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ABE Oral Board Review > Pulpal and Periapical Pathology > Flashcards

Pulpal and Periapical Pathology Flashcards

1
Q

Single greatest influence on pulpal and periapical disease.

A

Bacteria and their byproducts

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2
Q

Proximity of caries to the pulp for mild chronic vs severe acute inflammation

Author

A

1.1mm vs 0.5mm
Reeves and Stanley

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3
Q

Associated with both chewing discomfort and unexplained thermal sensitivity.

A

coronal fractures
Cameron

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4
Q

Why a cracked tooth hurts

A

Fluid movement within the crack, bacterial ingress

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5
Q

Restorative treatment can cause pulpal inflammation both _____ and ______

A

immediately and many years later.

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6
Q

Cumulative effect of restorative procedures on pulp tissue over time

A

Stressed pulp syndrome
Abou-Rass

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7
Q

Displacement of odontoblastic nuclei and pulpal inflammation following dry restorative procedures are usually reversible after ______ days

A

180
Cotton and Siegel

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8
Q

Remaining dentin thickness of ______ or greater is necessary to avoid pulpal injury

A

0.5mm
Murray et al

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9
Q

Reactionary dentin formation occurs with _____ of remaining dentin thickness

A

0.77mm
Murray et al

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10
Q

Any material placed within ______ of the pulp caused significant and irreversible lesions

A

0.5mm
Stanley

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11
Q

______ and ______ may promote tissue healing when placed in direct contact with pulp tissue

A

RMGI
MTA

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12
Q

Teeth restored with resin are ______ times more likely to require RCT compared to amalgam

A

1.9
Kwang

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13
Q

% of crowned teeth that require RCT

A

8% at 10 years
17% at 25 years
19% in general (Saunders)
32% if abutment for FPD

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14
Q

Heat and ice tests pose no threat to pulpal health

A

Ice - dowden
heat - Rickoff

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15
Q

temperature increase of ______ (preparation without coolant) will cause irreversible damage

A

5.6 C
Zach and Cohen

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16
Q

Orthodontic treatment may have _____ effect on pulp tissue

A

transient

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17
Q

During ortho treatment, altered response to _______ and decrease in _______

A

EPT - Cave
Pulp size by CBCT - Venkatesh

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18
Q

Levels of pulpal ______ increase when teeth are subjected to severe orthodontic forces

A

CGRP

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19
Q

Relationship between ortho and ______ processes is well documented

A

resorptive
Heithersay - ICR
Reitan - external (precementum and predentin are protective)

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20
Q

Argument against perio affecting endo

A

Seltzer and bender - perio exposes lateral canals without pulp necrosis

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21
Q

Argument for perio affecting endo

A

Giovanella - lower pulpal oxygen saturation rates in teeth with perio

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22
Q

Occlusal forces have no effect on pulpal ________

A

Histology

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23
Q

Acute occlusal trauma leads to increase in substance P levels in both _______ and ______

A

pulp and PDL

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24
Q

_______ reduces post operative pain in vital pulps with percussion sensitivity

A

occlusal reduction
Rosenberg

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25
Q

The theory that blood borne bacteria are attracted to areas of chronic inflammation

A

Anachoresis
Gier and Mitchell

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26
Q

Discredited anachoresis

A

Delivanis – bacteremia did not colonize unfilled root canals in cats

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27
Q

A focus of microorganisms can lead to systemic dissemination of infection

A

Focal infection theory
Weston Price

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28
Q

Discredited focal infection theory

A

Easlick

29
Q

Hollow tubes within the body collect circulatory elements and lead to inflammation

A

Hollow tube theory
Rickert and Dickson

30
Q

Discredited hollow tube theory

A

Torneck and Wenger
Hollow tubes implanted in tissue did not cause inflammation

31
Q

Pulpal irritants activate both ______ and ______ immune systems

A

Innate and Acquired

32
Q

Components of innate immune system (5)

A

Physical barriers
phagocytes
inflammation
mast cells
basophils

33
Q

Components of acquired immune system

A

B cells and T cells

34
Q

Stimuli transferred via _______ activate a delta and C fibers

A

fluid movements

35
Q

C fibers conduct signals and ________

A

release neuropeptides

36
Q

Pulpal blood flow is ______ in nature

A

Biphasic

37
Q

Cellular immunity within the pulp provided by

A

Leukocytes
macrophages
lymphocytes

38
Q

humoral immunity within the pulp provided by

A

immunoglobulins
prostaglandins
cytokines

39
Q

Pulp tissue necrosis via ______

Author

A

coalescing of micro-abscesses
Langeland

40
Q

Correlation between symptoms/clinical diagnosis with histology

A

Normal and reversible diagnoses are correct 96% of the time
Irreversible is correct 84% of the time
Ricucci

41
Q

Predominant immune cell in development of apical periodontitis

A

Lymphocytes

42
Q

T cell involved in active lesion development

A

T helper

43
Q

T cell involved in chronic lesions

A

T surpressor cells

44
Q

Predominant immunoglobulin in apical periodontitis

A

IgG

45
Q

Increase in circulating antibodies in patients with _____ and ________

A

AAA and flare-ups

46
Q

Prostaglandins are byproducts of _____ formed via the ________

A

Arachidonic acid
Cyclooxygenase pathway

47
Q

Symptomatic lesions have higher _______ activity

A

Prostaglandin

48
Q

Cytokines are produced by ______ when ______ becomes activated by pathogens

A

Macrophages
toll-like-receptor 4

49
Q

_______ has 15 times bone resorption potency

A

IL-1 B

50
Q

Cytokines including _____, _____, and ______ promote the fusion of osteoclast precursor cells which cause subsequent bone resorption

A

IL-1, TNF-a, and leukotrienes

51
Q

Bone resorption process

A

cytokines stimulate production of RANKL which stimulate osteoclasts

52
Q

The presence of live bacteria in periapical lesions is _______

A

controversial

53
Q

Diagnosis of granuloma vs cyst cannot be based on _______

A

radiographs

54
Q

Periapical granulomas are composed of _______ tissue and _______ inflammation

A

Granulation
Chronic (not granulomatous)

55
Q

Predominant immunoglobulin in granulomas

A

IgG

56
Q

Periapical cysts posses an _________

A

epithelial lining

57
Q

Torabinejad’s immunologic theory of cyst formation is that

A

inflammation stimulates epithelial rests of Mallasez to proliferate

58
Q

Two types of periapical cysts

A

true cyst – not connect to apex (more common)
bay cyst – communicate with periapex

59
Q

Of non-endodontic lesions, ______ were benign and ____ were malignant

A

66%
29%

60
Q

Most common benign lesions

A

ameloblastoma, nasopalatine duct cyst

61
Q

Most common malignant lesions

A

metastatic lesions, carcinomas

62
Q

Specimens are ______% granulomas, ______% abscesses, and _____% cysts

A

50%
35%
15%

63
Q

Post-operative exacerbation of symptoms

A

Endodontic flare-up

64
Q

Incidence of flare-up

A

5.8% of teeth with lesions
Yu
8.4% Tsesis

65
Q

Flare-up factors (5)

A

female sex
pre-operative pain and swelling
dx of pulpal necrosis
retreatment
history of allergies

66
Q

Flare-up cannot be prevented with abx

A

Walton and Fouad

67
Q

Abx can be used to control flare-up once initiated

A

Seltzer

68
Q

Flare-up is not associated with treatment failures

A

de Chevigny

ABE Oral Board Review (12 decks)

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