ICS Autumn midterm: Endo scope + pulpal

Question 1

whats endodontics

Answer 1

prevention, diagnosis and treatment of apical periodontitis

Question 2

whats the endo triad

Answer 2

1. access opening
2. clean and shape
3. seal

Question 3

what is a mineralized canal

Answer 3

mineralization IN the canal- cant see the day canal on x ray as well (more radiopaque) starts apically so may have to drill in to find canal

Question 4

whats dens invaginatus/evaginatus

Answer 4

variations fo tooth where theres an extra cusp (evaginatus) or a deep groove that shoots up into the tooth (invaginatus)

Question 5

what is inflammatory resorption

Answer 5

a risk following trauma! could occur

-caused by necrotic pulp/infection

Question 6

whats regeneration/guided repair?

Answer 6

endo treatment (not root canal)- stimulate blood flow at apex so that stem cells go up in the tooth pulp and this allows root to form (wide apex, etc) GUIDED REPAIR not regenerating just get root development and thickening of canal walls

Question 7

whats apexification

Answer 7

close end of open apex:
open apex issue, necrotized, clean it out put in calcium hydroxide, change every 2-3 months for over a year , barrier for orot, can then fill it with root canal filling materials.

etc

Question 8

whats apical surgery

Answer 8

failed root canal, incision is made- raise a flap of gingiva, gotta percha is removed. exposed root and removed lesion, cut off 3 mm of root. ultrasonic tip to create a class I cavity prep down the long axis of the tooth. filling in cavity, put gingiva back, suture..

Question 9

whats intentional replantation

Answer 9

extract tooth, class I with ultrasonic? filling.. take tooth and put it back in socket

Question 10

what is post removal

Answer 10

screw out with ultrasonic?

Question 11

whats normal pulp in terms of pain

Answer 11

little or no sensitivity to temperature. cold response dissapears when stimulus is removed.

Question 12

whats reversible

pulpitis

Answer 12

history of restoration recently, OR shallow caries present. sensitivity to air, cold liquids or food. symptoms resolve quickly after stimulus is removed- NOT LINGERING. radiographically normal apex

Question 13

whats irreversible pulpitis symptomatic type

Answer 13

symptomatic(SIP): positive rsponse to EPT/cold. history of spontaneous pain. LINGERING pain upon removal of cold/heat stimulus. in late stages, pain to heat becomes chief complaint, cold relieves. it. pain can radiate to adjacent areas, tmj or ear. tooth may be percussion sensitive. radiograph: within normal limits or widened pdl

(in early stages , cold is main issue, then as it progresses it gets sensitive to heat and they need cold to stop the pain!!)

Question 14

whats irreversible pulpitis- asymtpomatic?

Answer 14

caries to pulp but NO pain!! hyperplastic pulpitis= “pulp polyp”

Question 15

whats pulp necrosis and what symptoms may be present

Answer 15

may be asymptomatic
sinus tract may be present
usually has a radiolucency
cause symptoms when acutely infected: 
-percussion sensitive
-may have swelling (only if dead)
-may have mobility

Question 16

what is asymptomatic apical periodontits

Answer 16

AAP

-not sensitive to percussion!! periapical radiolucency IS present

Question 17

what is symptomatic apical periodontitis

Answer 17

SAP

• sensitive to percussion
• periapical radiolucency may or not be present

Question 18

acute apical abscess

Answer 18

• fast onset
• swelling
• pain
• may have trismus (lock jaw)

Question 19

whats a chronic apical abscess

Answer 19

presence of sinus tract, intermittent drainage of pus, not much pain usually (fill with gutta percha and x ray to see how far?)

(hole in gums where there is drainage of pus

Question 20

what are the features of acute vs chronic pain

Answer 20

acute: spontaneous, sharp, intense
chronic: history of pain, low grade, deep and gnawing

Question 21

what do you look for on the extraoral exam for endo issues

Answer 21

facial assymetry, aggressive swelling, purulent drainage, facial injuries

Question 22

what determines the spread of swelling

Answer 22

muscle attachments? pus takes pass of least resistance..

Question 23

whats checked in the intraoral visual exam

Answer 23

palpation, probings, mobility and percussion (RADIOGRAPH)

Question 24

what are 4 things to check w/intraoral exam

Answer 24

palpation, probings, mobility and percussion (RADIOGRAPH)

Question 25

whats RINN XCP

Answer 25

contraption for taking x ray(?)

Question 26

what are the two types of nerves in pulp

Answer 26

a delta and c fibers, BOTH PAIN cant tell if hot,cold, etc. just hurts

Question 27

what are A delta fibers features where are they

Answer 27

in pulp-dentin interface, they are myelinated and have large diameter -act fast SHARP

Question 28

what are C fiber features and where are they

Answer 28

central in pulp, unmyelinated, small diameter. slow steady and dull, gnawing pain. they are prolonged/spontaneous
-HEAT thermoreceptor for pain.

Question 29

LIst the vitality assessment options

Answer 29

thermal cold /heat, electric pulp tester, selective anasthesia (where pains coming from..), vital test cavity, tooth slooth (bite down on cusps-where pain), fiber optic light

Question 30

whats concussion of tooth

Answer 30

least intense type of trauma to tooth..

Question 31

whats the difference between a sinus tract and a fistula

Answer 31

a sinus tract is epithelial area to non epithelial area (gingiva to bone where theres none)

fistula is epithelial to epithelial (gingiva to sinus - has epithelia)

Question 32

how does caries removal work as a pulp test?

Answer 32

not sure if theres pulp exposure, remove decay and theres a pulp exposure, now pulps exposed– thats an irreversible condition so can do vital pulp therapy, root canal etc… dont know if pulps exposed unless remove decay sometimes

Question 33

when do you check for heat pain

Answer 33

only if the patient is complaining about heat sensitivity (must wait between teeth from one to the next)
-normal tooth does not feel heat at all

Question 34

whats the most important pulp test

Answer 34

cold!! if they feel it we know its vital. if it lingers- we know its irreversible (vs non lingering etc) if they dont feel the cold- necrotic!!!!!
-endo ice refrigerant and cotton, put on tooth for just a second

Question 35

how does periodontal probing help with diagnostic testing

Answer 35

must get to the bottom of the sulcus- but a isolated deep pocket can indicate a fracture

Question 36

what is the electric pulp tester?

Answer 36

tells you if pulp is VITAL or NECROTIC!
-put some toothpaste on conductor, dry tooth, put probe, have patient hold handle, meter starts going up, more current goes through, if they feel warm/tingling or buzzing let go and it tells you if vital or necrotic. (if they feel=vital)
if it goes to top and dont feel its necrotic

doesnt tell you if reversible or irreversible

Question 37

whats cracked tooth syndrome

Answer 37

pain to hard foods, cold and sometimes sweet
-cant see fracture on radiograph, if pulp tests normally try a crown. 80% dont need a root canal after a crown. if symptoms persist they do. fracture is into the pulp..

Question 38

whats the bite test

Answer 38

fractured cusp test, squeez and release bite on either a cue tip or TOOTH SLOOTH, fractured cusps hurt on release

Question 39

whats tooth slooth

Answer 39

squeeze and release test– thing you bite on

Question 40

whats transillumination for

Answer 40

can sometimes see crack on teeth with it

Question 41

whats the methylene blue test

Answer 41

stains organic tissue, can see cracks on teeth

Question 42

whats the anasthetic diagnostic test for pain

Answer 42

patient might think lower but you did pulp testing and think its upper you can do a anesthetic test and block lower jaw nerves. if pain doesnt go away it must be upper!! etc.

Question 43

when do you do a cavity test

Answer 43

last resort for pain tests

• only use when necrotic pulp is suspected and there is a crown in place. when other diagnostic tests dont work.
• drill till hit pulp, see nothings there and you know its necrotic

Question 44

whats trigeminal neuralgia features, how is it treated and what do you do

Answer 44

-electric shock type pain
-has a trigger point,
cannot find a dental etiology. refer to a neurologist!! can be treated with carbamezapine (tegretol)