Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endodontics > Quiz 3 > Flashcards

Quiz 3 Flashcards

1
Q

How can periodontal disease affect the pulp?

A

It is a two way street and microbes in subgingival biofilms could reach the pulp through canals. Pulpal necrosis only occurs if periodontal disease/pocket reaches the apical foramen due to damage of blood vessels that penetrate the apical foramen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the characteristics of irreversible pulpitis?

A

You can have symptomatic or asymptomatic, and the pain is usually prolonged rather than sharp, but pulp will eventually become necrotic so RCT is needed. The best time to treat is when it is asymptomatic and caries possibly into pulp space.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the steps in the vicious cycle in response to Trauma and the cause of pulpal pain?

A

1) Increased blood flow leads to vasodilation and an increased capillary pressure, which leads to 2) increased capillary filtration, which leads to 3) increased tissue pressure, resulting in pulpal pain because it is acting on sensory nerve receptors! Pain also happens because a release of mediators of inflammation by directly lowering the sensory nerve threshold. And it is this increased pressure that compresses the thin-walled venous vessels, which leads to decreased blood flow, strangulating the pulpal vessels, and if this goes on for a while, will lead to pulpal necrosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What type of immune cells does normal pulp, and even inflamed pulp contain?

A

T and B cells, macrophages, dendritic cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a main purpose of a pulp cap or dressing?

A

To put on the pulp to create an inflammatory process in order to start the healing process.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the symptoms of Asymptomatic Apical Periodontitis (chronic)?

A
  • Little or no pain, even with percussion
  • No response to Pulp Vitality Tests
  • Slightly sensitive to palpation
  • Widened PDL to Extensive lesion (starting lesion at least)
  • Granuloma—PMNS, Mast Cells, Macrophages (no epithelium)
  • Apical Cyst—Stratified squamus epithelium surrounded by CT containing all cellular components found in granuloma (Granuloma that contains a cavity lined with epithelium— Epithelial Cell Rests of Malessev or Hertwigs root sheath)
  • 59% granuloma, 22% cysts, 12% scars, 7% ?
  • A granuloma is your basica apical abscess
  • There may be slight sensitivity to palpation, indicating an alteration of the cortical plate of bone and extension of AAP into the soft tissues. Radiographic features range from interruption of the lamina dura to extensive destruction of periapical and interradicular tissues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the signs and symptoms of an acute apical abscess?

A

• Rapid onset of acute spontaneous pain to percussion and biting and palpation

  • Moderate to severe discomfort and swelling—intra and sometimes extraoral
  • Purulence (pus), sinus tract sometimes
  • Surrounding the abscess is granulomatous tissue (an

abscess within a granuloma)

  • Lymphadenophy—submandibular and cervical
  • Periapical Radiolucency
  • No response to Pulp Vitality Tests
  • Varying degree of mobility
  • Frequently febrile
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the main inflammatory mediators released when the pulp is irritated?

A

Histamine, bradykinin, arachidonic acid metabolites, PMN granule products (elastase, cathepsin G, lactoferrin), antitrypsin, calcitonin peptide.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a chronic apical abscess?

A
  • Inflammatory lesion of pulpal origin
  • Long standing lesion
  • Same histology as AAA
  • CAA has a pathogenesis similar to that of AAA. It also results from pulpal necrosis and is usually associated with chronic (asymptomatic) apical periodontitis that has formed an abscess. The abscess has “burrowed” through bone and soft tissue to form a sinus tract stoma on the oral mucosa or sometimes onto the facial dermis. CAA may also drain through the periodontium into the sulcus and may mimic a periodontal abscess or pocket
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are we treating when we do a root canal treatment?

A

Periapical Disease. Specifically, to prevent or treat apical periodontitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the 5 main types of pulp vitality testing?

A
  1. Cold 2. Heat 3. Electric 4. Test Cavity 5. Selective Anesthesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is another name for chronic hyperplastic pulpitis and what is it?

A
  • A pulp polyp, and it is when pulp cavity opens and instead of necrosis, pulp tissue proliferates and comes out the top to form a surface epithelium from oral epithelial cell implantation. Usually seen in the younger crowd, and is asymptomatic.
  • Treat this with a root canal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are more common with electric pulp testing? False negatives or false positives? And do you wear gloves?

A

False negatives are more common, and no you don’t wear gloves. If you get a positive response, you know you have a vital tooth.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which type of bacteria are usually eliminated by endodontic treatment? And which type usually persist especially post-instrumentation and post-operation?

A
  • Gram negative are usually eliminated
  • Gram positive and facultative bacteria like streptococi, enterococci, lactobacilli, they all usually stay and hang around, specifically Enterococcus faecalis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Bone loss in cancellous bone is often detected on radiographs. True or False?

A

False. It is not. Bone loss must extend to junction of cortical and cancellous bone to be observed usually. The location of root apices in correlation to this junction affects how early a PA lesion can be detected, and most anterior and pre-molar teeth apices are located closer to the cortical/cancellous junction than molar roots.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is bone resorption and what is its purpose?

A
  • It is a natural host defense mechanism associated with pathological changes in the periapical tissues.
  • Resorption provides a separation between the irritants and the bone preventing osteomyelitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the definition of anachoresis?

A

It is when microbes are transported in blood to areas of tissue damage. Traumatized teeth become infected thru this pathway, and thru enamel cracks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Does a cold test or a heat test induce pain with pulpal necrosis?

A

No, but a heat test can sometimes because it exacerbates pain due to expansion of gases or fluids.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the signs and symptoms of a chronic apical abscess?

A
  • • Generally asymptomatic
  • • Not sensitive to biting
  • • May feel different to percussion
  • • No response to pulp vitality tests
  • • Apical radiolucency
  • • Mucosal or facial sinus tract
  • If the abscesses are huge, they are generally in the chronic stage, so Chronic Apical Abscess
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the signs and symptoms of symptomatic acute periodontitis (also called acute)?

A
  • Spontaneous pain
  • Acute pain to biting or percussion
  • Hot, cold, electric sensitivity (pulpitis)
  • May or may not respond to Pulp Vitality Tests
  • May or may not have PA radiolucency (yet)
  • Widened (thickened) PDL
  • Histology—PMNs and macrophages
  • May have liquefaction necrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is another name for the lamina dura?

A

Alveolar bone proper

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What usually causes reversible pulpitis?

A

Caries, exposed dentin (most common), recent dental treatment, defective restorations, trauma. RCT’s are not needed. Pain on testing will be sharp.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

We should never treat until we have a diagnosis. True or False?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the characteristics of the Cell-Free Zone (Weil) of the pulp?

A

It is 40 nanomicrons long, right next to odontoblastic layer in coronal pulp, free of cells, traversed by blood capillaries and unmyelinated nerve fibers. This are also isn’t found in young or old pulps as much, mainly middle aged.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which group of microbes dominate intraradicular infections?

A
  • Obligate anaerobes, but are easily removed during conventional RCT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is Calcific metamorphosis?

A
  • It is long term low grade pulpal irritation, dentin formation obliterates canals, and is usually not pathosis. A yellowish discoloration of the crown is often a manifestation, and the pain threshold to thermal and electrical stimuli usually increases. Does not require treatment.
  • Book says = Another type of calcification is the extensive formation of hard tissue on dentin walls, often in response to irritation or death and replacement of odontoblasts. This process is called calcific metamorphosis. As irritation increases, the amount of calcification may also increase, leading to partial or complete radiographic (but not histologic) obliteration of the pulp chamber and root canal. A yellowish discoloration of the crown is often a manifestation of calcific metamorphosis. The pain threshold to thermal and electrical stimuli usually increases; often the teeth are unresponsive.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the 5 steps to the correct diagnosis?

A
  1. Chief Complaint
  2. Medical and Dental History (subjective)
  3. Oral Examination and Tests (objective)
  4. Correlate findings to reach differential diagnosis
  5. Formulate definitive diagnosis and treatment plan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the 6 pathways of pulpal disease?

A
  1. Dentinal tubules (doesn’t have to be direct)
  2. Direct pulp exposure
  3. Caries
  4. Iatrogenic
  5. Trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the four characteristics of periapical lesions of endodontic origin?

A
  1. Lamina dura is lost apically 2. Lucency remains at the apex in radiographs made at different cone angles 3. Lucency tends to resemble a hanging drop 4. The lesion is usually seen with a necrotic pulp
30
Q

What are the four characteristics of periapical lesions of endodontic origins?

A
  1. Lamina Dura lost apically (widened)
  2. Lucency remains at apex despite angulation
  3. Lucency resembles hanging drop
  4. Tooth has necro;c pulp
31
Q

What is severe swelling in the face usually indicative of?

A

An acute alveolar abscess, usually from bacteria that has spread from necrotic pulp.

32
Q

What is osteosclerosis?

A
  • This is idiopathic, no known cause. Tooth is vital, normal, shallow filling, completely asymptomatic. Usually you can elicit pain or you can see that there have been some heavy restorations or something.
33
Q

What is usually the first symptom of an inflamed pulp in a tooth?

A

Cold sensitivity

34
Q

What causes symptomatic apical periodontitis?

A
  • Eliciting irritants include irreversibe pulpitis, inflammatory mediators from an irreversibly inflamed pulp or egress of bacterial toxins from necrotic pulps, chemicals (such as irrigants or disinfecting agents), restorations in hyperocclusion, overinstrumentation of the root canal, and extrusion of obturating materials. The pulp may be reversibly inflamed, irreversibly inflamed or necrotic.
35
Q

What is an acute apical abscess?

A

• Localized or diffuse liquefaction lesion of pulpal origin

  • Destroys periapical tissues
  • Disintegrating PMNs

• Necrotic pulp

• Abcess within a granuloma

36
Q

What are the signs and symptoms of condensing osteitis?

A
  • Depending on the cause (pulpitis or pulpal necrosis), condensing osteitis may be either asymptomatic or associated with pain. Pulp tissue of teeth with condensing osteitis may or may not respond to electrical or thermal stimuli. Furthermore, these teeth may or may not be sensitive to palpation or percussion. Radiographically, the presence of a diffuse concentric arrangement of radiopacity around the root of a tooth is pathognomonic. Histologically, there is an increase in irregularly arranged trabecular bone and inflammation.
  • Root canal treatment, when indicated, may result in the complete resolution of condensing osteitis.
37
Q

If a patient has a necrotic pulp and fluctuant swelling (no drainage), how do you treat them?

A
  • • Treatment—Complete pulpectomy or clean and shape (apical penetration)
  • • Copious irrigation
  • • CaOH after drying
  • • Mucosal I & D (It can get dangerous if the swelling is diffuse and is low on the mandible because it can block the airway and they can die in the middle of the night. That is why drainage if super important)
  • • Cotton/cavit
  • • Antibiotics/Pain Management
38
Q

What are the characteristics of pulp necrosis?

A

Caused by bacteria and bacterial products or loss of blood supply. If exudate produced during irreversible pulpitis is absorbed or drains through caries into oral cavity, necrosis is delayed.

39
Q

What different types of necrosis are involved with pulpal necrosis?

A
  • Infectious agents cause liquefactive necrosis
  • Blood loss causes ischemia or coagulative necrosis
  • As stated before, pulp is encased in rigid walls, it has no collateral blood circulation, and its venules and lymphatics collapse under increased tissue pressure. Therefore irreversible pulpitis leads to liquefaction necrosis. If exudate produced during irreversible pulpitis is absorbed or drains through caries or through a pulp exposure into the oral cavity, necrosis is delayed; the radicular pulp may remain vital for long periods of time. In contrast, closure or sealing of an inflamed pulp induces rapid and total pulpal necrosis and periradicular pathosis. In addition to liquefaction necrosis, ischemic necrosis of the pulp occurs as a result of traumatic injury from disruption of the blood supply. Necrotic pulp is a clinical condition associated with subjective and objective findings indicat- ing death of the dental pulp.
40
Q

What causes Asymptomatic Apical Periodontitis (chronic)?

A
  • Caused by pulpal necrosis
  • Chronic
  • Generally asymptomatic
  • Sometimes patients don’t respond to SAP and it turns into this which won’t cause pain, they forget about it, and it becomes bad.
41
Q

What four things in a tooth can bacteria use as nutrients?

A
  • (1) necrotic pulp tissue
  • (2) proteins and glycoproteins from tissue fluids and exudate that seep into the root canal system via apical and lateral foramina
  • (3) components of saliva that may coronally penetrate the root canal
  • (4) products of the metabolism of other bacteria.
42
Q

What is condensing osteitis?

A
  • Condensing osteitis, a variant of asymptomatic apical periodontitis, represents an increase in trabecular bone in response to persistent irritation. The irritant diffusing from the root canal into periradicular tissues is the main cause of condensing osteitis. This lesion is usually found around the apices of mandibular posterior teeth, which show a probable cause of pulp inflammation or necrosis. However, condensing osteitis can occur in association with the apex of any tooth.
43
Q

If patient has irreversible pulpitis and Symptomatic (acute) Apical Periodontitis, how do you treat them?

A
  • They are extremely percussion sensitive
  • Treatment—complete pulpectomy or clean and shape (RCT without the obturation)
  • Cotton/cavit
  • Relieve occlusion
44
Q

What is the main source of microbial irritation to dental pulp and periradicular tissues?

A

Dental Caries

45
Q

Which type of sensory fibers travel into the dentin? A or C fibers?

A

A-fibers, which are myelinated, while C are not. The conduction velocity for A fibers (A alpha, beta, gamma, and delta) are a lot faster because of the myelination, they also have a larger diameter. C fibers are strictly for pain and found on the dorsal root and are unmyelinated. The different A fibers have different functions. A delta and C fibers are similar because they both respond to pain. A are found in region of pulp-dentin junction, and react to sharp prickling and have a low threshold, while C fibers are found throughout the pulp and are for burning, aching, less bearable sensations and have a high threshold.

46
Q

With the percussion test, what does a painful response from tapping on the crown indicate?

A

Periapical inflammation. This is more often a sharp pain.

47
Q

Primary RCT infections are polymicrobial? True or false?

A

True. And they are dominated by obligatory anaerobic bacteria. The most frequent are gram-neg anaerobic rods, gram-pos anaerobic cocci, gram-pos anaerobic and facultative rods, lactobacillus, and gram-pos facultative streptococus. So mostly everything but gram-neg cocci.

48
Q

What do mast cells do as part of the inflammatory process of irritated pulp?

A

They are not normally found in normal healthy pulp, but they can appear and release histamine, leukotrienes, and other platelet-activating factors, and their presence in blood vessel walls indicate their importance in pulpal inflammation.

49
Q

What kind of pulp vitality testing for cold do we have in the clinic?

A

We have CO2.

50
Q

With infections, which type of bacteria initially dominate for a brief period?

A

Facultative bacteria initially dominate, and then anaerobes take over as oxygen is depleted from the root canal and pulp necrosis takes place.

51
Q

What are the six common complaints for patients regarding endodontic problems?

A
  1. Pain 2. Swelling 3. Broken tooth 4. Loose tooth 5. Tooth discoloration 6. Bad taste/breath
52
Q

What type of bacteria is E. faecalis?

A

Facultative anaerobic gram positive coccus

53
Q

What are the 3 reactions that protect the pulp against caries?

A
  1. Decrease in dentin permeability
  2. Tertiary dentin formation
  3. Inflammatory and immune responses Pulp is the only connective tissue in the body with the ability to protect itself from certain external irritants.
54
Q

What are the 6 main types of mechanical irritants to the tooth/pulp?

A
  1. Deep cavity preps 2. Lack of cooling 3. Impact trauma 4. Occlusal trauma 5. Deep perio curettage 6. Orthodontic movement
55
Q

How is pulp tested with heat for a vitality test?

A
  1. Rubber prophy cup
  2. Gutta Percha stick (most common)
  3. Batter powered
56
Q

What paste do you use for electric pulp testing? For heat testing?

A

Toothpaste for electric and petroleum jelly for heat.

57
Q

Diagnosis Image from Book

A
58
Q

With the percussion test, what does a painful response from tapping on the facial surface but not the occlusal surface indicate?

A

Periodontal inflammation

59
Q

What is internal resorption?

A
  • It is inflamed pulp with dentinoclastic activity. The tooth needs to be vital in order for this to happen. Most of these cases are asymptomatic, but you can end up getting pink spots on the crown if it is advanced. You need to do a root canal on these.
  • Book says = The pulp is transformed into a vascularized inflammatory tissue with dentinoclastic activity; this condition leads to the resorption of the dentinal walls, advancing from its center to the periphery. Most cases of intracanal resorption are asymptomatic. Advanced internal resorption involving the pulp chamber is often associated with pink spots in the crown. Teeth with intracanal resorptive lesions usually respond within normal limits to pulpal and periapical tests. Radiographs reveal presence of radiolucency with irregular enlargement of the root canal compartment. Immediate removal of the inflamed tissue and completion of root canal treatment are recommended; these lesions tend to be progressive and eventually perforate to the lateral periodontium. When this occurs, pulp necrosis ensues and treatment of the tooth becomes more difficult.
60
Q

With orthodontic movement, extrusion reduces pulpal blood flow for a few minutes as the pressure is applied? True or False?

A

False. It is intrusion that does that.

61
Q

If a patient has a necrotic pulp and swelling with drainage, how do you treat them?

A
  • This is probably a chronic apical abscess
  • • Treatment—complete pulpectomy or clean and shape (apical penetration)
  • • Copious irrigation
  • • CaOH after drying
  • • Cotton/cavit
  • • Relieve occlusion
  • • Antibiotics/Pain Management
62
Q

If patient has irreversible pulpitis and normal periapex, how do you treat them?

A
  • Treatment—removal of as much pulpal tissue as time allows (pulpectomy/pulpotomy) or clean and shape
  • Cotton pellet (as good as anything)
  • Relieve occlusion (so not sore between appointments)
  • It’s not infected yet, but is just inflamed, but the longer you wait, it will become infected
63
Q

Which group of microbes is the most common bacteria in endodontic infections?

A

Gram negative

64
Q

What are the 5 factors that determine whether pulp tissue becomes necrotic slowly or rapidly after carious pulp exposure and pulpal inflammation?

A
  1. Virulence of bacteria
  2. Ability to release inflammatory fluids to avoid intrapulpal pressure
  3. Host resistance
  4. Amount of circulation
  5. Most importantly, lymph drainage
65
Q

How do you treat SAP, symptomatic apical periodontitis?

A
  • Do RCT unless it is a hyperocclusion and pulp is vital, reduce occlusion, give it a couple of days, and if not, do RCT
66
Q

What is a good way to differentiate periapical from periodontal inflammation?

A
  • If a painful response is obtained by pressing or by tapping on the crown, this indicates the presence of periapical inflammation. If a painful response is obtained by tapping on the facial surface but not the occlusal/incisal surface, periodontal inflammation is suspected. The pain related to periodontal inflammation is likely to be in the mild-to-moderate range. Periapical inflammation is more often a sharp pain. An additional approach, useful if the patient complains of pain on chewing, is the biting test in which the patient bites down on a cotton swab between each tooth in turn.
67
Q

What are the characteristics of the Cell-Rich (Hohl)Zone of the pulp?

A

It has a high proportion of fibroblasts, immune cells like macrophages, dendritic cells, undifferentiated mesenchymal cells. Also known as subodontoblastic area.

68
Q

When you get pulpal drainage, what comes out first?

A
  • You get purulence first, and then you get hemorrhage. This has to do with the Zones of Fisch. If you take a periapical granuloma there are different zones within that defect. The center of that defect is usually located at the apex of the canal, and in this center is the purulence material, and around that center area is where the battle is, and blood is.
69
Q

If a patient has a necrotic pulp and Symptomatic (acute) Apical Periodontitis, with no swelling, how do you treat them?

A
  • • They will be extremely percussion sensitive
  • • Treatment—complete pulpectomy or clean and
  • shape
  • • Establish drainage if possible
  • • Copious irrigation
  • • CaOH medicament if room after drying
  • • Cotton/cavit (old school—leave open)
  • • Relieve occlusion
  • • Antibiotics/Pain Management
70
Q

If if a tooth is discolored, what does that usually indicate?

A

Necrosis

71
Q

If a patient has a cold pack on their face to relieve pain, is it most likely reversible, irreversible, or necrosis?

A

Irreversible, because the cold may cause vasoconstriction, a drop in pulpal pressure, and subsequent pain relief.

Endodontics (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions