Pulp Flashcards
4 causes of pulp inflammation?
- mechanical injury (drilling)
- thermal injury (need water with drilling)
- chemical injury (acid etch on dentin)
- bacterial injury (MOST COMMON)
5 signs of inflammation?
Heat
redness
swelling (edema) - fluid from vasculature
pain (b/c fluid is puttin pressure on nerve endings
loss of function
Why is it when people say a tooth is dead its actually usually not completely dead?
because the cementum is still alive because it recieves its blood supply from PDL
5 components of pulp
- blood vessels
- lymphatic channels (removes edema/swelling)
- nerves
- odontoblasts (@periphery)
- undifferentiated connective tissue cells (mesenchymal cells)
What are the predominant cells histologically in ACUTE irreversible pulpitis? (2 types)
- PMN’s (polymorphonuclear neutrophils)
2. macrophages
What are the predominant cells histologically in CHRONIC irreversible pulpitis? (3 types)
- macrophages
- lymphocytes
- plasma cells
Can you get spontaneous pain with chronic irreversible pulpitis?
NO
If pain lingers for 1 minute or more with removal of stimulus what is the diagnosis?
acute irreversible pulpitis
Will a patient reach 80 on EPT for acute/chronic irreversible pulpitis?
NO
What is treatment for acute and chronic irreversible pulpitits?
RCT/EXO
will a patient be sensitive to percussion with reversible and irreversible pulpitis?
No (rare cases yes, such as multi rooted teeth, one with complete necrosis and the other may still have some viable pulp remaining)
Can apical periodontitis secondary to pulpal pathosis occur on a viable tooth?
NO
What does Granulation Tissue consist of? (2 things)
1- increase in fibroblasts/fibrous tissue
2- increase in endothelial cells and blood vessels
A periapical abscess is what type of infalammation?
Acute inflammation
why may we not be able to properly use LA for a periapical abcess?
Because LA only works in a certain range of pH, often these periapical abscesses alter the pH so much that LA is not effective.,
How do we treat periapical abscess?
IAD - incision and drainage
What is a scenario where a patient would not feel a periapical abscess?
Parulis has formed. elevated soft tissue lesion where puss is draining. Patient may not feel this because the puss is draining and not putting pressure on nerve endings
How do we treat a periapical abscess?
First, IAD. Then we need to deal with the infection by performing a RCT or EXO
How can we determine the source of infection with a periapical abscess?
We can often use gutta percha to enter the abscess and it will lead to the source of the infection. Than we will treat that tooth (RCT/EXO)
What would we see histologically if we biopsied periapical abscess?
“Sea of Neutrophils”
What is present in a parulis?
Granulation tissue - increase in firboblasts/fibrous tissue and an increase in endothelial cells/blood vessels.
Is a periapical abscess painful?
YES, may not be if a parulis has formed (because puss is draining)
What is the FIRST THING we would see with apical periodontitis secondary to pulpal pathosis?
Widening of PDL space (Lamina Dura may still be intact)
What is a Granuloma? (+ 3 things seen histologically)
A chronic inflammation (granulomatous inflammation) characterized by:
1- epithelioid histiocytes
2- multinucleated giant cells
3- peripheral mantle of lymphocytes/plasma cells
Is granulomatous inflammation the same thing as granulation tissue?
NO
What is a cyst?
A pathological cavity, lined by epithelium containing fluid or semi-fluid material
How can we differentiate apical radicular cyst from periapical granuloma?
ONLY histologically
Why do mand anteriors rarely have cavities?
Because they are constantly bathed in saliva
Will an apical radicular cyst be sensitive to percussion?
May not because it is chronic inflammation
What kind of tissue is present in an apical radicular cyst
granulation tissue
How do patients get periapical fibrous scar?
RARE, but usually after RCT
What is a periapical fibrous scar composed of?
dense connective tissue
What is the difference between osteitis and osteomyelitis?
Osteitis -> Inflammation of bone
Osteomyelitis -> inflammation of bone and bone marrow
What is a characteristic of chronic focal sclerosing osteomyelitis?
Increase in bone formation (stimulated osteoblasts)
How do we treat chronic focal sclerosing osteomyelitis?
RCT/EXO
What is difference between rarifying and condensing osteitis?
Rarifying -> decreased bone density
Condensing -> increased bone density
Difference between surgical and non-surgical RCT?
non surgical -> go through root
surgical -> lay back soft tissue flap and go through bone, clean it out and place gutta percha
What is a key characteristic of chronic osteomyelitis with proliferative periostitis?
layering of radiolucent/radiopaque bone cortex (radiologists call it onion skin)
Are periapical granulomas symptomatic?
They are often Asymptomatic but pain can develop if acute exacerbation occurs
In what scenario would sensitivity to percussion occur?
peri-apical inflammation
