polymicrobial

Question 20

Studies have shown that the normal plaque microflora, mainly subgingival, _________, _______ and _________ microorganisms, dominate infections of the pulp.

Answer 20

Gram negative….facultative and anaerobic

Question 21

Most of these studies have looked at cultivable species recovered from root canals. However, it is estimated that at least 50% of subgingival __________ are uncultivable.

Answer 21

gram-negatives

Question 22

More recent studies utilizing __________ techniques have found and average of ____-____ different bacteria species in individual infected pulp chambers!

Answer 22

molecular DNA…10-30

Question 23

What are the 5 gram -‘s that are commonly assoc with pulpitis? (hint: think perio disease!)

Answer 23

1.Fusobacterium Nucleatum 2.Porphyromonas Gingivalis 3.Prevotella Intermedia 4.Tannerella Forsythia 5.Treponema Denticola

Question 24

What is the RCT success rate for an endodontist? What about a GP?

Answer 24

95%=endodontist….80-90% for a GP

Question 25

Bugs that infect the pulp are very similar to the flora of a periodontal pocket in patients with active ________ disease.

Answer 25

periodontal

Question 26

Treatment consists of _______ elimination of the responsible agent/s.

Answer 26

complete

Question 27

The understanding of bacterial _________ (via _________) may begin to explain how pulp infections can smolder for extended periods of time, and then just seem to ‘blow up.’

Answer 27

communication (via quorum sensing