Test questions Flashcards
Reversible Pulpitis
- Pain
- Cold- exaggerated/non-lingering
Symptomatic Irreversible Pulpiitis
- Pain
- Cold- Hyperesponsive/ Lingering
Asymptomatic Irreversible Pulpitis
- No pain
- Responds to cold with no-lingering pain
Necrotic Pulp
- Non responsive to cold
Symptomatic Apical Periodontitis
- Pain
- Painful during
- Bitting
- Percussion
- May or may not have a RL
Asymptomatic Apical Periodontitis
- No response to anything
- RL
Acute Apical Periodontits
- Pain
- Swelling
- Painful to
- Palapation
- Bitting
- Percussion
- Radio
- WNL
- PARL
- Inflammatory reaction to pulpal infection and necrosis
- rapid onset, spontaneous pain, pus formation
Chronic Apical Periodontitis
- Sinus tract
- PARL
A-beta and A-delta fibers
- Myelinated
- Located in pulp and DENTIN
- Sharp pain, stabbing, pricking
- Low threshold
- Stimulated by hot/cold/air/drilling
- Warning sign, not neccesarily associated with tissue damage
C fibers
- Non-myelinated
- Centrally located throughout pulp
- Dull burning, aching prolonged pain
- High threshold
- May not be stimulated by hot/cold
- Usually associated with tissue damage w/i pulp
Prognosis for Vital pulp
95% prognosis
No bacteria
no infection, inflammation could be present
Non vital/necrotic prognosis
85% prognosis
bacteria and infection present
Antibiotics
- Very seldomly used
- Only RX if systemic indications
- Temp, swelling, cellulitis, malaise, trismus
T/F
An acute apical abcess will not respond to pulp vitality tests
An acute apical abcess is only observed in association with a necrotic pulp
T
T
Pt present with swelling, non-vital tooth
- Periapical dx
- Acute apical abcess
- Pulpal dx
- Non-vital tooth pulpal necrosis
- If no PARL does not mean there is not an abcess, could be very new due to rapid onset and just hasnt shown up on radio yet
What is a RL telling us?
Micro of tooth and number of species
- RL indicates presence of an inflammatory response and steoclast activity (bone resorption)
- 10-30 species 90% obligate anaerobes
- Mixed community
- Planktonic (free floating)
- Gram negative predominate
Case: swelling, spontaneous pain
No RL or might be RL
Negative EPT and cold
- Non-vital/Necrotic pulp
Put a cold pellet on tooth
Explain how A fibers are stimulated
- Hydrodynamic theory
- movement of fluid in tubules stimulates fibers
- Fluid within tubules directly act on pulpal nerves
- Fluid movement is result of capillary force
Younger vs older patients
cells and collagen diff
- Younger
- More cells and fewer collagen, less calcified
- Older
- Less cells more collagen more calcified
Pulp development
- Pulp develops from Dental Papilla (along with dentin)
- Dental papilla is ectomesenchymal origin (neural crest cells with local mesenchyme)
- Outer layer of dental papilla will differentiate into odontoblasts (dentin)
CDJ
What 2 soft tissues are present at CDJ
- Pulp to PDL transition
- Where youu want to end your working length
- .5-1mm coronal to radio apex
- Pulp and PDL are present at CDJ
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EPT
- Provides no diagnostic value with vital pulp pathosis
- Not indicated for teeth which respond to thermal challenge
- Indicates only pulp vitality or necrosis
- yes or no
- Device output numbers are insignificant
- EPT Vitality measures vascular supply
- Cold measures nerve response
- 0-79 vital
- 80+ necrotic
As you get closer to the pulp how do the numbers and size of dentinal tubules change
Increase in size, diameter and number
What dx test reflects the histologic status of pulp
NONE
Why do we do a pulp test when pt has trauma initially
Baseline
Can you test a crowned tooth with endo ice
How to test crown with EPT
- Yes can endo ice test crowned teeth
- To use an EPT on a crown need recession to contact natural tooth
Dentin and nerve hypersensitivity, what nerve fiber is involved
A delta fibers are associated with dentin hypersensitivity
If lingering pain–>C
Apexogenesis
A vital pulp therapy to encourage continued physiologic development and formation of the root end
Need vital pulp to allow root to develop
Apexification
- Process where a non-vital immature permanent tooth which has lost ability to further develop is induced to form a calcified barrier at the root terminus
- This barrier forms a matrix against which a root canal filling can be compacted with length control
How long for pulpal anesthesia to set in
10-15 mins
Vitality by performing pulp test
Cant verify by soft tissue
Restoring an endo tx tooth
max 2nd molar
what are the exceptions
- When is a post not necessary
- If tooth has 3-4mm of tooth structure coronally with good wall thickness remaining
- Ferrule- a crown that surrounds healthy tooth strcture 360
- When not to restore a prev endo tx tooth
- Perio probing depth
- Fracture
- If tx was not succesful and cant dx the problem
Post length, diameter, ferrule
- Short posts more likely to fracture
- Posts dont strengthen teeth themselves, only increase retention
- Bigger diameters make it more likely to fracture
- Ferrule keeps everything nice and tight, interlocking notch, also increases retention
Avulsion open apex
- Under 60 mins
- Revascularization recall every 3-4wks
- Rinse
- Soak in doxycyclin or coat in minocycline/tetracycline
- reimplant
- Over 60 mins open apex
- Start apexification at 2nd visit
- Acid 5 min
- Stannous flouride
- Extraoral endo
- Submerge by decoronation
- can use systemic AB
PDL damage vs pulp damage
- PDL
- intrusion
- avulsion
- lateral luxation
- Pulp necrosis
- Avulsion
- Intrusion
- Lateral luxation
CDJ
- 1mm from anatomical apex
- Apical foramen to CDJ- 0.5-1mm
- Apical constriction does not equal CDJ
- This is where the PDL meets the pulp
- Cant be located radiographically
- CDJ not clinically evident in all teeth
*
aging teeth/necrotic and their relationship with CDJ
- Necrotic
- Root canal filling will be closer to the apex
- may be due to root resorption
- Aging
- As cementum gets deposited over time at the apex of the tooth, the canal appears to elongate
- The CDJ does not change position
- Bc of this depositon of cementum it seems the canal is being elongated apically
- Prec RCT may seem short of anatomical apex
Most accurate way to find CDJ
Apex locator 95% accurate
When will PDL be useless
1 hr after avulsion
Indications for internal bleaching
- Indications
- Pulp necrosis, trauma, pulp tissue remnants, endo materials
- Ready to restore
- 2 weeks
- Immediate bonding of composite to bleached tooth results in sig reduction of adhesive bond strength
- wait 1-3 weeks to place permanent restoration
When does the apical area of the tooth form?
In a newly erupted tooth when does the root form?
2-3 years after eruption
Endodontic therapy definition
Prevention or tx of apical periodontitis
Testing an older pt that doesnt respond to cold due to calcification
- EPT
Can devitalized pulp cause apical periodontits
No
Pulp does not cause apical periodontitis, bacteria stimulate inflammatory responses within the pulp which then activates osteoclasts leading to appical periodontits
Pulpotomy
- Vital tooth
- If pt presents with irreversible pulpitis with negative percussion (normal apex)
- no need for pulpectomy bc apex is not affected
Full Pulpectomy
- Non-vital tooth
- If pt presents with irreversible pulpitis with positive percussion (abnormal apex)
- Complete a pulpectomy since apex is not affected
ells involved in chrnic lesion
Lymphocytes macrophages plasma cells
Caries is a
Chronic inflammation process
What should you never use to stop bleeding
Formocresol, hemostatic agents, can cause resorption
Instead you want it to stop bleeding on its own bc it indicates healthy pulpal tissue
Emergency tx for a tooth you need to know dx
- Irreversible pulpitis
- with percussion
- Pullpectomy
- Irreversible pulpitis
- with negative percussion
- Pulpotomy
- Reversible pulpitis
- no tx or direct/indirect pulp cap
- Necrotic pulp
- Pulpectomy
