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Tim's Cards > Operative Dentistry > Flashcards

Operative Dentistry Flashcards

1
Q

What is the origin of the Oral Cavity and teeth in the developing embryo?

A

Neural Crest Cells

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2
Q

How does the tooth form developmentally?

A

Crown to Root

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3
Q

Dentinogenesis occurs when?

A

Before Amelogenesis (enamel formation)

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4
Q

_____ formation occurs in a crown down fashion after Dentinogenesis and Ameliogenesis.

A

Root

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5
Q

Primordial Root 3 Terms:

A

Cervical Loop

Hertwig’s Epithelial root sheat

Epithelial diaphragm

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6
Q

What are epithelial cells that remain in the periodontal space during root formation?

A

Rests of Malassez

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7
Q

T/F

Lateral and Accessory Canals contain pulp tissue

A

False

*CT only

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8
Q

T/F

Accessory canals are more numerous apically

A

True

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9
Q

Why does the Apical Foramen move and/or narrow throughout life?

A

Cementum growth

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10
Q

What is the most prominent cell in the pulp?

Where are they located?

What do they differentiate into?

A

Fibroblasts

Cell Rich Zone

Odontoblasts

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11
Q

What types of Collagen do Fibroblasts of the pulp make?

A

Type I and III

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12
Q

T/F

Odontoblasts are unique to pulp tissue and make Dentin, they are more organized in the apical region

A

True

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13
Q

Shape of Odontoblasts Coronal:

Middle:

Apical:

A

Columnar

Cuboidal

Squamous

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14
Q

2 Afferent Sensory Fibers of the Pulp:

A

A-Delta fibers

C fibers

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15
Q

T/F

Efferent Motor Fibers of the Pulp are associated with Sympathetic contractions of smooth muscles in the capillaries.

A

True

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16
Q

***What type of Fibers are associated with Reversible Pulpitis clinically?

A

A (alpha) Pain Fibers

  • sharp, non-lingering type pain
  • myelinated
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17
Q

The low conduction velocity Fibers associated with Symptomatic Irreversible Pulpitis of the pulp are what?

A

C Fibers

*dull, throbbing, lingering pain

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18
Q

What are the 3 primary theories of Dentin Sensitivity?

A

Direct innervation

Odontoblastic Receptor

Hydrodynamic (accepted theory)

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19
Q

What is the origin of the Blood Supply to all the Pulp?

A

Internal Maxillary Artery

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20
Q

Blood flow is greater in the _____ pulp

A

Coronal

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21
Q

What bypasses the capillary bed during inflammation of the pulp (this decreases interpulpal bp).

A

A-V shunt

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22
Q

What are the 5 functions of the Pulp?

A

Induction

Formation (continuously forms secondary dentin)

Nutrition

Defense

Innervation

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23
Q

T/F

Reparative, Irritational, and Tertiary are all terms that form in response to an irritant

A

True

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24
Q

What are the 4 Zones of the Pulp?

A

Pulp Proper

Cell Rich Zone

Cell Free Zone

Odontoblastic Layer

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25
Q

T/F

Pulp Stones are always an indication of needing a root canal

A

False

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26
Q

What is another name for Pulp Stones in the pulp Chamber?

What are pulp stones occurring along nerves, vessels, or collagen bundles called (in CANALS)?

A

Denticles

Diffuse/Linear Calcifications

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27
Q

What is the consequence of bacteria reaching the pulp?

A

Necrosis

***requires endodontic extraction

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28
Q

T/F

Do not perform a direct pulp cap of a carious lesion

A

True

*However, new substances may change this

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29
Q

T/F

Three is a 13% success rate after a direct pulp cap of a carious lesion

A

True

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30
Q

T/F

Crowns cause damage and can lead to root canals

A

True

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31
Q

T/F

Pulpal rxns are vascular and neural

A

True

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32
Q

T/F
Increased flow will cause painful inflammation

Decreased blood flow will cause necrosis

A

True

True

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33
Q

What are 4 Defense mechanisms of the Pulp?

A

AV shunting

Secondary Dentin

Reparative (tertiary) Dentin (caused by irritant)

Immune response

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34
Q

Within the Caries Balance (in CAMBRA), what are 3 Pathological Factors and 3 Protective Factors?

A

Acid-producing bacteria, low salivary rate, frequent consumption of fermentable carbs

Saliva, Fluoride, Antibacterials (CHX, xylitol)

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35
Q

What 4 Disease Indicators (clinical observations) immediately put someone in a High Risk Category?

A

Visible Cavities present

Caries restored in last 3 years

Interproximal lesions

White spots on enamel surfaces

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36
Q

What are the 9 risk factors, any of which will put a pt at Moderate Risk?

A

Mutans/Lactobacilli medium/high in culture

Heavy plaque

Frequent snacks

Deep pits/fissures

Recreational drugs

Inadequate Saliva

Meds, radiation, Sjogren’s (reducing saliva)

Exposed Roots

Orthodontics

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37
Q

In the absence of disease indicators, what are the 11 Protective factors automatically putting someone at Low Risk?

A

Fluoridated community, Fluoride toothpaste (once), Fluoride toothpaste (twice), Fluoride mouthrinse

5000 ppm F toothpaste, F varnish last 6 mo., Office topical F last 6 mo., CHX (once week, last 6 mo.)

Xylitol gum (4x daily 6 mo.), MI past 6 mo., Adequate Saliva Flow

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38
Q

What are the 4 Risk Assessment Procedures?

A

Diet Analysis

Plaque pH measurment

Saliva Flow

Bacterial Test

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39
Q

High Dietary Risk (like a frequent snacker) puts on at a ______ Risk for caries

A

Moderate

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40
Q

What is the cutoff Salivary Flow Rate that defines Xerostomia?

A

Less than 0.7 ml/min

(greater thatn 1.4 ml/min is normal)

*this may be wrong - thought he said 1 ml, and there was no grey area

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41
Q

Decreased Salivary flow can inhibit remineralization because _____ and _____ ions are reduced.

A

Calcium

Phosphate

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42
Q

What cancer therapy can cause Xerostomia?

A

Radiation to head and neck

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43
Q

Above 1500 bacterial test is “at risk,” putting the pt in what category?

A

Medium risk category

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44
Q

CAMBRA guidelines, Frequency of Radiographs Low Risk:

Moderate Risk:

High Risk:

Extreme Risk:

A

18-24 months

18-24 months

6-12 months

6 months

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45
Q

Frequency of Periodic Oral Exams Low Risk:

Moderate Risk:

High Risk:

Extreme Risk:

A

12 months

12 months

6-12 months

3-6 months

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46
Q

T/F

Sealants for deep pits and fissures are recommended for all CAMBRA risk levels.

A

False

*none for Low Risk

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47
Q

For CAMBRA, when are Bacteria Test and Saliva Flow tests done for Low Risk:

Moderate Risk:

High Risk:

Extreme Risk:

A

Baseline for New pts

Baseline for New pts/high bacterial challenge suspicion

Every POE (periodic oral exam)

Every POE

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48
Q

CAMBRA intervention CHX (chrorhexidine) are used how at Low Risk:

Moderate Risk:

High Risk:

Extreme Risk:

A

No

No

1 min/day, 1 week/month

1 min/day, 1 week/month

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49
Q

What can’t CHX be combined with?

A

Fluoride

*1 hour gap required

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50
Q

T/F

The Bacterial cell is positively charged, and CHX is negatively charges

A

False

CHX+ and Bacterial Cell -

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51
Q

CHX is effective against ______, but _____ are resistant in the mouth

A

S. mutans

Lactobacilli

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52
Q

T/F

CHX and Betadine (Iodine) stain

A

True

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53
Q

Fluoride CAMBRA interventions for Low Risk:

Moderate Risk:

High Risk:

Extreme Risk:

A

F toothpaste 2x daily

F toothpaste 2x daily/0.5% NaF rinse daily

Varnish/1.1% NaF toothpaste

Varnish/F toothpaste/F trays (Prevident gel)

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54
Q

What is the Therapeutic Concentration of Fluoride in the mouth?

A

.04-.1 ppm

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55
Q

What does Fluoride Varnish form on enamel surfaces?

A

Calcium Fluoride “time bomb”

56
Q

Xylitol/Baking Soda CAMBRA intervention for Low Risk:

Moderate Risk:

High Risk:

Extreme Risk:

A

None

gum/mints 2x/day

gum/mints 4x/day

gum/mints 4x/day Baking Soda rinse 4-6x/day

57
Q

T/F

Xylitol easily penetrates biofilm and alters the way bacteria stick to surfaces

A

True

58
Q

The use of Xylitol Gum by mothers reduced colonization in infants. Xylitol was better than _____, which was better than ______.

A

CHX

F varnish

59
Q

What are 7 diagnostic tests we can run with Saliva?

A

Myocardial Infarction (C-reactive protein)

Renal disease

Breast cancer (CA 15-3 cancer antigen)

Type II Diabetes

Sjogren’s

Forensics

Bacterial, fungal, viral (in future)

60
Q

Name 5 Antibacterial Functions of Saliva:

A

sIgA: inhibits S. mutans attach

Histatin: pellicle

Lactoferrin: binds Fe, competes w/ S.mutans

Salivary Peroxidase

Amylase

61
Q

What Salivary component is important for Lubrication?

A

Mucin

62
Q

Buffering in Saliva is dependent on what 2 components:

Remineralization in Saliva is dependent on what 2 components:

A

Phosphate, Bicarb

Phosphate, Calcium

63
Q

What protein is involved in pellicle formation and inhibits precipitation of Calcium by binding to it?

A

PRP - Proline Rich Proteins

64
Q

What in Pellicle formation inhibits the primary precipitation of Calcium and Phosphorus?

A

Statherins

65
Q

What is the normal pH of Saliva?

A

6.8-7.3

66
Q

T/F

A biofilm lives at the interface between a solid and liquid

A

True

67
Q

In Caries Risk Assessment, what 4 conditions requires a mandatory bacteria test?

A

Visible cavities

Caries restored last 3 yrs

Interproximal caries/lesions/radiolucencies

White spots on enamel surfaces

68
Q

Visible cavities, Caries restored in the last 3 yrs, Interproximal caries, or white spots on enamel surfaces will automatically put the pt in what Risk Category?

A

High Risk

69
Q

dmfs:

DMFS:

A

decayed/missing/filled surfaces (primary dentition)

decayed/missing/filled surfaces (permanent dentition)

70
Q

What are the 4 requirements to produce Dental Caries?

A

Substrate

Bacteria

Tooth/host

Time

71
Q

How does F enter the bacterial cell?

How does F ion damage the bacteria?

A

HF under Acidic Conditions

Interferes with enzymes (enolase)

72
Q

T/F
F combines with Ca and phosphate to make a low solubility veneer of Fluoroapatite like mineral and enhances mineralization

A

True

73
Q

What is the mottling of tooth enamel caused by a developmental consumption of excess fluoride?

When is this risk the highest?

A

Fluorosis

20-30 months

74
Q

What are current fluoridation levels in the water?

A

1.0 ppm

75
Q

ATP bioluminescence activity of S.mutans is done by what marker?

A

Luciferin

*test takes one minute

76
Q

Bacterial Test 0-1500 =

1500 and above =

A

Low risk

At risk

77
Q

T/F

Brushing reduces caries

A

False

78
Q

T/F

Caries is an infectious disease

A

True

79
Q

Name 4 Chemotherapeutics:

A

Fluoride

Baking soda

CHX

Xylitol

80
Q

What is the percentage of carbonate associated with hydroxyapatite crystals?

A

20%

81
Q

What bacterial species first colonizes the pellicle?

A

S. sanguinis

*low colonization threshold

82
Q

pH at which enamel dissolves?

A

5.5

83
Q

What bacterial species is Acidogenic, Aciduric, Adherent, uses Bacteriocins, and has a High Colonization Threshold?

A

S. mutans

84
Q

Where does S. mutans live in the mouth?

A

Everywhere - furrows of tongue as well as teeth

85
Q

Name 3 Cariogenic Bacteria:

A

S. sobrinus

S. mutans

Lactobacilli

86
Q

What primarily remineralizes enamel?

A

Calcium and phosphate in solution

*F blocks demineralization

87
Q

What is the most soluble apatite structure?

Medium soluble?

Least soluble?

A

Carbonated apatite

Hydroxyapatite

Fluoroapatite

88
Q

High dietary risk is _____ risk for caries and they are not directly correlated

A

Moderate

89
Q

What is the reduction in caries rates with F varnish?

A

46%

90
Q

Xylitol Gum > CHX > Fluoride Varnish in what?

A

Vertical S.mutans transmission

91
Q

____ canals are found in the Coronal 2/3 of the tooth

____ canals are found in the Apical 1/3 of the tooth

A

Lateral

Accessory

92
Q

T/F

The apical foramen changes with age due to cementum deposition and contains a Neurovascular Bundle

A

True

93
Q

What is used to lower interpulpal bp (making blood flow greater in the Coronal Pulp)?

A

A-V shunts

94
Q

What are the 4 zones of pulp from inside out?

A

Pulp proper

Cell rich zone

Cell free zone

Odontoblasts lining predentin

95
Q

T/F

There is no correlation between pulp calcification due to age and symptoms

A

True

96
Q

Where are Linear Pulpar Calcifications found?

A

Root

97
Q

T/F

Pulpal Calcifications require root canals

A

False

98
Q

What is a Dentricle?

A

Pulp stone/calcification

99
Q

A small Carious exposure will have what immune response?

A

APC (antigen presenting cells) and random migration of T cells

100
Q

A large Carious exposure will have what immune response?

A

PMN’s and B cell activation

101
Q

A prolonged Carious exposure will have what immune response?

A

Specific T cells in effector phase

102
Q

What are the 4 defense mechanisms of the pulp to insult?

A

AV shunting

Secondary Dentinal Mechanisms

Reactionary/reparative dentin formation

Immune

103
Q

A clinical diagnostic category in which the pulp is Symptom Free and Normally Responsive to pulp testing?

A

Normal Pulp

104
Q

A clinical diagnosis based upon subjective and objective finding indicating that the inflammation should resolve and the pulp return to normal

A

Reversible Pulpitis

105
Q

A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing.

Additional descriptors: Lingering thermal pain, spontaneous pain, referred pain.

A

Symptomatic Irreversible Pulpitis

106
Q

A clinical diagnosis based on the subjective and objective findings indicating that the vital inflamed pulp is incapable of healing.

Additional descriptors: No clinical symptoms but inflammation produced by caries, caries excavation, trauma, etc.

A

Asymptomatic Irreversible Pulpitis

107
Q

A clinical diagnostic category indicating death of the dental pulp. The pulp is usually nonresponsive to pulp testing.

A

Pulp Necrosis

108
Q

A clinical diagnostic category indicating that the tooth has been endodontically treated and the canals are obturated with various filling material other than intracanal medicaments.

A

Previously Treated

109
Q

A clinical diagnostic category indicating that the tooth has been previously treated by partial endodontic therapy (e.g., pulpotomy, pulpectomy)

A

Previously Treated Therapy

110
Q

Teeth with normal perriadicular tissues that are not sensitive to percussion or palpation testing. The lamina dura surrounding the root is intact and the periodontal ligament space is uniform.

A

Normal Apical Tissues

111
Q

Inflammation, usually of the apical periodontium, producing clinical symptoms including a painful response to biting and/or percussion of palpation. It may or may not be associated with an apical radiolucent area.

A

Symtomatic Apical Periodontitis

112
Q

Inflammation and destruction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area, and does not produce clinical symptoms.

A

Asymptomatic Apical Periodontitis

113
Q

An inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation and swelling of associated tissues.

A

Acute Apical Abscess

114
Q

An inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little or no discomfort, and the intermittent discharge of pus through an associated sinus tract.

A

Chronic Apical Abscess

115
Q

Diffuse radiopaque lesion representing a localized bony reaction to a low-grade inflammatory stimulus, usually seen at apex of tooth.

A

Condensing Osteitis

116
Q

Normal pulp

A

A clinical diagnostic category in which the pulp is Symptom Free and Normally Responsive to pulp testing?

117
Q

Reversible Pulpitis

A

A clinical diagnosis based upon subjective and objective finding indicating that the inflammation should resolve and the pulp return to normal

118
Q

Symptomatic Irreversible Pulpitis

A

A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing.

Additional descriptors: Lingering thermal pain, spontaneous pain, referred pain.

119
Q

Asymptomatic Irreversible Pulpitis

A

A clinical diagnosis based on the subjective and objective findings indicating that the vital inflamed pulp is incapable of healing.

Additional descriptors: No clinical symptoms but inflammation produced by caries, caries excavation, trauma, etc.

120
Q

Pulp Necrosis

A

A clinical diagnostic category indicating death of the dental pulp. The pulp is usually nonresponsive to pulp testing

121
Q

Previously Treated

A

A clinical diagnostic category indicating that the tooth has been endodontically treated and the canals are obturated with various filling material other than intracanal medicaments.

122
Q

Previously Treated Therapy

A

A clinical diagnostic category indicating that the tooth has been previously treated by partial endodontic therapy (e.g., pulpotomy, pulpectomy)

123
Q

Normal Apical Tissues

A

Teeth with normal perriadicular tissues that are not sensitive to percussion or palpation testing. The lamina dura surrounding the root is intact and the periodontal ligament space is uniform.

124
Q

Symptomatic Apical Periodontitis

A

Inflammation, usually of the apical periodontium, producing clinical symptoms including a painful response to biting and/or percussion of palpation. It may or may not be associated with an apical radiolucent area.

125
Q

Asymptomatic Apical Periodontitis

A

Inflammation and destruction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area, and does not produce clinical symptoms.

126
Q

Acute Apical Periodontitis

A

An inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation and swelling of associated tissues.

127
Q

Acute Apical Abscess

A

An inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation and swelling of associated tissues.

128
Q

Chronic Apical Abscess

A

An inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little or no discomfort, and the intermittent discharge of pus through an associated sinus tract.

129
Q

Condensing Osteitis

A

Diffuse radiopaque lesion representing a localized bony reaction to a low-grade inflammatory stimulus, usually seen at apex of tooth.

130
Q

***Maxillary 1st Molars: _____ have 4 canals

_____ have 3 canals

A

***94%

6%

131
Q

What is the most variable tooth?

A

Maxillary 1st molars

132
Q

Mandibular C.I. has 1 canal ____ %

2 canals _____%

A

70

30

*cingulum has 2nd canal

133
Q

T/F

Quality Restoration is key in the prevention of Root Canal Failure

A

True

134
Q

Where is the pulp always at the Center of the Tooth?

A

CEJ

135
Q

The Maxillary Lateral Incisor’s Root usually takes a _____ curve

A

Distal

136
Q

What is the longest tooth in the mouth?

A

Maxillary Canine

*facio-lingually very broad

137
Q

The Mandibular lateral incisor is usually longer by ___ mm

A

2 mm

Tim's Cards (140 decks)

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