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Endodontics > Lecture 2 (8/29) > Flashcards

Lecture 2 (8/29) Flashcards

1
Q

Provides an ideal environment for bacterial colonization:

A

root canal system

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2
Q

Why is the RC system an ideal environment for bacterial colonization?

A
  1. warm
  2. moist
  3. nutritious (has lots of substrate)
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3
Q

Describe the climate of the RC system:

A

variable but largely anaerobic climate

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4
Q

What allows the RC system to be largely protected from the host defenses?

A

due to lack of circulation in a diseased pulp

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5
Q

What does the lack of circulation in a diseased pulp allow for?

A

The area to be protected from the host defenses

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6
Q

Because the root canal system of a diseased pulp does not have circulation allowing it to evade host defenses, it is considered a:

A

privileged sanctuary

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7
Q

The basic science most closely associated with the practice of endodontics:

A

microbiology

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8
Q

By using a special “anaerobic glove box: technique, ____ were successfully cultured from the canal system

A

anaerobic bacteria

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9
Q

Sundqvist proved that many of the pathological bacteria found in the root canal system are:

A

black pigmented anaerobic gram negative rods

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10
Q

The black pigmented anaerobic gram negative rods found in the RC system: (6)

A
  1. porphyromonas
  2. prevotella nigrescens
  3. peptostreptococcus
  4. fusobacterium
  5. eubacterium
  6. actinomyces
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11
Q

Black pigmented anaerobic rods found in the RC system release:

A

Lipopolysaccharides (LPS), also known as endotoxins: fever, collagenolysis, osteolysis

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12
Q

The LPS (also known as endotoxins) released by the black pigmented anaerobic rods can cause:

A
  1. fever
  2. collagenolysis
  3. osteolysis
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13
Q

The root canal walls/spaces are conductive for the formation of:

A

biofilm

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14
Q

A complex, colonized community of bacteria:

A

biofilm

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15
Q

In an infection, ____ is adhered to the root canal walls

A

biofilm

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16
Q

“floating bacteria”

A

planktonic

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17
Q

Ricucci states that with apical periodontitis, :

A

NO single microorganism is responsible

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18
Q

Progression of RC system infections:

  1. carious lesion or trauma opens tubules to _____.
  2. Bacteria inflame the ___.
  3. ___ may overcome the pulpal defenses and ____ may form in the ____.
  4. Infection increases in the pulp and ___ begins
  5. ____ involves the entire ___
  6. Infection uses “portals of exit” (_______) to invade _____ (_____)
  7. ____ infection occurs beyond ___ (_____)
A
  1. bacterial invasion
  2. pulp locally
  3. Inflammation; localized abscesses; coronal pulp
  4. necrosis
  5. necrosis; entire root canal system
  6. apical foramen & lateral canals; periradicular tissues (apical periodontitis)
  7. periradicular; apex (apical abscess)
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19
Q

During the progression of RC system infections:

What opens the tubules to bacterial invasion?

A

carious lesion or trauma

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20
Q

During the progression of RC system infections:

What is the significance of a carious lesion or trauma?

A

opens tubules to bacterial invasion

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21
Q

During the progression of RC system infections:

Initially, where does the inflammation from the bacteria occur?

A

locally within the pulp

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22
Q

During the progression of RC system infections:

What happens when inflammation overcomes the pulpal defenses?

A

localized abscesses may form in coronal pulp

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23
Q

During the progression of RC system infections:

Localized abscesses may form in the coronal pulp once what occurs?

A

once inflammation overcomes the pulpal defenses

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24
Q

During the progression of RC system infections:

Once infection increases in the pulp, what may begin?

A

necrosis

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25
Q

During the progression of RC system infections:

Necrosis involves:

A

the entire RC system

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26
Q

During the progression of RC system infections:

What are the “portals of exit” used by the infection to invade peri-radicular tissues?

A

apical foramen and lateral canals

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27
Q

During the progression of RC system infections:

Once infection invades the peri-radicular tissues this is considered:

A

apical periodontitis

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28
Q

During the progression of RC system infections:

Where does periradicular infection occur?

A

beyond the apex

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29
Q

During the progression of RC system infections:

When a periradicular infection occurs beyond the apex:

A

apical abscess

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30
Q

The biofilm must accomplish 6 things to cause:

A

disease within the RC system

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31
Q

What 6 things must a biofilm accomplish in order to cause disease with RC system?

A
  1. MO must adhere to host surfaces
  2. Obtain nutrients from the host
  3. Multiply
  4. Invade tissue
  5. Overcome host defenses
  6. Introduce tissue damage
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32
Q

How could we describe a biofilm?

A
  • complex
  • variable
  • constantly changing
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33
Q

A multicellular microbial community characterized by cells that are firmly attached to a surface and enmeshed in a self produced matrix of extracellular polymeric substance (EPS), usually polysaccharide:

A

biofilm

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34
Q

Biofilms are usually enmeshed in a self produced matrix of:

A

Extracellular polymeric substance (EPS) usually polysaccharide

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35
Q

Bacteria that appear to be the most common microorganisms in primary endodontic infections:

A

anaerobic gram negative

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36
Q

List the most common anaerobic gram negative microorganisms in primary endodontic infections: (7)

A
  1. porphyromonas
  2. prevotella
  3. propionibacterium
  4. peptostreptococcus
  5. streptococcus
  6. actinomyces
  7. olsenella
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37
Q

porphyromonas
prevotella
propionibacterium
peptostreptococcus
actinomyces
olsenella

What do all of these microorganisms have in common?

A

anaerobic gram negative

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38
Q

The long the infection exists in the RC system, the more ___ is consumed by bacterial activity and the more ___ the RC system environment becomes

A

oxygen; anaerobic

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39
Q

The longer the infection exists within the RC system, the more oxygen is consumed by bacterial activity and the more anaerobic the RC environment becomes

Therefore ___ infections within the RC system tend to favor ___ bacterial flora

A

chronic infections; anaerobic

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40
Q

Explains why chronic infections within the RC system tend to favor anaerobic bacterial flora:

A

because the longer the infection exists within the RC, the more the bacteria consume the oxygen leaving the RC environment to be more anaerobic

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41
Q

What type of bacteria do chronic infections in the RC system favor??

A

anaerobic bacterial flora

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42
Q

As a rule ____ is responsible for an Endo infection

A

No ONE organism

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43
Q

All endo infections are ___ (___)

A

mixed; polymicrobial

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44
Q

Endo infections are mostly caused by ___ & ____ ___

A

facultative and obligate anaerobes

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45
Q

Aerobes which can also survive in an an anaerobic environment:

A

facultative anaerobes

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46
Q

Facultative anaerobes may become more numerous & virulent with:

A

the addition of oxygen

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47
Q

Bacterial species that must anaerobic environment to survive:

A

obligate anaerobe

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48
Q

Bacterial species that cannot survive in aerobic environments:

A

obligate anaerobe

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49
Q

_____ liberates O2

A

NaOCl

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50
Q

Biofilm becomes more varied, complex, and difficult to control when the tooth is further challenged by ____ or ____ (_____ or _____)

A

salivary contact or operative contamination (new bugs or altered environment)

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51
Q

_____ becomes more varied, complex, and difficult to control when the tooth is further challenged by salivary contact or operative contamination (New BUGS or altered environment)

A

Biofilm

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52
Q

Biofilm becomes more varied, complex, and difficult to control when the tooth is further challenged by salivary contact or operative contamination (New BUGS or altered environment)

SO _____ of rubber dam or temporary AND _____ during treatment (leaky dental dam, etc.)

A

avoid leakage; avoid iatrogenic contamination

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53
Q

How do we destroy the bacteria in RC treatment?

A

8.3% sodium hypochlorite (NaOCl)

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54
Q

Our major weapons in destroying RC bacteria:

A

cleaning and shaping with NaOCl and intra-canal medicaments

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55
Q

How does the NaOCl work to kill the RC bacteria?

A

kills directly or starves them out

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56
Q

What makes RCs resistant to mechanical shaping?

A

diverse shapes are resistant to mechanical shaping

(Files never reach ALL spaces in the complex pulpal system)

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57
Q

What implication does the diverse shape of RCs have on mechanical shaping?

A

Files never reach ALL spaces in the complex pulpal system

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58
Q

Due to diverse shapes of RC systems, files never reach ALL spaces in the complex pulpal system, therefore correct use of ___ is extremely important and ____.

A

NaOCl; eliminating microorganisms in these spaces

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59
Q

What are the 6 functions of NaOCl?

A
  1. disinfect over time
  2. dilutes an inactivates toxins
  3. dissolves substrate over time
  4. dissolves necrotic tissue over time
  5. flushes & floats out debris
  6. lubricates canals
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60
Q

Typical RC treatment case requires about ____ of ____ as irrigant PER VISIT.

A

10-12 cc. of NaOCl

61
Q

____ degrades rapidly to ____ (salt water) in the canal, therefore must be replenished @3-5 min

A

NaOCl; NaCl

62
Q

NaOCl degrades rapidly to NaCl (salt water) in the canal, therefore must be:

A

replenished @ 3-5 min

63
Q

NaOCl must be in contact with shaped canal a minimum of ____ after the canal enlarged to ____ or larger

A

30 minutes; #30

64
Q

During RC treatment, why must the canal be enlarged to #30 or greater?

A

a canal smaller than #30 will seldom if ever allow any irrigant to reach the apical 1/3 of the canal

65
Q

Enlarging the canal to #30 or larger allows for:

A

irrigant to reach the apical 1/3 of the canal

66
Q

Medications are placed ____ the canal system ___ appointments

A

within; between

67
Q

The medications that are placed within the canal system between appointments are intended to increase ___ and to further decrease ____ within the RC system

A

local antimicrobial action; decrease the microbial challenge

68
Q

Historically, many harsh medications were used in RC treatment were ___ & ___ to healthy tissue

A

toxic; damaging

69
Q

Some of the medications that were historically used to RC treatment are now recognized as ___ and are no longer acceptable for use

A

carcinogenic

70
Q

Due to their toxic/and or carcinogenic nature, the following formulations are no longer acceptable for use in RC treatment (4):

A
  1. CMCP
  2. Formocresol
  3. Cresatin
  4. Beachwood Creosote
71
Q

Near universal acceptance as the intracranial medication of choice (esp. in necrotic cases)

A

CaOH

72
Q

The pH of the intracranial medication CaOH:

A

between 11 & 12

73
Q

CaOH discourages ____ microbial growth

A

MOST

74
Q

What four characteristics of CaOH make it a widely accepted intracanal medication?

A
  1. discourages MOST microbial growth
  2. long-lasting (effective over extended periods of time)
  3. no reported allergic responses
  4. easy to apply & remove as a paste
75
Q

What is CaOH available in clinic as?

A

Ultracal

76
Q

Use of antibiotics to relieve pain:

A

useless

77
Q

Systemic antibiotics are ONLY useful in: (2)

A
  1. acute P-R infections (swelling & fever)
  2. immunologically surpassed patient
78
Q

What type of infection would present as swelling & fever and may require use of antibiotic treatment?

A

Acute P-R infections

79
Q

Healthy patients WITHOUT systemic signs & symptoms of infections but WITH the following conditions do NOT require antibiotics (4):

A
  1. symptomatic pulpitis
  2. symptomatic apical periodontitis
  3. a draining sinus tract
  4. localized swelling
80
Q

healthy patients that present with symptomatic pulpits, symptomatic apical periodontitis, a draining sinus tract, or localized swelling, that otherwise are healthy without systemic signs and symptoms of infection do NOT requires:

A

Treatment with antibiotics

81
Q

What indicates performance of an I&D?

A

usually fluctuant swelling

82
Q

Drainage fluctuant swelling is accomplished by:

A

I&D (incision & drainage)

83
Q

Following treatment of I&D we are committed to:

A

following the acute patient daily & monitoring progress

84
Q

When do we use antibiotics in endodontics?

A

In conjunction with definitive procedures to deride and drain when there is:

  1. persistent or spreading infection
  2. systemic involvement with temp of 100+
  3. medically compromised patient
  4. pre-med when indicated
85
Q

If bacteria from the infected pulp tissue gain entry into the periradicular tissue and the immune system is unable to suppress the invasion, and otherwise healthy patient eventually shows signs and symptoms of an _____, _____ or both.

A

acute periradicular abscess; cellulitis

86
Q

If bacteria from the infected pulp tissue gain entry into the periradicular tissue and the immune system is unable to suppress the invasion, and otherwise healthy patient eventually shows signs and symptoms of an acute periradicular abscess, cellulitis, or both.

Clinically this patient experiences:

A

swelling, fever, and mild to severe pain

87
Q

A patient may develop acute periradicular abscess, cellulitis, or both If the bacteria from the infected pulp tissue gains entry into the ___ and the ___ is unable to suppress the invasion

A

periradicular tissue; immune system

88
Q

Depending on the relationship of the apices of the involved tooth to the muscular attachments, virulence factors and host resistance, the swelling may be ____ or may extending into a ___

A

localized to the vestibule; fascial space (cellulitis)

89
Q

When swelling extends into a fascial space:

A

cellulitis

89
Q

What factors may determine whether swelling will remain localized to the vestibule or whether it will extend into the fascial space resulting in cellulitis?

A
  1. relationship of apices of involved tooth muscular attachments
  2. virulence factors
  3. host resistance
90
Q

A patient presenting with cellulitis generally will also have ___ such as ___.

A

systemic manifestations:

  1. fever
  2. chills
  3. lymphadenopathy
  4. headache
  5. nausea
91
Q

In cases off cellulitis with systemic manifestations, because the reaction to the infection may occur very quickly, the involved tooth may or may not show radiographic evidence of:

A

A widened periodontal ligament space

92
Q

In cases of cellulitis with systemic manifestations, because the reaction to the infection may occur very quickly, the involved tooth may or may not show radiographic evidence of a widened periodontal ligament space.

However in most cases, the tooth elicits a positive response to ___, and the periradicular area is ___.

A

positive response to percussion; tender to palpation

93
Q

In cases of cellulitis with systemic manifestations, because the reaction to the infection may occur very quickly, the involved tooth may or may not show radiographic evidence of a widened periodontal ligament space.

However in most cases, the tooth elicits a positive response to percussion, and the periradicular area is tender to palpation

Describe this case:

A

This is a serious (critical infection) in fascial plane

94
Q

_____ are important in relation to where the lesion “points”

A

muscle attachments

95
Q

If lesion exits coronal muscle to attachment, it is generally on ___ or ___ and we have a localized abscess (which is more easily treated due to no systemic involvement)

A

attached gingival or alveolar mucosa

96
Q

If lesion exits coronal muscle attachment, it is generally on attached gingiva or alveolar mucosa and we have a:

A

localized abscess

97
Q

___ is more easily treated because no systemic involvement

A

localized abscess

98
Q

The following image would be diagnosed as

A

localized abscess

99
Q

What could be diagnosed looking a the following patient?

A

Fluctuant swelling; I&D

100
Q

____ are the potential anatomic areas that exist between the fascia and underlying organs and other tissues:

A

fascial spaces

101
Q

Development of a critical infection:

During an infection, fascial spaces are formed as a result of:

A

spread of purulent exudate

102
Q

The spread of infection of odontogenic origin into the fascial spaces of the head and neck is determined by the ____ of ____ of the involved tooth in relation to its overlying ____ or ___ and the relationship of the apex to the ____.

A

location of the root end; buccal or lingual cortical plate; attachment of muscle

103
Q

The spread of infection of _____ origin into the fascial spaces of the head and neck is determined by the location of the root end of the involved tooth in relation to its overlying buccal or lingual cortisol plate and the relationship of the apex to the attachment of muscle.

A

odontogenic

104
Q

The spread of infection of odontogienic origin into the fascial spaces of the head and neck is determined by the location of the root end of the involved tooth in relation to its overlying buccal or lingual cortisol plate and the relationship of the:

A

apex to the attachment of muscle

105
Q

If the source of the infection is a mandibular molar and the apices of the molar lie closer to the lingual cortical plate and above the attachment of mylohyoid muscle of the floor of the mouth, the purulent exudate breaks through the cortical plate into the _____.

If the apices yes below (or apical) to tea attachment of the mylohyoid muscle, the infection spreads into the ____.

A

sublingual space; submandibular space

106
Q

Infections that spread into the fascial spaces are critical and have the potential to be ____ if not ___

A

lethal; treated aggressively

107
Q

Label the following image:

A

A: Submandibular space

108
Q

We should be especially vigilant with infections of ____ (especially _____) when cellulitis occurs in the submandibular space with swallowing difficulty

A

mandibular molars; 2nd and 3rd molars

109
Q

We should be especially vigilant with infection of mandibular molars (especially 2nd and 3rd molars) when:

A

cellulitis occurs in the submandibular space with swallowing difficulty

110
Q

We are especially vigilant with infections of mandibular molars when cellulitis occurs in submandibular space with swallowing difficulty, why?

A

Access from S-M space to sublingual and submittal spaces (all 3 are called Ludwig’s Angina) and infection in these spaces can be life threatening

111
Q

What can you diagnose looking at the following image?

A

Cellulitis with involvement of the submandibular space

112
Q

This is cellulitis with involvement of the submandibular space. The infection has pointed apical to the attachment of the ___ muscle and superior to the ____ muscle.

What treatment is indicated?

A

mylohyoid muscle; platysma muscle

I&D; Referral

113
Q

Endodontic infections may be classified according to:

A
  1. location
  2. symptoms (acute or chronic)
  3. degree of virulence or organization (localized or diffuse and spreading)
114
Q

How might you describe the symptoms of an endodontic infection?

A

acute or chronic

115
Q

How might you describe the degree of virulence or organization of and endodontic infection?

A

localized or diffuse and spreading

116
Q

How might you classify the location of an endodontic infection?

A
  1. intraradicular
  2. extraradicular
117
Q

Location of endodontic infection that is caused by bugs colonizing within the RCS:

A

Intraradicular

118
Q

Location of endodontic infection that is usually a sequel to untreated intradicular infection:

A

extraradicular

119
Q

Location of endodontic infection that is characterized by microbial invasion of the periradicular tissues resulting in inflammation and infection. AAA or CAA

A

extraradicular

120
Q

Intraradicular infection is caused by bugs colonizing within the ____. Extraradicular infection is caused by microbial invasion of the _____ tissues.

A

RCS; periradicular tissues

121
Q

What are the 3 subclasses of intraradicular infections?

A
  1. primary infections
  2. secondary infection
  3. persistant infection
122
Q

Intraradicular infection caused by the bugs that initially invade and colonize necrotic pulp tissues within the RCS:

A

Primary infection

123
Q

Intraradicular infection caused by bugs not present in the primary infection but introduced into the RCS sometime following professional intervention (secondary to professional intervention; iatrogenic by definition)

A

Secondary infection

124
Q

Secondary intraradicular infections are secondary to professional intervention meaning they are:

A

iatrogenic by definition

125
Q

Example of a ____ infection is when symptoms arise in a previously ASYMPTOMATIC infected tooth if operator allowed R. Dam leakage or placed leaky temporary.

A

secondary infection

126
Q

Example of a secondary infection is when symptoms arise in a previously ______ infected tooth if operator allowed R. Dam leakage or placed leaky temporary.

A

asymptomatic

127
Q

intraradicular infection caused by bugs that were members of a primary or secondary infection and in some way, resisted intracanal antimicrobial procedures and were able to endure periods of nutrient deprivation within the RCS (i.e.) FAILURE OF RCT TO HEAL

A

persistant infection

128
Q

How can we describe an intraradicular persistent infection?

A

FAILURE of RCT TO HEAL

129
Q

The ability to form ____ has been regarded as a virulence factor

A

BIO

130
Q

The ability to form BIO has been regarded as a virulence factor. Neighboring cells of different species can produce enzymes such as ____, ____ and _____ that are retained in the biofilm matrix and can protect other bacteria against antibiotics and host defenses.

A

B-Lactamase, Catalase, proteinases

131
Q

In an endodontic infection, bacterial products contribute to:

A

virulence

132
Q

_____ can cause direct tissue damage & osseous breakdown by releasing enzymes, endotoxins, LPS & peptides/amino acids

A

gram negative anaerobes

133
Q

gram negative anaerobes can cause ____ & ____ by releasing enzymes, endotoxins/exotoxins, LPS & peptides/amino acids

A

direct tissue damage & osseous breakdown

134
Q

gram negative anaerobes can cause direct tissue damage & osseous breakdown by releasing:

A
  1. enzymes
  2. endotoxins/exotoxins
  3. LPS
  4. peptides/amino acids
135
Q

What are some enzymes that are released by gram negative anaerobes that can cause direct tissue damage & osseous breakdown?

A
  1. collagenase
  2. chondroitinase
  3. hyaluronidase
136
Q

Toxic substances associated with the outer cell walls that are released upon destruction of cell walls and exotoxins:

A

endotoxins

137
Q

An endotoxin in the cell wall of gram negative bugs:

A

LPS

138
Q

Bacteria responsible for causing serious suppurative infections:

A

Staph Aureus (S. Pyogenes)

139
Q

Is staph aureus (S. pyogenes) gram negative or gram positive?

A

gram positive

140
Q

What is the oxygen requirement for S. Aureus (S. Pyogenes)?

A

facultative anaerobe

141
Q

Staph Aureus (AKA) S. Pyogenes (Gram +) is thought to produce:

A

penicillinase

142
Q

A B-lactamase that has the potential to render PCN ineffective:

A

Penicillinase

143
Q

What bacteria is thought to be responsible for the production of penicillinase:

A

S. Aureus (S. Pyogenes)

144
Q

Staph Aureus (S. Pyogenes) treatment:

A

Augmentin

145
Q

Augment is the combination of:

A

Amoxicillin + Clavulanic acid

146
Q

Clavulanic acid inhibits:

A

penicillinase

147
Q
A

Endodontics (19 decks)

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