Periodontal-Endodontic Interrelationships

Question 1

What are three ways in which pulp vitality is put at risk?

Answer 1

1. deep caries
2. trauma (accident)
3. Restorative Procedures (overheating for example)

Question 2

Cell ____ is an immune response to deep caries.

Answer 2

proliferation

Question 3

Why do bacteria thrive in “dead pulp?”

Answer 3

blood supply is cut off (usually by inflammation)

Question 4

True or False: In periodontal-endodontic interrelationships, neutrophils become overwhelmed by bacteria.

Answer 4

True

Question 5

How does the host response attempt to “wall-off” infection in periodontal-endodontic infections?

Answer 5

Inflammatory infiltrate forms DENSE connective tissue around the infection (usually root apex)

Question 6

True or False: Periodontal-endodontal interrelationships are characterized by abscesses that spread from the apex, through PDL space, and toward the marginal level.

Answer 6

True

Question 7

How can you tell whether the infection is beginning at the pulp or the periodontium?

Answer 7

Periodontium = no pain

Endo (Pulp) = throbbing pain

Question 8

There is an anatomical connection between the pulp and PDL via ______ foramen, ______ canals, and _______ tubules.

Answer 8

apical foramen
accessory canals
dentinal

Question 9

Frequency of accessory canals increase toward the _____.

Answer 9

Apex

Question 10

True or False: There are more accessory canals near the crown of a tooth.

Answer 10

False, more near the apex

Question 11

Accessory canals travel in multiple directions in the _____ areas.

Answer 11

furcation

Question 12

The dentinal tubules connect the pulp to the PDL. This if very important in the _____ area.

Answer 12

CEJ

Question 13

If a periodontal-endodontic interrelationship begins in the pulp, will there be increased probing depths?

Answer 13

no! probing depths do not increase and swelling does not increase

Question 14

Which is treated first, the endo or perio problem?

Answer 14

Treat endo FIRST! Why?

• Potential for “two for one” = most perio problems will self correct if the pulp is resolved
• sometimes endo is not successful and you need to take different approach

Question 15

If the tooth is vital, the primary lesion is ______ origin. If the tooth is non-vital, the primary lesion is ______.

Answer 15

vital = Periodontal
non-vital = endodontic

Question 16

If a tooth is vital (aka: pulp is not the cause) but the periodontal lesion reaches the apex, what would be the effect of SRP?

Answer 16

scaling at the root apex would involve the pulp…now endo treatment is needed

Question 17

What are the three possible sequences of events for periodontal-endodontic interrelationships?

Answer 17

1. endo first
2. perio first
3. occur independently and then combine

Question 18

Describe the sequence of events if endo occurs first.

Answer 18

Necrotic pulp–> disease extends to periodontal tissues

Question 19

Describe the sequence of events if perio occurs first.

Answer 19

Pulp is vital.

Periodontal lesion–>bacteria spread to pulp–>necrosis

Question 20

Describe a “true combined lesion.”

Answer 20

Pulpal and periodontal pathologies initiate independently and then coalesce

Question 21

Why does Dentin Hypersensitivity occur most easily at the CEJ?

Answer 21

Scaling and Root planing in this area = extreme sensitivity because the cementum is thinnest at the CEJ

Question 22

Dentin hypersensitivity can occur in response to what kind of stimuli?

Answer 22

hot, cold, acid, sweetness, touch, air flow

Question 23

True or False: Dentin Hypersensitivity peaks during the first week and then subsides.

Answer 23

True

Question 24

What are three complications associated with endodontic therapy?

Answer 24

1. Decreased bone level
2. Perforations
3. Vertical Fractures