Pulpal and Periapical Pathology Flashcards
Single greatest influence on pulpal and periapical disease.
Bacteria and their byproducts
Proximity of caries to the pulp for mild chronic vs severe acute inflammation
Author
1.1mm vs 0.5mm
Reeves and Stanley
Associated with both chewing discomfort and unexplained thermal sensitivity.
coronal fractures
Cameron
Why a cracked tooth hurts
Fluid movement within the crack, bacterial ingress
Restorative treatment can cause pulpal inflammation both _____ and ______
immediately and many years later.
Cumulative effect of restorative procedures on pulp tissue over time
Stressed pulp syndrome
Abou-Rass
Displacement of odontoblastic nuclei and pulpal inflammation following dry restorative procedures are usually reversible after ______ days
180
Cotton and Siegel
Remaining dentin thickness of ______ or greater is necessary to avoid pulpal injury
0.5mm
Murray et al
Reactionary dentin formation occurs with _____ of remaining dentin thickness
0.77mm
Murray et al
Any material placed within ______ of the pulp caused significant and irreversible lesions
0.5mm
Stanley
______ and ______ may promote tissue healing when placed in direct contact with pulp tissue
RMGI
MTA
Teeth restored with resin are ______ times more likely to require RCT compared to amalgam
1.9
Kwang
% of crowned teeth that require RCT
8% at 10 years
17% at 25 years
19% in general (Saunders)
32% if abutment for FPD
Heat and ice tests pose no threat to pulpal health
Ice - dowden
heat - Rickoff
temperature increase of ______ (preparation without coolant) will cause irreversible damage
5.6 C
Zach and Cohen
Orthodontic treatment may have _____ effect on pulp tissue
transient
During ortho treatment, altered response to _______ and decrease in _______
EPT - Cave
Pulp size by CBCT - Venkatesh
Levels of pulpal ______ increase when teeth are subjected to severe orthodontic forces
CGRP
Relationship between ortho and ______ processes is well documented
resorptive
Heithersay - ICR
Reitan - external (precementum and predentin are protective)
Argument against perio affecting endo
Seltzer and bender - perio exposes lateral canals without pulp necrosis
Argument for perio affecting endo
Giovanella - lower pulpal oxygen saturation rates in teeth with perio
Occlusal forces have no effect on pulpal ________
Histology
Acute occlusal trauma leads to increase in substance P levels in both _______ and ______
pulp and PDL
_______ reduces post operative pain in vital pulps with percussion sensitivity
occlusal reduction
Rosenberg
The theory that blood borne bacteria are attracted to areas of chronic inflammation
Anachoresis
Gier and Mitchell
Discredited anachoresis
Delivanis – bacteremia did not colonize unfilled root canals in cats
A focus of microorganisms can lead to systemic dissemination of infection
Focal infection theory
Weston Price
Discredited focal infection theory
Easlick
Hollow tubes within the body collect circulatory elements and lead to inflammation
Hollow tube theory
Rickert and Dickson
Discredited hollow tube theory
Torneck and Wenger
Hollow tubes implanted in tissue did not cause inflammation
Pulpal irritants activate both ______ and ______ immune systems
Innate and Acquired
Components of innate immune system (5)
Physical barriers
phagocytes
inflammation
mast cells
basophils
Components of acquired immune system
B cells and T cells
Stimuli transferred via _______ activate a delta and C fibers
fluid movements
C fibers conduct signals and ________
release neuropeptides
Pulpal blood flow is ______ in nature
Biphasic
Cellular immunity within the pulp provided by
Leukocytes
macrophages
lymphocytes
humoral immunity within the pulp provided by
immunoglobulins
prostaglandins
cytokines
Pulp tissue necrosis via ______
Author
coalescing of micro-abscesses
Langeland
Correlation between symptoms/clinical diagnosis with histology
Normal and reversible diagnoses are correct 96% of the time
Irreversible is correct 84% of the time
Ricucci
Predominant immune cell in development of apical periodontitis
Lymphocytes
T cell involved in active lesion development
T helper
T cell involved in chronic lesions
T surpressor cells
Predominant immunoglobulin in apical periodontitis
IgG
Increase in circulating antibodies in patients with _____ and ________
AAA and flare-ups
Prostaglandins are byproducts of _____ formed via the ________
Arachidonic acid
Cyclooxygenase pathway
Symptomatic lesions have higher _______ activity
Prostaglandin
Cytokines are produced by ______ when ______ becomes activated by pathogens
Macrophages
toll-like-receptor 4
_______ has 15 times bone resorption potency
IL-1 B
Cytokines including _____, _____, and ______ promote the fusion of osteoclast precursor cells which cause subsequent bone resorption
IL-1, TNF-a, and leukotrienes
Bone resorption process
cytokines stimulate production of RANKL which stimulate osteoclasts
The presence of live bacteria in periapical lesions is _______
controversial
Diagnosis of granuloma vs cyst cannot be based on _______
radiographs
Periapical granulomas are composed of _______ tissue and _______ inflammation
Granulation
Chronic (not granulomatous)
Predominant immunoglobulin in granulomas
IgG
Periapical cysts posses an _________
epithelial lining
Torabinejad’s immunologic theory of cyst formation is that
inflammation stimulates epithelial rests of Mallasez to proliferate
Two types of periapical cysts
true cyst – not connect to apex (more common)
bay cyst – communicate with periapex
Of non-endodontic lesions, ______ were benign and ____ were malignant
66%
29%
Most common benign lesions
ameloblastoma, nasopalatine duct cyst
Most common malignant lesions
metastatic lesions, carcinomas
Specimens are ______% granulomas, ______% abscesses, and _____% cysts
50%
35%
15%
Post-operative exacerbation of symptoms
Endodontic flare-up
Incidence of flare-up
5.8% of teeth with lesions
Yu
8.4% Tsesis
Flare-up factors (5)
female sex
pre-operative pain and swelling
dx of pulpal necrosis
retreatment
history of allergies
Flare-up cannot be prevented with abx
Walton and Fouad
Abx can be used to control flare-up once initiated
Seltzer
Flare-up is not associated with treatment failures
de Chevigny
