L13-ENDO Flashcards
What is the technical term for inflammation of the pulp that endodontists don’t use :) ?
pulpitis
Can pulp inflammation occur from sources other then bacterial infection?
YES! Trauma, dental instruments, restorative materials)
What is the chief unique characteristic that modifies the pulp inflammatory response?
Hard root canal walls that prevent increase in volume of the tissue during edema
What are the two results of the pulp tissue not being able to expand during inflammation? (what is the “theory” for one of them?)
- increase in pressure=PAIN 2. increase in pressure = less circulation “strangulation theory”
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?
There is POOR or NONEXISTENT collateral circulation
What is the most common way for plaque bacteria to reach the root canal?
carious lesions
Severe ________ infections may progress down the periodontal ligament and gain access to the pulp via the apical foramen.
periodontal
Enamel-dentin _______, or ______, also give plaque bacteria access to deep dentin tubules and eventually the pulp itself.
cracks, or breaks,
In rare instances bacteria may enter a pulp chamber via the ________.
blood stream
What is the role of viruses in pulpitis?
Unknown! (research opportunity?!)
Inflammation of the dental pulp develops _______ as in any other tissue.
the same!
What are the first leukocytes to infiltrate the pulp tissue?
PMNs (neutrophils!)
_____’s in acute, and ______’s in chronic inflammation of the pulp.
PMN’s…..MØ’s
Dental pulp, like all internal tissues, is normally ______.
sterile
How did they determine that bacterial invasion caused pulpitis?
Experiments using germ-free animals where the pulp was exposed yet pulpitis did not develop as it always did in conventional animals.
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.
chronic…..dentin
What can act as a conduit for bacteria once a carious lesion reaches the dentin?
dentin tubules!
Once plaque bacteria reach the pulp, _________ (with today’s treatment methods) inflammation (usually acute – polynuclear inflammatory cells: PMN’s) almost always sets in.
irreversible
Dental pulp infections are almost always _________ infections.
polymicrobial
Studies have shown that the normal plaque microflora, mainly subgingival, _________, _______ and _________ microorganisms, dominate infections of the pulp.
Gram negative….facultative and anaerobic
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.
gram-negatives
More recent studies utilizing __________ techniques have found and average of ____-____ different bacteria species in individual infected pulp chambers!
molecular DNA…10-30
What are the 5 gram -‘s that are commonly assoc with pulpitis? (hint: think perio disease!)
1.Fusobacterium Nucleatum 2.Porphyromonas Gingivalis 3.Prevotella Intermedia 4.Tannerella Forsythia 5.Treponema Denticola
What is the RCT success rate for an endodontist? What about a GP?
95%=endodontist….80-90% for a GP
Bugs that infect the pulp are very similar to the flora of a periodontal pocket in patients with active ________ disease.
periodontal
Treatment consists of _______ elimination of the responsible agent/s.
complete
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.’
communication (via quorum sensing
