Operative Dentistry Flashcards
What is the origin of the Oral Cavity and teeth in the developing embryo?
Neural Crest Cells
How does the tooth form developmentally?
Crown to Root
Dentinogenesis occurs when?
Before Amelogenesis (enamel formation)
_____ formation occurs in a crown down fashion after Dentinogenesis and Ameliogenesis.
Root
Primordial Root 3 Terms:
Cervical Loop
Hertwig’s Epithelial root sheat
Epithelial diaphragm
What are epithelial cells that remain in the periodontal space during root formation?
Rests of Malassez
T/F
Lateral and Accessory Canals contain pulp tissue
False
*CT only
T/F
Accessory canals are more numerous apically
True
Why does the Apical Foramen move and/or narrow throughout life?
Cementum growth
What is the most prominent cell in the pulp?
Where are they located?
What do they differentiate into?
Fibroblasts
Cell Rich Zone
Odontoblasts
What types of Collagen do Fibroblasts of the pulp make?
Type I and III
T/F
Odontoblasts are unique to pulp tissue and make Dentin, they are more organized in the apical region
True
Shape of Odontoblasts Coronal:
Middle:
Apical:
Columnar
Cuboidal
Squamous
2 Afferent Sensory Fibers of the Pulp:
A-Delta fibers
C fibers
T/F
Efferent Motor Fibers of the Pulp are associated with Sympathetic contractions of smooth muscles in the capillaries.
True
***What type of Fibers are associated with Reversible Pulpitis clinically?
A (alpha) Pain Fibers
- sharp, non-lingering type pain
- myelinated
The low conduction velocity Fibers associated with Symptomatic Irreversible Pulpitis of the pulp are what?
C Fibers
*dull, throbbing, lingering pain
What are the 3 primary theories of Dentin Sensitivity?
Direct innervation
Odontoblastic Receptor
Hydrodynamic (accepted theory)
What is the origin of the Blood Supply to all the Pulp?
Internal Maxillary Artery
Blood flow is greater in the _____ pulp
Coronal
What bypasses the capillary bed during inflammation of the pulp (this decreases interpulpal bp).
A-V shunt
What are the 5 functions of the Pulp?
Induction
Formation (continuously forms secondary dentin)
Nutrition
Defense
Innervation
T/F
Reparative, Irritational, and Tertiary are all terms that form in response to an irritant
True
What are the 4 Zones of the Pulp?
Pulp Proper
Cell Rich Zone
Cell Free Zone
Odontoblastic Layer
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
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.
Asymptomatic 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.
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
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.
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
