1-1 Disease of the Pulp

Question 1

Cardinal signs of inflammation

Answer 1

1. rubor (redness)
2. tumor (swelling)
3. calor (heat)
4. dolor(pain)
5. function laesa (loss of function)

Question 2

features of the pulp that makes it unusually fragile and sensitive (Regezi)

Answer 2

1. encased by hard tissue that does not allow for the usual swelling associated with the exudate of the acute inflammatory process
2. pain/dolor is the only symptom that would determine the severity of the inflammation in most cases
3. no collateral circulation to maintain pulp vitality
4. biopsies and direct application of chemical would cause organ death

Question 3

Etiology of pulp diseases

Answer 3

1. caries
2. operative procedures (mechanical irritants)
3. trauma
4. periodontal diseases

Question 4

most frequent etiology of pulp diseases and how/route

Answer 4

CARIES

-MO would go inside the pulp via route of the dentinal tubules

Question 5

T/F Degree of damage depends on the rapidity and extent of hard tissue destruction

Answer 5

true

Question 6

T/F Entry of bacteria into the pulpal tissue through a carious lesion is necessary for pulpitis to occur

Answer 6

false

not necessary

Question 7

usually the cause of pulpitis of a “virgin tooth”

Answer 7

periodontal disease

Question 8

periodontal disease follows a ___ path

Answer 8

RETROGRADE path

Question 9

Classification of Pulp Disease

Answer 9

1. Focal reversible/Reversible Pulpitis
2. Irreversible pulpitis
   a. acute irreversible
   b. chronic irreversible
   
   • Variant: Chronic hyperplastic pulpitis
3. Pulpal Necrosis
   a. Partial necrosis
   b. total necrosis

Question 10

test wherein a tooth is subjected to a mild electric current (closed circuit) and response is recorded

Answer 10

electric pulp testing

Question 11

function of electric pulp testing

Answer 11

tests the vitality of the pulp

Question 12

a test wherein a tooth is tapped with the butt end of a mouth mirror

Answer 12

percussion test

Question 13

function of percussion test

Answer 13

determine the integrity of the periodontal ligament

Question 14

other test to determine integrity of pdl aside from percussion test

Answer 14

palpation

Question 15

T/F For pulpitis, palpation and percussion test is positve

Answer 15

false

negative since only the pulp is involved

Question 16

define focal/reversible pulpitis

Answer 16

acute, mild inflammatory pulpal reaction that typically follows carious destruction of a tooth or placement of a large metallic filling without an insulating base
“reversible” -only needs some management

Question 17

Symptoms of Focal/reversible pulpitis

Pain Quality

Answer 17

Mild to moderate

intermittent (pain is dependent on the application of stimulus)

Question 18

Symptoms of Focal/reversible pulpitis

Duration of Pain

Answer 18

short (10 sec - 30 sec)

disappears upon removal of stimulus

Question 19

Symptoms of Focal/reversible pulpitis

Stimulus needed

Answer 19

Yes

pain is provoked by cold/sweet (not hot)

Question 20

Symptoms of Focal/reversible pulpitis

Sensitivity to percussion

Answer 20

no response

Question 21

Symptoms of Focal/reversible pulpitis

sensitivity to palpation

Answer 21

no response

Question 22

Symptoms of Focal/reversible pulpitis

mobility

Answer 22

no unless there is concomitant plaque - induced periodontitis

Question 23

Symptoms of Focal/reversible pulpitis

PPD

Answer 23

not greater than 3mm unless there is concomitant plaque-induced periodontitis

Question 24

Symptoms of Focal/reversible pulpitis

Pain Quality

Answer 24

Mild to moderate

intermittent (pain is dependent on the application of stimulus)

Question 25

Symptoms of Focal/reversible pulpitis Duration of Pain

Answer 25

short (10 sec - 30 sec) | disappears upon removal of stimulus

Question 26

Symptoms of Focal/reversible pulpitis Stimulus needed

Answer 26

Yes pain is provoked by cold/sweet (not hot)

Question 27

Symptoms of Focal/reversible pulpitis Sensitivity to percussion

Answer 27

no response

Question 28

Symptoms of Focal/reversible pulpitis sensitivity to palpation

Answer 28

no response

Question 29

Symptoms of Focal/reversible pulpitis mobility

Answer 29

no unless there is concomitant plaque - induced periodontitis

Question 30

Symptoms of Focal/reversible pulpitis PPD

Answer 30

not greater than 3mm unless there is concomitant plaque-induced periodontitis

Question 31

Other observations of Focal/reversible pulpitis EPT

Answer 31

responds to lower levels of current than normal teeth

Question 32

Teeth condition that are possible portals of entry for the bacteria from the saliva to cause inflammation

Answer 32

1. deep caries 2. large metallic resto 3. defective margins

Question 33

Histological features of focal/reversible pulpitis

Answer 33

hyperemia (predominant feature of reversible pulpitis)

Question 34

what's hyperemia

Answer 34

dilation and engorgement of blood vessels, characteristic of any inflammation

Question 35

Pulp testing responses of reversible pulpitis Stimuli: thermal

Answer 35

hypersensitive-short-mild

Question 36

Pulp testing responses of reversible pulpitis Stimuli:sweets

Answer 36

sensitive-short-mild

Question 37

Pulp testing responses of reversible pulpitis Stimuli: Biting pressure

Answer 37

none-none-none

Question 38

Thermal testing Heat test vs cold test

Answer 38

Heat test: uses heated gutta percha cone and apply it to the tooth and see how fat the tooth reacts and how long pain will linger Cold test: ice

Question 39

Clinical findings in reversible pulpitis Visual inspection

Answer 39

check for decay, fracture lines, orientation of tooth and hyper occlusion

Question 40

Clinical findings in reversible pulpitis palpation

Answer 40

no response

Question 41

Clinical findings in reversible pulpitis percussion

Answer 41

no response

Question 42

Clinical findings in reversible pulpitis mobility

Answer 42

none unless perio condition existed

Question 43

Clinical findings in reversible pulpitis periodontal probing

Answer 43

within normal limits

Question 44

Clinical findings in reversible pulpitis thermal testing

Answer 44

hypersensitive response to cold | heat is for irreversible?

Question 45

Clinical findings in reversible pulpitis EPT

Answer 45

positive response

Question 46

Clinical findings in reversible pulpitis transillumination

Answer 46

little use unless a fracture is the cause

Question 47

test used to detect tooth fracture

Answer 47

transillumination

Question 48

Clinical findings in reversible pulpitis radiographic exam

Answer 48

normal periapical area

Question 49

Clinical findings in reversible pulpitis selective anesthesia

Answer 49

usually not necessary

Question 50

Clinical findings in reversible pulpitis test cavity

Answer 50

usually not necessary bec tooth is vital

Question 51

why is selective anesthesia not used that much?

Answer 51

teeth are in close proximity to one another and there's a common nerve supply so it's hard to determine where the pain was felt particularly

Question 52

what's test cavity

Answer 52

to know if the tooth is vital, they bur it out and if it does not cause pain even if it's already deep, then pulp is dead

Question 53

Tx for focal/reversible pulpitis

Answer 53

remove irritant if present if no pulp exposure: use CaOH base, direct/indirect pulp capping, restore presence of pulp exposure: carious=initiate RCT mechanical= >1mm-initiate RCT <1mm crown planned-initiate RCT <1mm-direct pulp cap or RCT if irritant is not present. postpone and monitor