Pulpal Diseases and Diagnosis Flashcards
The pulp contains
nerves
blood vessels
connective tissue
What limits the available room for expansion and restricts the pulp’s ability to tolerate edema
Dentin
The pulp lacks _______, which severely limits its ability to cope
with bacteria, necrotic tissue, and inflammation.
collateral circulation
hard tissue-secreting cells
odontoblasts
what is formed to protected the pulp from injury?
odontoblasts and mesenchymal cells that differentiate into osteoblasts
The sensibility of the dental pulp is controlled by what nerve fibers?
A-delta
C
What type of nerve fibers are A-delta and C
afferent
A-delta fibers
are larger myelinated nerves that enter the root canal and divide into
smaller branches, coursing coronally through the pulp
How is pain perceived by a-delta fibers
immediately as quick, sharp, momentary pain, which dissipates quickly
what cell layer and tissue is intimately associated with the a-delta fibers?
odontoblastic cell layer and dentin
aka the pulpodentinal complex
what is it called when the response is exaggerated and disproportionate to
the challenging stimulus
hyperalgesia
C fibers
small, unmylenated nerves that course centrally in the pulp stroma
C fiber pain surfaces with
tissue injury and is mediated by inflammatory mediators,
vascular changes in blood volume and blood flow and increases in tissue pressure
When C fiber pain dominates, it signifies what
irreversible local tissue damage
How can you classify pupal diseases
normal pulp
reversible pulpitis
Symptomatic irreversible pulpits
Asymptomatic Irreversible Pulpitis
Pulp Necrosis
Previously treated
In RP, thermal stimuli (usually cold) cause a
quick, sharp, hypersensitive response that
subsides as soon as the stimulus is removed
What may cause reversible pulpits
Any irritant that can affect the pulp
In RP, if the irritant is removed, what happens to the pulp?
return to a normal healthy state
In RP, if the irritant remains, what happens to the pulp?
the symptoms may lead to irreversible pulpitis
How to distinguish between symptomatic irreversible and reversible pulpitis
- Reversible pulpits causes a momentary painful response to thermal change that
subsides as soon as the stimulus. symptomatic irreversible pulpits causes a painful response to thermal change that
lingers after the stimulus is removed - Reversible pulpits does not involve a complaint of spontaneous
What is the crossover from RP to IP
penetration of bacteria
What is symptomatic irreversible pulpitis
the pulp has been damaged beyond repair, and even with removal
of the irritant, it will not heal
what is the end result of irreversible pulpitis?
necrosis
what are characteristics of SIP
spontaneous, unprovoked, intermittent or continuous pain
postural change, such as lying down or
bending over, induces pain
what tool of vitality is of little value in the diagnosis of SIP
electrical pulp test
are there clinical syptoms of AIP
There are no clinical symptoms, but inflammation produced by caries, caries
excavation or trauma occurs
what leads to pulp necrosis
Untreated irreversible pulpits
Traumatic injury
Any event that causes long-term interruption of the blood supply to the pulp
what can pulp necrosis be further classified as
partial or total
what is partial necrosis
Partial necrosis may manifest with some of the symptoms associated with irreversible pulpits.
For example, a tooth with two canals could have and inflamed pulp in one canal and necrotic
pulp in the other.
what is total necrosis
asymptomatic before it affects the PDL, and there is no response to thermal
or electrical pulp tests
what leads to thickening of the PDL and manifests as tenderness to percussion and chewing
Protein breakdown products and bacteria and their toxins eventually spread beyond the apical foramen
Previously Treated Pulp means?
Clinical diagnostic category indicating that the tooth has been endodonticaly
treated and the canals are obdurated with various filling materials other than
intracanal medicaments. i.e. CaOH
Hyperplastic pulpitis
reddish, cauliflower-like growth of pulp tissue through and
around a carious exposure. The proliferative nature of this type of pulp is
attributed to low-grade, chronic irritation of the pulp and the generous vascular
supply characteristically found in young people
Internal resorption
commonly identified during routine radiographic examination. If
undetected, internal resorption eventually perforates the root
symptoms of apical diseases
Slight sensitivity to chewing.
Sensation of tooth elongation or elevation, hitting first.
Intense pain
Swelling
Fever
Malaise
The sign most indicative of an apical inflammatory lesion is
radiographic bone
resorption
T/F: Apical lesions are frequently not visible on
radiographs
True
Classification of Apical Diseases
Symptomatic Apical Periodontitis (SAP)
Asymptomatic Apical Periodontitis (AAP)
Acute Apical Abscess (AAA)
Chronic Apical Abscess (CAA)
Symptomatic Apical Periodontitis (SAP)
painful inflammation around the apex (localized inflammation of the PDL
in the apical region)
What is the only way to confirm the need for endo treatment on vital or nonvitial teeth?
pulp test because of symptomatic apical periodontitis
T/F: Even when present, the apical PDL may radiographically appear within normal limits or
only slightly widenen
true
increased pressure can also cause
physical pressure on the nerve endings, which subsequently causes intense, throbbing apical pain because of what
there is little room for expansion of the PDL
Asymptomatic Apical Periodontitis (AAP)
a long-standing asymptomatic or mildly symptomatic lesion
What usually acompanies a long-standing asymptomatic apical periodontitis (AAP)
visible apical bone resorption
What is the diagnosis of AAP confirmed by
General absence of symptoms
Radiographic presence of an apical radiolucency
Confirmation for pulpal necrosis
A totally necrotic pulp provides a safe harbor for what type of organisms?
primarily anaerobic
AAP traditionally has been classified histologically as
apical granuloma or apical
cyst
Acute Apical Abscess (AAA)
An acute apical abscess is painful, with purulent exudate around the apex
what is the characteristics of the PDL with AAA (acute apical abscess)
PDL may radiographically appear within normal limits or only slightly
thickened
What are signs and symptoms of AAA
Rapid onset of swelling
Moderate to severe pain
Pain with percussion and palpation
Slight increase in tooth mobility
Extent and distribution of swelling are determined by the location of the apex and the muscle attachments and the thickness of the cortical plate.
Usually the swelling remains localized. However, it also may become diffuse and
spread widely (Cellulitis)
Chronic Apical Abscess (CAA) is associated with what?
continuously or an intermittently draining sinus tract
without discomfort
What can mimick a perio lesion with a pocket
draining sinus tract without discomfort.the exudate can also drain through the gingival sulcus
Chronic Apical Abscess (CAA) has what results for pulp test
negative because of the necrotic pulp
Chronic Apical Abscess (CAA) will show what radiographically
bone loss at the apical area
Condensing Osteitis
Excessive bone mineralization around the apex of an asymptomatic vital tooth.
This process is asymptomatic and benign. It does not require Endodontics therapy
What are the types of cracked teeth
craze lines
fractured cusp
cracked tooth
slip tooth
vertical root fracture
what are some clinical features of cracked tooth syndrome
Sustained pain during biting pressures.
Pain only on release of biting pressures.
Occasional, momentary, sharp, poorly localized pain during mastication that is very difficult to reproduce.
Sensitivity to thermal changes.
Sensitivity to mild stimuli, such as sweet or acidic foods.
what are some radiographic features of cracked tooth syndrome
line of fracture is not in the plane of the radiograph
what is the incidence of cracked tooth syndrome
primarily mandibular molars, with a slight preference for the first over the
second molar
what is the diagnostic process of cracked tooth syndrome?
transillumination
use of a tooth slooth or a cotton-tipped applicator
Stain
What is transillumination?
The light is transmitted through the
tooth structure but is reflected in the crack
plane, leaving the area behind the crack in
darkness.
Tooth Slooth device
the tip of the pyramid is touching the tested cusp
while the wide base is supported by multiple contacts.
what are the outcomes of cracked tooth syndrome?
healthy pulp or reversible pulpitis
irreversible pulpitis or necrosis with acute apical periodontitis (symptomatic or asymptomatic)
restoration
what are examples of a guarded prognosis
The presence and extent of an isolated probing
Extension of the crack to the floor of the pulp chamber
what are examples of a poor prognosis
Fracture traceable all the way from mesial to distal
what are 3 types of vertical root fractures?
coronally located VRF extending apically
mid root VRF extending along the middle third of the root
apically located VRF extending coronally as far as the apical two-thirds of the root
How can an early VRF pocket can easily be missed
Not checking carefully at every millimeter of the sulcus
periodontal pockets appear more commonly where
in the proximal sides of the root
VRF pockets are more common on what sides
on the buccal or lingual sides
Vertical root fracture starts apically and progresses
coronally
T/F: There is an isolated probing defect at the site of the fracture in most cases.
True
What is an important radiolucency found in the apical region of the root?
J-shape
Vertical root fracture may mimic what
perio disease
failed root canal
what is the etiology of vertical root fracture
Extensive enlargement of the canal
Mechanical stress from obturation
Unfavorable placement of posts
how can you confirm a diagnose of vertical root fracture?
visualizing with an exploratory surgical flap
what is the goal of treatment for a vertical root fracture
eliminate the fracture space
treatment for VRF in a single rooted tooth
extraction
treatment for VRF in a multi rooted tooth
hemisection
extraction
what is a hemisection?
root resection with the removal of only the affected root
how does the pulp and periodontium communicate?
dentinal tubules
lateral accessory canals
furcation canals
apical foramen
can endo problems cause perio problems?
yes
does periodontal disease usually does not cause endodontic
no UNLESS the apices is involved
