Operative Dentistry Flashcards by Tim Agee

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

Neural Crest Cells

How well did you know this?

Not at all

Perfectly

How does the tooth form developmentally?

Crown to Root

How well did you know this?

Not at all

Perfectly

Dentinogenesis occurs when?

Before Amelogenesis (enamel formation)

How well did you know this?

Not at all

Perfectly

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

Root

How well did you know this?

Not at all

Perfectly

Primordial Root 3 Terms:

Cervical Loop

Hertwig’s Epithelial root sheat

Epithelial diaphragm

How well did you know this?

Not at all

Perfectly

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

Rests of Malassez

How well did you know this?

Not at all

Perfectly

T/F

Lateral and Accessory Canals contain pulp tissue

False

*CT only

How well did you know this?

Not at all

Perfectly

T/F

Accessory canals are more numerous apically

True

How well did you know this?

Not at all

Perfectly

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

Cementum growth

How well did you know this?

Not at all

Perfectly

What is the most prominent cell in the pulp?

Where are they located?

What do they differentiate into?

Fibroblasts

Cell Rich Zone

Odontoblasts

How well did you know this?

Not at all

Perfectly

What types of Collagen do Fibroblasts of the pulp make?

Type I and III

How well did you know this?

Not at all

Perfectly

T/F

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

True

How well did you know this?

Not at all

Perfectly

Shape of Odontoblasts Coronal:

Middle:

Apical:

Columnar

Cuboidal

Squamous

How well did you know this?

Not at all

Perfectly

2 Afferent Sensory Fibers of the Pulp:

A-Delta fibers

C fibers

How well did you know this?

Not at all

Perfectly

T/F

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

True

How well did you know this?

Not at all

Perfectly

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

A (alpha) Pain Fibers

sharp, non-lingering type pain
myelinated

How well did you know this?

Not at all

Perfectly

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

C Fibers

*dull, throbbing, lingering pain

How well did you know this?

Not at all

Perfectly

What are the 3 primary theories of Dentin Sensitivity?

Direct innervation

Odontoblastic Receptor

Hydrodynamic (accepted theory)

How well did you know this?

Not at all

Perfectly

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

Internal Maxillary Artery

How well did you know this?

Not at all

Perfectly

Blood flow is greater in the _____ pulp

Coronal

How well did you know this?

Not at all

Perfectly

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

A-V shunt

How well did you know this?

Not at all

Perfectly

What are the 5 functions of the Pulp?

Induction

Formation (continuously forms secondary dentin)

Nutrition

Defense

Innervation

How well did you know this?

Not at all

Perfectly

T/F

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

True

How well did you know this?

Not at all

Perfectly

What are the 4 Zones of the Pulp?

Pulp Proper

Cell Rich Zone

Cell Free Zone

Odontoblastic Layer

How well did you know this?

Not at all

Perfectly

T/F | Pulp Stones are always an indication of needing a root canal

False

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)?

Denticles Diffuse/Linear Calcifications

What is the consequence of bacteria reaching the pulp?

Necrosis ***requires endodontic extraction

T/F | Do not perform a direct pulp cap of a carious lesion

True *However, new substances may change this

T/F | Three is a 13% success rate after a direct pulp cap of a carious lesion

True

T/F | Crowns cause damage and can lead to root canals

True

T/F | Pulpal rxns are vascular and neural

True

T/F Increased flow will cause painful inflammation Decreased blood flow will cause necrosis

True True

What are 4 Defense mechanisms of the Pulp?

AV shunting Secondary Dentin Reparative (tertiary) Dentin (caused by irritant) Immune response

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

Acid-producing bacteria, low salivary rate, frequent consumption of fermentable carbs Saliva, Fluoride, Antibacterials (CHX, xylitol)

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

Visible Cavities present Caries restored in last 3 years Interproximal lesions White spots on enamel surfaces

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

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

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

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

What are the 4 Risk Assessment Procedures?

Diet Analysis Plaque pH measurment Saliva Flow Bacterial Test

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

Moderate

What is the cutoff Salivary Flow Rate that defines Xerostomia?

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

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

Calcium Phosphate

What cancer therapy can cause Xerostomia?

Radiation to head and neck

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

Medium risk category

CAMBRA guidelines, Frequency of Radiographs Low Risk: Moderate Risk: High Risk: Extreme Risk:

18-24 months 18-24 months 6-12 months 6 months

Frequency of Periodic Oral Exams Low Risk: Moderate Risk: High Risk: Extreme Risk:

12 months 12 months 6-12 months 3-6 months

T/F | Sealants for deep pits and fissures are recommended for all CAMBRA risk levels.

False *none for Low Risk

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

Baseline for New pts Baseline for New pts/high bacterial challenge suspicion Every POE (periodic oral exam) Every POE

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

No No 1 min/day, 1 week/month 1 min/day, 1 week/month

What can't CHX be combined with?

Fluoride *1 hour gap required

T/F | The Bacterial cell is positively charged, and CHX is negatively charges

False CHX+ and Bacterial Cell -

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

S. mutans Lactobacilli

T/F | CHX and Betadine (Iodine) stain

True

Fluoride CAMBRA interventions for Low Risk: Moderate Risk: High Risk: Extreme Risk:

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)

What is the Therapeutic Concentration of Fluoride in the mouth?

.04-.1 ppm

What does Fluoride Varnish form on enamel surfaces?

Calcium Fluoride "time bomb"

Xylitol/Baking Soda CAMBRA intervention for Low Risk: Moderate Risk: High Risk: Extreme Risk:

None gum/mints 2x/day gum/mints 4x/day gum/mints 4x/day Baking Soda rinse 4-6x/day

T/F | Xylitol easily penetrates biofilm and alters the way bacteria stick to surfaces

True

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

CHX F varnish

What are 7 diagnostic tests we can run with Saliva?

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)

Name 5 Antibacterial Functions of Saliva:

sIgA: inhibits S. mutans attach Histatin: pellicle Lactoferrin: binds Fe, competes w/ S.mutans Salivary Peroxidase Amylase

What Salivary component is important for Lubrication?

Mucin

Buffering in Saliva is dependent on what 2 components: Remineralization in Saliva is dependent on what 2 components:

Phosphate, Bicarb Phosphate, Calcium

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

PRP - Proline Rich Proteins

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

Statherins

What is the normal pH of Saliva?

6.8-7.3

T/F | A biofilm lives at the interface between a solid and liquid

True

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

Visible cavities Caries restored last 3 yrs Interproximal caries/lesions/radiolucencies White spots on enamel surfaces

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?

High Risk

dmfs: DMFS:

decayed/missing/filled surfaces (primary dentition) decayed/missing/filled surfaces (permanent dentition)

What are the 4 requirements to produce Dental Caries?

Substrate Bacteria Tooth/host Time

How does F enter the bacterial cell? How does F ion damage the bacteria?

HF under Acidic Conditions Interferes with enzymes (enolase)

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

True

What is the mottling of tooth enamel caused by a developmental consumption of excess fluoride? When is this risk the highest?

Fluorosis 20-30 months

What are current fluoridation levels in the water?

1.0 ppm

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

Luciferin *test takes one minute

Bacterial Test 0-1500 = 1500 and above =

Low risk At risk

T/F | Brushing reduces caries

False

T/F | Caries is an infectious disease

True

Name 4 Chemotherapeutics:

Fluoride Baking soda CHX Xylitol

What is the percentage of carbonate associated with hydroxyapatite crystals?

20%

What bacterial species first colonizes the pellicle?

S. sanguinis *low colonization threshold

pH at which enamel dissolves?

5.5

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

S. mutans

Where does S. mutans live in the mouth?

Everywhere - furrows of tongue as well as teeth

Name 3 Cariogenic Bacteria:

S. sobrinus S. mutans Lactobacilli

What primarily remineralizes enamel?

Calcium and phosphate in solution *F blocks demineralization

What is the most soluble apatite structure? Medium soluble? Least soluble?

Carbonated apatite Hydroxyapatite Fluoroapatite

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

Moderate

What is the reduction in caries rates with F varnish?

46%

Xylitol Gum > CHX > Fluoride Varnish in what?

Vertical S.mutans transmission

____ canals are found in the Coronal 2/3 of the tooth ____ canals are found in the Apical 1/3 of the tooth

Lateral Accessory

T/F | The apical foramen changes with age due to cementum deposition and contains a Neurovascular Bundle

True

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

A-V shunts

What are the 4 zones of pulp from inside out?

Pulp proper Cell rich zone Cell free zone Odontoblasts lining predentin

T/F | There is no correlation between pulp calcification due to age and symptoms

True

Where are Linear Pulpar Calcifications found?

Root

T/F | Pulpal Calcifications require root canals

False

What is a Dentricle?

Pulp stone/calcification

A small Carious exposure will have what immune response?

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

A large Carious exposure will have what immune response?

PMN's and B cell activation

A prolonged Carious exposure will have what immune response?

Specific T cells in effector phase

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

AV shunting Secondary Dentinal Mechanisms Reactionary/reparative dentin formation Immune

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

Normal Pulp

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

Reversible Pulpitis

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.

Symptomatic Irreversible Pulpitis

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.

Asymptomatic Irreversible Pulpitis

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

Pulp Necrosis

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.

Previously Treated

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

Previously Treated Therapy

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.

Normal Apical Tissues

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.

Symtomatic Apical Periodontitis

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

Asymptomatic Apical Periodontitis

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.

Acute Apical Abscess

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.

Chronic Apical Abscess

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

Condensing Osteitis

Normal pulp

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

Reversible Pulpitis

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

Symptomatic Irreversible Pulpitis

Asymptomatic Irreversible Pulpitis

Pulp Necrosis

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

Previously Treated

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.

Previously Treated Therapy

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

Normal Apical Tissues

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.

Symptomatic Apical Periodontitis

Asymptomatic Apical Periodontitis

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

Acute Apical Periodontitis

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.

Acute Apical Abscess

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.

Chronic Apical Abscess

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.

Condensing Osteitis

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

***Maxillary 1st Molars: _____ have 4 canals _____ have 3 canals

***94% 6%

What is the most variable tooth?

Maxillary 1st molars

Mandibular C.I. has 1 canal ____ % 2 canals _____%

70 30 *cingulum has 2nd canal

T/F | Quality Restoration is key in the prevention of Root Canal Failure

True

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

CEJ

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

Distal

What is the longest tooth in the mouth?

Maxillary Canine *facio-lingually very broad

The Mandibular lateral incisor is usually longer by ___ mm

2 mm