Pulpal and periapical pathology

Question 1

List causes of pulpal disease

Answer 1

• Bacteria
• Trauma
• Chemical
• Mechanical
• Iatrogenic
• Idiopathic

Question 2

_________ infection is the most common cause of dental pulp death.

Answer 2

Bacterial

Question 3

How can trauma cause pulpal disease?

Answer 3

Accidental (e.g. fracture) or physiological (e.g. attrition, abrasion, etc)

Question 4

How does chemical cause pulpal disease

Answer 4

Erosion, restoration material, medication

Question 5

Which mechanical causes pulpal disease?

Answer 5

Cavity preparation, surgery, orthodontics

Question 6

List causes of periapical pathology

Answer 6

• Infection of root canal system (most common cause)
• Trauma
• Foreign body reaction

Question 7

Most common cause of endodontic failure and apical periodontitis

Answer 7

Pulpal infection

Question 8

Infected necrotic pulp will cause?

Answer 8

Apical periodontitis

Question 9

Uninfected necrotic pulp will?

Answer 9

NOT have apical periodontitis

Question 10

Microbiology of intra-radicular infection

Answer 10

Enterococcus faecalis

Question 11

Enterococcus faecalis is often found alone in?

Answer 11

Infection of pulp

Question 12

Virulence factors of enterococcus faecalis

Answer 12

• Can withstand very basic conditions (~ pH 11.5)
• Root canal irrigant may only reach ~pH 10
• Can survive in low nutrient environments

Question 13

What happens in extra-radicular infection?

Answer 13

• Bacterial persisting in periapical tissue

Question 14

Is root canal therapy sufficient for extra-radicular infection?

Answer 14

No

Question 15

Microbiology of extra-radicular infection?

Answer 15

Actinomyces species

Propionibacterium species

Question 16

Describe foreign body reaction

Answer 16

• Tissue reactions to foreign material (e.g. root filling material)
• Characterized by multi-nucleated giant cells

Question 17

How can trauma cause periapical pathology?

Answer 17

Luxation (periodontal trauma) causes damage to pulp and periodontal tissue

Question 18

List the five classes of periodontal disease

Answer 18

• Symptomatic apical periodontitis
• Asymptomatic apical periodontitis
• Acute apical abscess
• Chronic apical abscess
• Condensing osteitis

Question 19

Describe what happens in symptomatic apical periodontitis

Answer 19

• Neutrophils and macrophages present in local area around apex
• Bone and root resorption may be present
• Inflammation is short but may develop into abscess or chronic inflammation

Question 20

Describe what happens in asymptomatic apical periodontitis

Answer 20

• Chronic inflammation at tooth apex

- Granulomatous tissue - lymphocytes, plasma cells and macrophages

Question 21

Describe what happens in acute apical abscess

Answer 21

• Localized area of necrosis containing pus (cell debris, exudate, dead PWN)
• Intracellular and extracellular microorganisms are seen

Question 22

Describe what happens in chronic apical abscess

Answer 22

• Granulation tissue enclosed with dense collagenous capsule

- Microorganisms present in abscess

Question 23

Describe condensing osteitis

Answer 23

• Periapical inflammatory disease

- Increased bone production in response to irritation, rather than destruction

Question 24

There is _______ between the histological findings of pulpal inflammation and clinical signs and symptoms.

Answer 24

Little correlation

Question 25

List two examples of radicular cyst

Answer 25

• Periapical true cyst

- Periapical pocket cyst

Question 26

What is periapical true cyst?

Answer 26

Distinct pathological cavity completely enclosed with epithelial lining with no communication with the root canal

Question 27

What is periapical pocket cyst?

Answer 27

Epithelial lined cavity that is open and continuous with the root canal