Disease Of The Pulp And Periodontium

Question 1

Clinical features of pulp hyperaemia

Answer 1

Pain lasting for seconds

Pain stimulated by hot/cold/sweet foods

Pain resolves after stimulus

Caries approaching pulp but can be retreated without affecting the pulp

Question 2

Clinical features of acute pulpitis

Answer 2

Constant severe pain

Reacts to thermal stimuli

Poorly localised pain

Referral of pain

Minimal response to analgesics

Question 3

How to diagnose acute pulpitis

Answer 3

History, visual, -ve tenderness to percussion, radiographs

Question 4

How to diagnose acute apical periodontitis

Answer 4

Tenderness to percussion, non-vital, slight mobility, radiographs

Question 5

What would you see in the radiographs of acute apical periodontitis

Answer 5

Loss of clarity in the laminate dura

Radiolucent shadow

Widening of periodontal space

Question 6

What is traumatic periodontitis caused by diagnoses and treatment

Answer 6

Parafunction (clench)

Clinical examination of the occlusion, tender to percussion, normal vitality, radiographs

To treat you do occlusal adjustment and therapy for parafunction

Question 7

What’s the most common Pus producing infection

Answer 7

Acute apical abscess

Question 8

What other pus producing infection are there

Answer 8

Periodontal abscess

Pericoronitis

Sialadenitits

Question 9

What causes dental abscesses

Answer 9

Organisms- polymicrobial anaerobes

Usually staphylococcal lymphadenitis of childhood

Question 10

What are symptoms of acute apical abscesses before it perforated bone

Answer 10

Severe unremitting pain
Acute tenderness in function
Acute tenderness on percussion

Question 11

What’s symptoms after acute apical abscess perforates bone

Answer 11

Pain often remits

Swelling, redness, heat

Swelling increases pain returns

Question 12

5 clinical signs of inflammation

Answer 12

Heat
Redness
Swelling
Pain
Loss of function

Question 13

The site of the swelling will depend upon what in an acute apical abscess

Answer 13

The position of the tooth in the arch

Root length

Muscle attachments

Potential spaces in proximity to lesion
Submental Space
Sublingual Space
Submandibular Space
Buccal Space
Infraorbital Space
Lateral Pharyngeal Space (a.k.a. Parapharyngeal Space)
Palate

Question 14

Acute Apical Abscess – Treatment

Answer 14

Provide Drainage

-Soft tissue incision intraorally
-Soft tissue incision extraorally

Remove source/cause
-Extract tooth
-Pulp extirpation
-Periradicular surgery

Need for antibiotics determined by

Severity
Absence of adequate drainage
Patient’s medical condition

Question 15

What is reversible pulpitis

Answer 15

Denotes a level of inflammation in which returning to a normal state is possible if noxious stimuli removed

Mild-moderate tooth pain when stimulated, no pain without stimulus, subsides within seconds (<5 secs), no mobility, no pain on percussion

Question 16

What is irreversible pulpitis

Answer 16

Denotes a higher level of inflammation in which dental pulp has been damaged beyond point of recovery

Sharp, throbbing, severe pain upon stimulation, and pain may be spontaneous or occur without stimulation, pain persists after stimulation removed (>5 secs); tx: RCT or extraction

Question 17

Describe periapical granuloma (chronic apical periodontitis)

Answer 17

Mass of chronically inflamed granulation tissue at apex of tooth (plasma cells, lymphocytes, and few histiocytes with fibroblasts and capillaries).

NOT a true granuloma because not granulomatous inflammation! (Note that granulomatous inflammation has epithelioid histiocytes mixed with lymphocytes and giant cells)

Question 18

What is the etiology of periapical (radicular) cyst

Answer 18

Caries, trauma, periodontal disease
Death of dental pulp
Apical bone inflammation
Dental Granuloma
Stimulation of epitheialial rests of Malassez
Epithelial Proliferation
Periapical Cyst Formation