Pulp Pathology and Irritants

Question 1

What are the 3 main types of pulpal irritants?

Answer 1

1-Microbial
2-Mechanical
3-Chemical

Question 2

______ dominate intraradicular infections while ______ are the most common bacteria in endodontic infections

Answer 2

Obligate anaerobes

Gram Negative

Question 3

What bacteria is frequently isolated from failed RCTs?

Answer 3

E. Faecalis

Question 4

Which fibers are myelinated, carry sharp or pricking pain and slightly innervate dentin tubules?

Answer 4

A-delta fibers

Question 5

Which fibers are not myelinated, carry burning or aching sensations and are deeper in the pulp?

Answer 5

C fibers

Question 6

What layer immediately adjacent to the odontoblastic layer is traversed by blood capillaries?

Answer 6

Cell Free Zone of Weil

Question 7

What are 5 pathways of pulpal disease?

Answer 7

1-Dentinal tubules
2-Direct pulp exposure
3-Caries
4-Iatrogenic
5-Trauma

Question 8

Pulpal necrosis can result from periodontal disease if it reaches where

Answer 8

The apical foramen

Question 9

Traumatized teeth can become infected through what process that transports microbes to tissue damage through blood?

Answer 9

Anachoresis/Chemotaxis

Question 10

What three reactions protect the pulp against caries?

Answer 10

1-Decrease dentin permeability
2-Tertiary dentin formation
3-Inflammatory and immune responses

Question 11

What rare condition may occur if an opening of the pulp cavity occurs and the pulp becomes hyper plastic?

Answer 11

Pulp Polyp

*usually younger teeth

Question 12

What are the 5 classes of periapical pathosis?

Answer 12

1-SAP (Symptomatic Apical Periodontitis)
2-AAP (Asymptomatic Apical Periodontitis)
3-AAA (Acute Apical Abscess)
4-CAA (Chronic Apical Abcess)
5-Condensing Osteitis

Question 13

What are 6 irritants that can result in SAP?

Answer 13

1-Irreversible pulpitis
2-Bacterial toxins from necrotic pulp
3-Chemical irritants or disinfectants
4-Hyperocclusion
5-Overinstrumentation
6-Overextension of obturation material

Question 14

Spontaneous, acute pain to biting or precision, hot, cold, and electric sensitivity with a widened PDL is likely what?

Answer 14

Symptomatic Apical Periodontitis

*may or may not respond to pulp vitality tests. May not have radiolucency yet

Question 15

What condition is caused by pulpal necrosis, is a sequel to SAP, is chronic and asymptomatic with widened PDL and likely cyst?

Answer 15

Asymptomatic Apical Peridontitis

*no response to pulp vitality.

Question 16

What is the breakdown of the 4 likely kinds of cysts?

Answer 16

1-Granuloma (59%)
2-Cysts (22%)
3-Scars (12%)
4-??? (7%)

Question 17

Which variant of AAP is an increase in trabecular bone as a response to persistent irritation in the pulp, is mostly found in mandibular posterior teeth and is not a problem on its own?

Answer 17

Condensing Osteitis

Question 18

What rapid onset liquefactive lesion destroys periapical tissues, may have swelling, varying degree of mobility, pain to percussion, biting and palpation and is frequently accompanied by fever?

Answer 18

Acute Apical Abscess

*may have fistula or sinus tract. may need I & D

Question 19

What lesion is generally asymptomatic, may feel different to percussion, has an apical radiolucency but does not respond to pulp vitality tests?

Answer 19

Chronic Apical Abscess

*long standing lesion. May have mucosal or facial sinus tract

Question 20

What 8 conditions merit Root Canal Therapy?

Answer 20

1-Hyperplastic pulpitis
2-Irreversible pulptitis (symptomatic or asymptomatic)
3-Necrotic pulp
4-SAP
5-AAP
6-AAA
7-CAA
8-Condensing Osteitis