what encompasses endo treatment

Question 1

root canal

Answer 1

remove pulp

Question 2

vital pulp therapy

Answer 2

1) caries is removed, cap the exposure

Question 3

how do you decide the status of the pulp

Answer 3

1) inflamed or dead?
2) inflamed or irreversible?
3) history of damage?

Question 4

apical periodontitis

Answer 4

1) when pulp gets infected, it will progress to this and cause bone loss
2) microorgs and toxins going into PA tissues

Question 5

background

Answer 5

1) thousands of microorgs in the mouse
2) bacterial biofilms or foreign material to tissues that are not adapted to their presence triggers inflammation

Question 5

insults to pulp

Answer 5

1_ microbial
- dental caries
- periodontitis
2) mechanical
- trauma
- occlusion
- fractures
- non carious lesions
- ortho
- bruxism
3) thermal
- tooth prep without coolant
- metallic restorations without pulp protection
- lasers
4) chemical
- anything to do with adhesive restorations
5) electrical
- galvanic shock
6) iatrogenic
- no coolant
- insufficient pulp protection
- pulp exposure

Question 6

cumulative effects

Answer 6

1) every restoration has cumulative trauma
2) when you test these teeth, you can have wrong responses
- because parts can be inflamed and part can be necrosis
3) microbial, iatrogenic

Question 6

inflammation

Answer 6

1) redness, swelling, warmth, pain, loss of function
2) does not always mean there is an infection

Question 7

infection

Answer 7

1) host is detrimentally colonized by a pathogen
2) causes inflammation

Question 8

what causes infection

Answer 8

1) microbial
- bacterial
- exotoxin and endotoxin
- virulence factors
- biofilm
2) thermal
3) chemical
- corrosion
- resin monomers

Question 9

what happens during inflammation

Answer 9

1) a vascular event
- vasodilation
- increased permeability
- edema
- increased hydrostatic pressure
- WBC margination
- increased in PMN and monocytes
- tissue death
- PMN breakdown and release proteolytic enzymes
- liquefaction necrosis and purulence

Question 10

normoxia to hypoxia to anoxia

Answer 10

1) increased pulp blood flow during inflammation
2) increased interstitial pressure
3) venous collapse
4) reduce perfusion
5) local necrosis
6) chronic increase in pressure
7) chronic inflammation and total pulp necrosis

Question 11

microbial

Answer 11

1) microbes and microbial toxins in the dentinal tubules
2) dental caries and periodontal infections
3) microleakage around restorations

Question 12

dental caries

Answer 12

1) if there is radiographic evidence of caries into dentin
2) DO A COLD TEST!!
3) chronic disease
- cycle of remin and demin
4) enamel is microporous solid
5) dentin - pulp complex
- microbes and microbial toxins traverse through dentinal tubules to reach the pulp

Question 13

caries progression

Answer 13

1) enamel demineralization and cavitation
2) zone of destruction
3) zone of microbial invasion
4) zone of demineralization

Question 14

insults to the pulp

Answer 14

1) mechanical, thermal, and chemical
2) exposure of patent dentinal tubules
(anatomical, iatrogenic, trauma)
3) scaling and root planing
4) cavity preparation
5) non carious tooth structure loss, fractures, periodontal disease

Question 15

remaining dentin thickness

Answer 15

1) distance between the base of a prepared cavity and the pulp
2) lesser the RDT, more is the expected pulp damage
3) pulp protection (liners and bases)
- less than 0.5 mm

Question 16

dentin dehydration and heat generation

Answer 16

1) other insults to the pulp
2) coolant, heat generating materials
3) about 5.5C, 15% chance of necrosis
4) 11C increase is 60% chance of necrosis

Question 17

dental materials

Answer 17

1) acid etching
2) dentin bonding agents and resin composites
3) bleaching agents

• can be toxic to the pulp
• remaining dentin thickness 1.5 mm or less, consider protecting the pulp

Question 18

sprole’s pulp horns

Answer 18

1) can be exposed during crown prep (they are microscopic)
- cannot be seen radiographically
2) cervical pulp horns
- could be the cause of major sensitivity

Question 19

fate of pulp beneath vital crowns

Answer 19

1) 15.6-32.5% chance of necrosis under metal ceramic crown
2) 5-13% following crown preparation

Question 20

how does pulp respond to caries

Answer 20

1) defensive
2) combo of inflammation
3) depth of caries penetration
4) anywhere between 0.5-1.1, there is mild chronic inflammation
5) severe acute inflammation when caries is 0.5 mm from pulp
6) even 2 mm of dentin means microbial products can still cross

Question 21

pulp exposure

Answer 21

1) pulp test
2) no hemorrhage on sterile exposure
3) direct pulp cap
4) restoration

Question 22

pulp exposure on caries

Answer 22

1) remove infected dentin if you find an exposure.
since this is not a sterile exposure, you have to remove it to make a “post-operative” diagnosis
2) no hemorrhage => pulpotomy
3) hemorrhage (irreversibly inflamed) => RCT

Question 23

pulpal response to injury/insults

Answer 23

1) reversible pulpitis
2) irreversible pulpitis
3) pulp necrosis
4) calcification

Question 24

reversible pulpitis

Answer 24

1) removal of irritant will resolve inflammation
2) never spontaneous pain
3) stimulated by hot and cold
4) never lingering on pulp sensibility tests
5) restorative intervention, pulp capping, pulpotomy
6) RCT no indicated

Question 25

irreversible pulpitis

Answer 25

1) removal of irritant will not resolve inflammation
2) spontaneous pain
3) stimulated by hot and cold
4) lingering on pulp sensibility
5) pain on percussion (but cannot make a pulpal diagnosis on this)
6) RCT indicated

Question 26

pulp necrosis

Answer 26

1) dead pulp tissue
2) may not be 100% dead
3) usually no response to pulp test
- faint response
4) not stimulated by heat and cold
5) may have pain on percussion (spread to periradicular tissues)
6 )RCT

Question 27

changing evidence and changing paradigms in pulp status

Answer 27

1) reversible, irreversible pulpitis and necrosis are histological states
2) clinical signs and symptoms poorly correlate

Question 28

emerging evidence

Answer 28

1) that vital pulp therapy (pulpotomy) may be successful in teeth diagnosed as irreversible pulpitis
2) if you see that there is no hemorrhage

Question 28

fractured central incisor

Answer 28

1) pulp is not exposed
- look at age, vitality test, how long the fracture was there
2) pulp is exposed

Question 29

forecasting

Answer 29

1) do not depend on PA widening and vitality test
2) if there is NO pinpoint exposure and clinically you determined there it was irreversible
- maybe do not intentionally go into the pulp
4) if there is a pinpoint exposure after all caries is removed
- check if there is hemorrhage
- if bigger than pinpoint, EXPAND TO OTHER CANALS TO CHECK AGAIN (ONLY FOR MOLAR TOOTH):
pulpotomy
- if hemorrhage: consider RCT