Pulpal Diseases and Diagnosis Flashcards

1
Q

The pulp contains

A

nerves
blood vessels
connective tissue

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2
Q

What limits the available room for expansion and restricts the pulp’s ability to tolerate edema

A

Dentin

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3
Q

The pulp lacks _______, which severely limits its ability to cope
with bacteria, necrotic tissue, and inflammation.

A

collateral circulation

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4
Q

hard tissue-secreting cells

A

odontoblasts

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5
Q

what is formed to protected the pulp from injury?

A

odontoblasts and mesenchymal cells that differentiate into osteoblasts

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6
Q

The sensibility of the dental pulp is controlled by what nerve fibers?

A

A-delta
C

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7
Q

What type of nerve fibers are A-delta and C

A

afferent

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8
Q

A-delta fibers

A

are larger myelinated nerves that enter the root canal and divide into
smaller branches, coursing coronally through the pulp

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9
Q

How is pain perceived by a-delta fibers

A

immediately as quick, sharp, momentary pain, which dissipates quickly

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10
Q

what cell layer and tissue is intimately associated with the a-delta fibers?

A

odontoblastic cell layer and dentin
aka the pulpodentinal complex

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11
Q

what is it called when the response is exaggerated and disproportionate to
the challenging stimulus

A

hyperalgesia

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12
Q

C fibers

A

small, unmylenated nerves that course centrally in the pulp stroma

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13
Q

C fiber pain surfaces with

A

tissue injury and is mediated by inflammatory mediators,
vascular changes in blood volume and blood flow and increases in tissue pressure

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14
Q

When C fiber pain dominates, it signifies what

A

irreversible local tissue damage

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15
Q

How can you classify pupal diseases

A

normal pulp
reversible pulpitis
Symptomatic irreversible pulpits
Asymptomatic Irreversible Pulpitis
Pulp Necrosis
Previously treated

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16
Q

In RP, thermal stimuli (usually cold) cause a

A

quick, sharp, hypersensitive response that
subsides as soon as the stimulus is removed

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17
Q

What may cause reversible pulpits

A

Any irritant that can affect the pulp

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18
Q

In RP, if the irritant is removed, what happens to the pulp?

A

return to a normal healthy state

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19
Q

In RP, if the irritant remains, what happens to the pulp?

A

the symptoms may lead to irreversible pulpitis

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20
Q

How to distinguish between symptomatic irreversible and reversible pulpitis

A
  1. 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
  2. Reversible pulpits does not involve a complaint of spontaneous
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21
Q

What is the crossover from RP to IP

A

penetration of bacteria

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22
Q

What is symptomatic irreversible pulpitis

A

the pulp has been damaged beyond repair, and even with removal
of the irritant, it will not heal

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23
Q

what is the end result of irreversible pulpitis?

A

necrosis

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24
Q

what are characteristics of SIP

A

spontaneous, unprovoked, intermittent or continuous pain

postural change, such as lying down or
bending over, induces pain

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25
Q

what tool of vitality is of little value in the diagnosis of SIP

A

electrical pulp test

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26
Q

are there clinical syptoms of AIP

A

There are no clinical symptoms, but inflammation produced by caries, caries
excavation or trauma occurs

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27
Q

what leads to pulp necrosis

A

Untreated irreversible pulpits

Traumatic injury

Any event that causes long-term interruption of the blood supply to the pulp

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28
Q

what can pulp necrosis be further classified as

A

partial or total

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29
Q

what is partial necrosis

A

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.

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30
Q

what is total necrosis

A

asymptomatic before it affects the PDL, and there is no response to thermal
or electrical pulp tests

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31
Q

what leads to thickening of the PDL and manifests as tenderness to percussion and chewing

A

Protein breakdown products and bacteria and their toxins eventually spread beyond the apical foramen

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32
Q

Previously Treated Pulp means?

A

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

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33
Q

Hyperplastic pulpitis

A

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

34
Q

Internal resorption

A

commonly identified during routine radiographic examination. If
undetected, internal resorption eventually perforates the root

35
Q

symptoms of apical diseases

A

Slight sensitivity to chewing.

Sensation of tooth elongation or elevation, hitting first.

Intense pain

Swelling

Fever

Malaise

36
Q

The sign most indicative of an apical inflammatory lesion is

A

radiographic bone
resorption

37
Q

T/F: Apical lesions are frequently not visible on
radiographs

A

True

38
Q

Classification of Apical Diseases

A

Symptomatic Apical Periodontitis (SAP)
Asymptomatic Apical Periodontitis (AAP)
Acute Apical Abscess (AAA)
Chronic Apical Abscess (CAA)

39
Q

Symptomatic Apical Periodontitis (SAP)

A

painful inflammation around the apex (localized inflammation of the PDL
in the apical region)

40
Q

What is the only way to confirm the need for endo treatment on vital or nonvitial teeth?

A

pulp test because of symptomatic apical periodontitis

41
Q

T/F: Even when present, the apical PDL may radiographically appear within normal limits or
only slightly widenen

A

true

42
Q

increased pressure can also cause
physical pressure on the nerve endings, which subsequently causes intense, throbbing apical pain because of what

A

there is little room for expansion of the PDL

43
Q

Asymptomatic Apical Periodontitis (AAP)

A

a long-standing asymptomatic or mildly symptomatic lesion

44
Q

What usually acompanies a long-standing asymptomatic apical periodontitis (AAP)

A

visible apical bone resorption

45
Q

What is the diagnosis of AAP confirmed by

A

General absence of symptoms

Radiographic presence of an apical radiolucency

Confirmation for pulpal necrosis

46
Q

A totally necrotic pulp provides a safe harbor for what type of organisms?

A

primarily anaerobic

47
Q

AAP traditionally has been classified histologically as

A

apical granuloma or apical
cyst

48
Q

Acute Apical Abscess (AAA)

A

An acute apical abscess is painful, with purulent exudate around the apex

49
Q

what is the characteristics of the PDL with AAA (acute apical abscess)

A

PDL may radiographically appear within normal limits or only slightly
thickened

50
Q

What are signs and symptoms of AAA

A

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)

51
Q

Chronic Apical Abscess (CAA) is associated with what?

A

continuously or an intermittently draining sinus tract
without discomfort

52
Q

What can mimick a perio lesion with a pocket

A

draining sinus tract without discomfort.the exudate can also drain through the gingival sulcus

53
Q

Chronic Apical Abscess (CAA) has what results for pulp test

A

negative because of the necrotic pulp

54
Q

Chronic Apical Abscess (CAA) will show what radiographically

A

bone loss at the apical area

55
Q

Condensing Osteitis

A

Excessive bone mineralization around the apex of an asymptomatic vital tooth.

This process is asymptomatic and benign. It does not require Endodontics therapy

56
Q

What are the types of cracked teeth

A

craze lines
fractured cusp
cracked tooth
slip tooth
vertical root fracture

57
Q

what are some clinical features of cracked tooth syndrome

A

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.

58
Q

what are some radiographic features of cracked tooth syndrome

A

line of fracture is not in the plane of the radiograph

59
Q

what is the incidence of cracked tooth syndrome

A

primarily mandibular molars, with a slight preference for the first over the
second molar

60
Q

what is the diagnostic process of cracked tooth syndrome?

A

transillumination

use of a tooth slooth or a cotton-tipped applicator

Stain

61
Q

What is transillumination?

A

The light is transmitted through the
tooth structure but is reflected in the crack
plane, leaving the area behind the crack in
darkness.

62
Q

Tooth Slooth device

A

the tip of the pyramid is touching the tested cusp
while the wide base is supported by multiple contacts.

63
Q

what are the outcomes of cracked tooth syndrome?

A

healthy pulp or reversible pulpitis
irreversible pulpitis or necrosis with acute apical periodontitis (symptomatic or asymptomatic)
restoration

64
Q

what are examples of a guarded prognosis

A

The presence and extent of an isolated probing

Extension of the crack to the floor of the pulp chamber

65
Q

what are examples of a poor prognosis

A

Fracture traceable all the way from mesial to distal

66
Q

what are 3 types of vertical root fractures?

A

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

67
Q

How can an early VRF pocket can easily be missed

A

Not checking carefully at every millimeter of the sulcus

68
Q

periodontal pockets appear more commonly where

A

in the proximal sides of the root

69
Q

VRF pockets are more common on what sides

A

on the buccal or lingual sides

70
Q

Vertical root fracture starts apically and progresses

A

coronally

71
Q

T/F: There is an isolated probing defect at the site of the fracture in most cases.

A

True

72
Q

What is an important radiolucency found in the apical region of the root?

A

J-shape

73
Q

Vertical root fracture may mimic what

A

perio disease
failed root canal

74
Q

what is the etiology of vertical root fracture

A

Extensive enlargement of the canal
Mechanical stress from obturation
Unfavorable placement of posts

75
Q

how can you confirm a diagnose of vertical root fracture?

A

visualizing with an exploratory surgical flap

76
Q

what is the goal of treatment for a vertical root fracture

A

eliminate the fracture space

77
Q

treatment for VRF in a single rooted tooth

A

extraction

78
Q

treatment for VRF in a multi rooted tooth

A

hemisection
extraction

79
Q

what is a hemisection?

A

root resection with the removal of only the affected root

80
Q

how does the pulp and periodontium communicate?

A

dentinal tubules

lateral accessory canals

furcation canals

apical foramen

81
Q

can endo problems cause perio problems?

A

yes

82
Q

does periodontal disease usually does not cause endodontic

A

no UNLESS the apices is involved