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Endo > 05 Pathogenesis of the Dental Pulp > Flashcards

05 Pathogenesis of the Dental Pulp Flashcards

1
Q

What are the goals of endodontic treatment?

A
  • Prevent the development of and treat apical periodontitis

- create adequate conditions for periradicular tissue healing

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2
Q

what is apical periodontitis?

A

an inflammatory disease of microbial origin caused primarily by infection of the root canal system

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3
Q

what are the types of apical periodontitis?

A
  • Symtomatic apical pd
  • asymptomatic apical periodonititis (cyst, granuloma, reactive bone formation: condensing osteitis or chronic focal sclerosing osteomyelitis)
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4
Q

what happens to the bone in apical pd?

A

the apical bone undergoes resorption

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5
Q

what are the different routes of root canal infection?

A
  • caries, fractures, exposed dentinal tubules
  • coronal leakage
  • vai periodontium
  • anachoresis (collection, or deposit, of bacteria or other irritants from the blood stream)
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6
Q

In a caries lesion or fracture, how does the bacteria get to the pulp?

A

-most bacteria are non-motile, thus repeated cell division pushes cells into dentinal tubules (being forced into tubules by hydrostatic pressures developed on dentin during mastication)

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7
Q

What are the main bacteria in deep carious lesions?

A
  • Lactobacillus
  • Actinomyces
  • Streptococcus mutans
  • Prohyromonas endodontalis
  • Peptostreptococcus
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8
Q

Anachoresis

A
  • localization of blood-borne bacteria during bacteremia to a site of inflammation
  • seeding of bacteria directly into the inflamed pulp via the pulpal blood supply during bacteremia
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9
Q

Bacteremia:

A

presence of viable organisms in blood

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10
Q

Virulence

A
  • the degree of pathogenicity or disease producing ability of a microorganism
  • virulence factors: characterisitics of a microorganism that enable it to induce disease
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11
Q

what are the main inflammatory mediators in an infected pulp?

A
  • cytokines
  • chemokines
  • neuropeptides
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12
Q

the loss of bone is mainly caused by activated osteoclasts which are induced by:

A

IL-1, IL-11, IL-17, and TNF-alpha

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13
Q

microorganisms entering the pulp and pa tissue, must be able to:

A
  • colonize
  • evade host defense mechanisms
  • initiate tissue destruction
  • deal with variable conditions within the root canal system
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14
Q

types of endodontic infections

A
  • intraradicular infection

- extraradicular infeciton

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15
Q

intraradicular infection

A
  • Primary infection: caused by microorgnaisms that intially invade and colonize necrotic pulp tissue
  • secondary infection: caused by microorganisms not present in the primary infection but introduced in the root canal at some time after professional intervention
  • persisten infection: caused by microorganisms that were members of a primary or secondary infection and in some way resisted intracanal antimicrobial procedures and were able to endure periods of nutrient deprivation in treated canals
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16
Q

distribution of microorganisms

  • apical area:
  • coronal part of the canal:
A
  • apical: dominated by slow growing obligate anaerobes

- coronal: more rapidly growing facultative anaerobes

17
Q

what viruses are associated with endo?

A
  • Epstein-Barr virus may be associated with pulpitis and apical periodontitis
  • Herpes viruses present in dental pulp but not required for development of acute apical abscess or cellulitis of endodontic origin
18
Q

bacteria in primary vs perviously treated canals:

A
  • Primary: predominantly gram negative anaerobic rods
  • Previously treated: gram positive facultative anaerobes, starvation-survival capacity is likely a selection factor for microbial participation in post treatment disease
19
Q

what bacteria is associated with unsuccessful tx?

A

89.6% enterococcus faecalis

20
Q

Enterococcus Faecalis

A
  • Gram positive
  • Nonmotile
  • facultatively anaerobic bacteria
  • present in failed tx 3X more than primary Tx
21
Q

extraradicular infection:

A
  • characterized by microbial invasion of the inflamed periradicular tissues and is a sequel to the intraradicular infection
  • it can be dependent on or independent of the intraradiular infection
22
Q

fascial space infections:

A

bacteria from the infected root canal gain entry into the periradicular tissues…actute apical abscess can evolve to cellulitis

23
Q

Which of the following is not a source of nutrients for bacteria within a root canal system?
Answer
a.
necrotic pulp tissue
b.
vital pulp tissue
c.
proteins seeping into the root canal system
d.
components of saliva penetrating the pulp space

A

B

24
Q 
Which of the following is not a category of intraradicular infections?
Answer
	a. 	
primary
	b. 	
secondary
	c. 	
tertiary
	d. 	
persistant
A

c, tertiary

25
Q

Condensing osteitis is often confused with:

A

nonpathologic sclerotic bone

26
Q

Evidence from a study by Mumford indicates when electrical stimulation is applied, inflamed and uninflamed pulps have similar pain perception thresholds.
Answer True
False

A

True

27
Q 
Which of the following conditions will require an antibiotic prescription be written for the patient?
Answer
	a. 	
Fascial space infection
	b. 	
Apical abscess
	c. 	
Apical periodontitis
	d. 	
Deep carious lesion
A

A

28
Q 
On a radiograph the apical radiolucency is caused by:
Answer
	a. 	
Bone resorption
	b. 	
Bone infection
	c.

Bone sclerosis
d.
Bone formation

A

A

29
Q

Diffusion of bacterial products through dentinal tubules induces pulpal inflammation only after the pulp tissue is exposed.
Answer True
False

A

False

30
Q 
Bacteria of the deep carious lesion mainly include:
Answer
	a. 	
Aerobes
	b. 	
Staph
	c. 	
Lactobacillus
	d. 	
Enterobacter
A

C lactobacillus

31
Q 
The prevalence of apical periodontitis:
Answer
	a. 	
increases as we get older
	b. 	
decreases as we get older
	c. 	
stays the same throughout our life
	d. 	
increases between ages 20 and 30 and then dereases as we get older

10 points

A

A

32
Q 
Apical periodontitis is caused mainly by:
Answer
	a. 	
infection
	b. 	
trauma
	c. 	
occlusion
	d. 	
fracture
A

A

Endo (10 decks)

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