PMI03-2018

Question 1

What are the possible outcomes of acute inflammation?

Answer 1

Complete resolution (regeneration of native cells and restoration to normalcy)

Healing by connective tissue replacement/fibrosis

Progression to chronic inflammation

Question 2

What occurs during typical acute inflammation?

Answer 2

Vasodilatation and increased vascular permeability

Fluid exudation and emigration of leukocytes (esp PMNs)

Question 3

What are the types of aetiological cause of pulpitis?

Answer 3

Microbial

Thermal

Chemical

Question 4

How can microbes gain access to the pulp?

Answer 4

Carious cavitation

Attrition/abrasion/erosion

Fractures/cracks

Perio-endo lesions

Iatrogenic

Question 5

What are the different ways of classifying pulpitis?

Answer 5

Acute/chronic (clinical and histological features)

Reversible/irreversible (clinical features)

Open/closed

Subtotal/generalised

Sterile/infected

Question 6

Describe the general course of pulpal inflammation with no treatment.

Answer 6

Increase in pulpal pressure due to oedema from acute inflammation (vasodilatation and increased vascular permeability)

Leads to venous stasis –> ischaemia –> necrosis

Destruction of odontoblasts and adjacent pulpal tissue

May lead to periapical periodontitis and abscesses

Question 7

What local factors affect healing in pulpitis?

Answer 7

Blood supply

Degree of infection

Mobility of tooth

Question 8

What systemic factors affect healing in pulpitis?

Answer 8

Age

Nutrition

Pre-existing medical conditions

Question 9

What host factors affect healing in pulpitis?

Answer 9

Pulpal anatomy

Apical blood flow

Pre-existing state of pulp

Question 10

What irritant factors affect healing in pulpitis?

Answer 10

Nature

Severity

Duration

Question 11

What cells are characteristic of chronic inflammation?

Answer 11

Lymphocytes

Plasma cells

Macrophages

Question 12

Can patients often tell exactly which tooth has pulpitis? Why?

Answer 12

No - pulps of individual teeth are NOT precisely represented in the sensory cortex so pain is poorly localised

Question 13

Does pulpitis react to pressure on tooth surface (biting, percussion)? Why?

Answer 13

No

Infection/inflammation has not reached periodontal/periapical tissues

Question 14

Describe what you would see in reversible pulpitis.

Answer 14

Hypersensitive to hot and cold

Hyperaemia and oedema

Chronic inflammatory cells with scattered acute inflammatory cells

Pain subsides on removal of stimulus

Positive response to sensibility testing

May have some tertiary dentine

Question 15

Describe what you would see in irreversible pulpitis.

Answer 15

Pain becomes persistent and spontaneous

Reduced/no/abnormal response to sensibility testing

Often congestion of venules that results in focal necrosis

Fibrosis

Mix of neutrophils and chronic inflammatory cells

Question 16

How would you treat reversible pulpitis?

Answer 16

Remove local irritant

Question 17

How would you treat irreversible pulpitis?

Answer 17

Tooth extraction or RCT (or even vital pulp therapy)

Question 18

Are most cases of pulpitis open or closed?

Answer 18

Closed

Question 19

Describe open pulpitis.

Answer 19

Large exposure/infection/carious cavity but pulp survives

Often associated with open apices (seen in children) as it allows a better blood supply

Question 20

Describe chronic hyperplastic pulpitis.

Answer 20

In deciduous molars of 6s in children with large pulp chambers

Large carious cavity in which entire pulpal roof is often missing

Chronic inflammation results in hyperplastic granulation tissue that extrudes from the pulp chamber

Apex may be open which decreases the likelihood of necrosis

Tooth is asymptomatic excepts for a possible feeling of pressure during mastication

Surface of polyp/tissue may be covered with stratified squamous epithelium that can migrate from adjacent gingiva

Question 21

What is the alternative name for pulpal polyp?

Answer 21

Chronic hyperplastic pulpitis