3 - Etiology of Pulpal Disease Flashcards
(93 cards)
1
Q
what are pulpal irritants
A
living and non-living
2
Q
examples of living pulapl irritatngs
A
bacteria, fungii, viruses
3
Q
examples of non-living pulpal irritants
A
mechanical, thermal, and chemical
4
Q
what are bacterial toxins
A
- endotoxin
- LPS
- exotoxin
5
Q
what is an endotoxint
A
bacterial toxin part of bacteria
6
Q
what is an exotoxin
A
bacterial toxin excreted by microorganism
7
Q
are bacterial toxins very potent and cause cell damage
A
YES
8
Q
what are microbial irritants
A
- bacterial proper
- microbial toxins (endo and exotoxins)
9
Q
is direct pulp exposure a prerequisite for pulapl resonse and inflammation
A
NO
10
Q
what are factors affecting pulapl response
A
- Virulence of bacteria
- Ability to release inflammatory fluids
- Host resistance
- Amount of circulation
- Lymph drainage
11
Q
If bacterial invasion of pulp is severe sooner or later what happens
A
damage will become extensive and
spread throughout the pulp
12
Q
___ can lead to an interruption of blood flow to the pulp
A
Inflammation
13
Q
Inflammation can lead to an interruption of blood flow to the pulp, THE PULP THEN WILL BECOME
___
A
NECROTIC
14
Q
one the pulp becomes necrotic, what is it colonized by ___
A
bacteria
15
Q
Eventually bacterial byproducts and other irritants from necrotic tissue will diffuse from the ___ into the ___causing destruction of these tissues
A
canal; periapical tissues
16
Q
what is the Kakehashi Study
A
- pulp exposure in conventional and germ free rats
- conventional rats developed pulpal and periradicular lesions
- germ free rats did not develop lesions
17
Q
what is considered the most important study in endodontics
A
Kakehashi
18
Q
what are mechanical irritants to the pulp
A
- operative procedures
- trauma
- ortho
- periodontal scaling
19
Q
what removes cementum therefore exposing dentinal tubules resulting mechanical irritation to the pulp
A
periodontal scaling
20
Q
what are chemical irritants to the pulp
A
- antibacterial agents
- acids
- acidic liners and bases
- temporary and permanent filling materials
21
Q
what are steps lesion progression
A
- release of inflammatory mediators
- increased vascular permeability
- exudate formation
- increase in intrapulpal pressure
22
Q
where does pressure increase occur? does it progress fast or slowly?
A
occurs in small compartmentalized regions
progresses slowly
23
Q
does pain associated w/ inflammatory mediators lower the sensory nerve threshold
A
YES
24
Q
T/F: pain associated w/ inflammation mediators effects vascular permeability resulting in DECREASED tissue pressure
A
FALSE! ELEVATED tissue pressure
25
does pressure associated w/ inflammatory mediators act directly on sensory nerve receptors
YES
26
describe the special environment of the pulp
1. poor collateral circualtion
2. pulp surrounded by hard unyielding walls
3. area of terminal circulation
27
Among the various forms of dental treatment, ___ are the most common cause
of pulpal injury
restorative procedures
28
what are sources of bacteria in leaky restorations
1. ingrowth from surface (open margins)
2. bacteria in smear layer
3. bacteria in deep dentin
29
Diameter and density of dentinal tubules [increases, decreases] in direct proportion to the depth of the cavity preparation
INCREASES
30
Usually ___mm of dentin thickness is needed to protect the pulp from most irritants
2
31
what is frictional heat
drastic increase in temp severely damages pulp
32
can frictional heat initiate inflammatory response
yes
33
can frictional heat desiccate dentinal tubules
yes
34
preps without coolant can reduce what
pulpal blood flow
35
how to prevent heat
1. use high speed with EFFICIENT water coolant
2. light pressure (use new burs so less pressure needed)
3. intermittent cutting
36
what speed to use high speed at
100,000 - 250,000 RPM
37
preps without coolant can markedly reduce pulapl blood flow. why wouldn't we want that
reduction of blood flow makes tooth necrotic
38
Use of rubber points at high-speed can increase pulp temperature by ___ degrees Celsius enough to cause pulpal damage
16
39
what is an outward movement of dentinal fluid if back pressure can dispace odontoblasts?
dentin dessication
40
prolonged air drying should be avoided to avoid what
dentin desiccation
41
Impressions or cementation of restorations can produce an outward movement of dentinal fluid. This is what type of force?
hydraulic forces
42
Research indicates ___ of
materials to be more important than their
___
physical properties; chemical composition
43
Evidence is that pulpal injury after restorations is
mainly caused by ___
bacterial microleakage
44
Bacteria will grow underneath a restoration only a in the presence of ___
microleakage
45
what are factors that affect microleakage
1. Marginal adaptation of the material
2. Shrinkage
3. Contraction gaps
4. Elastic deformation of tooth structure
46
T/F: In and of itself acid etchants DO appear to produce injury to the pulp
FALSE! it does NOT
47
how do acid etchants cause pulpal injury
1. Buffering effect of dentin neutralizes acid
2. Greatly increases dentin permeability
48
in tooth sensitivity after restoration placement, is discomfort usually a short or long duration?
SHORT
49
what to do to avoid sensitivity after restoration placement
check occlusion
50
persistent and increasing discomfort after restoration placement might be indicative of what? especially when?
indicative of irreversible pulp damage especially if there is spontaneous pain
51
spread of canal inflammation and/or infection occurs thru what
1. apical foramen
2. lateral canals
3. dentinal tubules
52
periradicular pathosis can range from ___ to ___
slight inflammation to extensive tissue destruction
53
cellular damage occurs thru what
1. release of non-specific inflammatory mediators
2. specific immunologic mediators
54
in periradicular lesions, products released from ___ contribute to inflammatory process and cause swelling, pain, and tissue destruction
activated systems
55
what are inflammatory mediators found in PA lesions
1. vasoactive amines
2. bradykinin
3. lysosomal enzymes
4. complement fragments
5. leukotrienes
5. PROSTAGLANDINS
6. CYTOKINES
56
what are vasoactive amines
hismatine, serotonin, etc.
57
what inflammatory mediators are shown to play important role on bone resorption
cytokines and prostaglandins
58
what are arachidonic acid metabolites
phospholipase A2
59
phosphalipase A2 results from what
1. cycooxigenase
2. lipooxygenase
60
cyclooxigenase results from what
1. prostablandins
2. prostacyclin
3. thromboxane A2
61
lipooxygenase results from what
leukotrienes
62
arachidonic acid ->/<- phospholipase A2 pathway is inhibited by what
corticosteroids inhibit both pathways
63
what medication affects cyclooxigenase and inhibits prostaglandin, prostacyclin, and thromboxane A2?
Aspirin and NSAIDS
64
what medication inhibits prostaglandins
COX-2 inhibitors: clebrex
65
what medication inhibits leukotrienes
- some asthma meds
- some asthritis meds
66
what is an intense pain and/or swelling after a root canal procedure
flare up
67
pushing canal contents into periradicular lesions can create a type ___ reaction that could result in severe flare up
TYPE I
68
what are mechanical and chemical irritants
1. over-instrumentation
2. overfills gutta-percha and/or sealer
3. irrigants
4. medications
69
what results in endo damage
1. severance of BV
2. activation of coagulation pathways contribute to inflammation
3. activation of kinin system and complement cascade
4. vasoactive amines
5. foreign body reactions
70
what causes endo damange
1. endo irrigating solutions NaOCl (chlorox)
2. intracanal medications
71
what are specific mediators
antigen/antibody
72
T/F: root canals are a pathway for sensitization
TRUE
73
what are immunologic responses
1. antigen (bacteria and their products)
2. B and lympohcytes and plasma cells
3. antibodies and T lymphocytes
74
are are antigens of immunologic responses
1. microorganisms
2. microbial toxins
3. altered pulp tissue
75
what are specific antibodies of immunologic responses
1. immunoglobulins
2. immunocompetent cells
3. IgE and Mast cells
76
IgE and Mast Cells in PA lesions suggest what
type I immunologic response may occur
77
what are the elements needed for reactions to be present in human periradicular lesions
1. antigens
2. immuno-competent cells
3. specific antibodies (immuno-globulins)
78
T/F: vaious types of immunologic reactions can start, amplify and perpetuate lesions
TRUE
79
how to prevent periradicular inflammation
1. avoid pushing debris thru apex
2. do not over-instrument
3. do not overmedicate
4. avoid pushing NaOCl thru apex
80
do periradicular lesions persist until causing agent is removed (bacteria in canals)
YES
81
how should canals be sealed to avoid recurrence of pariradicular lesions
hermetically sealed
82
if defense mechanisms are compromised, infection can spread where
spread into adjacent tissues
83
if defense mechanisms are compromised, is it potentiall grave and result in fatal consequences
yes
84
you should worry about the host response for what type of patients
immunocompromised patients
85
it is important to distinguish infection from what
inflammatory conditions
86
T/F: medications you give to the patient is more important that the local treatment done to patient
FALSE! what you do for the patient (local treatment) is more important than any medications you give the patient
87
is it possible for periraduclar tissues that have been destroyed to regenerate with original tissue after endo therapy? why?
YES! because irritating stimulus has been removed
88
what periradicular tissues that have been destroyed can be regenerated
1. alveolar bone
2. cementum
3. periodontal ligament
89
can dentin regenerate? why?
NO! because odontoblasts originate in pulp
90
etiology of endodontic lesions is from what
microbes, microbial toxins and/or inflammatory mediators within root canal system
91
what is the first tissue to be destroyed by endo disease
PDL of periapical tissues
92
what is the last tissue to fully regenerate
PDL of periapical tissues
93
T/F: after successful RCT, all tissue CANNOT be restored to their original state except dentin
FALSE!
after sucessful RCT, all tissues CAN be restored to their original state except dentin
