Final Exam Flashcards by Michael Lindsay

Circulation of the Pulp
Lacks?
Type of Circulatory system
Largest Vessels are \_\_\_ and \_\_\_
Vessels of the pulp

ture arteries and viens
microcirculatory system
arterioles and venules
arterioles, capillaries, venules, lymphatic vessels

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What two aspects of the pulp inhibit its ability to heal?

it is encased within an unyielding chamber

lacks a collateral circulation

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Most effects from restorative dentistry have what kind of effect on the pulp

indirect

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Cavity Preparation Pulp Injury

frictional heat
desiccation
exposure of dentinal tubules
direct damage to odontoblasts and processes 
chemical exposure of dentin tubules

Cavity Preparation Pulp Injury

frictional heat
desiccation
exposure of dentinal tubules
direct damage to odontoblasts and processes 
chemical exposure of dentin tubules

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Restorative Material Pulp Injury

material Toxicity
insertion Pressures
thermal effects
induced Stresses

Restorative Material Pulp Injury

Material Toxicity
Insertion Pressures
Thermal effects
Induced Stresses

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Subsequent to the Restoration Pulp Injury

Marginal Leakage
Cuspal Flexture

Subsequent to the Restoration Pulp Injury

Marginal Leakage
Cuspal Flexture

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Coronal bacterial leakage has been shown to be an important fact in

pulpal inflammation

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Pathway of Bacterial Invasion

dental caries
direct pulp exposure
microleakage
periodontal disease
dental anomalies
anachoresis-bacteria in blood infects tissue sepicemia

Pathway of Bacterial Invasion

dental caries
direct pulp exposure
microleakage
periodontal disease
dental anomalies
anachoresis-bacteria in blood infects tissue sepicemia

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What Pulpal Cells Respond to Irritation

form dentin, decreasing dentin permeability to irritants?

odontoblasts

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What Pulpal Cells Respond to Irritation

form collagen to wall of irritants, become secondary odontoblasts?

fibroblasts

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What Pulpal Cells Respond to Irritation

neutralize irritants, destroy bacteria, release mediators involved in repair?

inflammatory cells

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Pressure in a confined spaces alters the pulpal structure depresses the function of the pulpal tissues and cell death results in edema and increased pressure is known as?

Compartment syndrome

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Sequence of Pulpal Inflammation Secondary to Caries

Chronic Inflammation
Hyperemia
Acute Inflammation
Repair or Necrosis

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Chronic Inflammation Phase 1

definition

Lymphocytes and plasma cells localize adjacent involved dentinal tubules in an immune response to bacterial toxins penetrating the tubules

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Chronic Inflammation Phase 2
Active Hyperemia
Passive Hyperemia

an increase in the inflow of blood due to chemical mediators causes vasodilation and capillary permeability
a decrease in the outflow of blood

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Acute Inflammation Phase 3

cell type and what they do

PMN, destroy bacteria and pulpal tissue

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Acute Inflammation Phase 4

Irreversible vs Reversible

if bacterial assault and pulpal destruction continues, acute inflammation leads to necrosis
if bacterial assault and pulpal destruction ceases repair can occur

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Four Stages of Irreversible Pupal Necrosis

1.microabscess formation
2.ulceration
3.partial necrosis
4.Total Necrosis
MUPeTs

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Localized abscess adjacent to the dentin containing the invading bacteria which leads to a dense infiltration of PMNs surrounding the abscess is known as?

Microabscess Formation

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Carious exposure allow exudate to escape decreasing the intrapulpal pressure

Ulceration

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Define Partial Necrosis, why is it important?

the coral pulp can be totally necrotic what the apical pulp is vital, thus we must anesthetizing teeth even if they test negative to pulp testing

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Two Types of Necrosis
Liquefaction Necrosis
-tissue
-intrapulpal pressure
-sensitivity

structureless tissue mass
may have elevated intrapulpal pressure
may still be sensitive to heat

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Two Types of Necrosis
Dry Necrosis
-tissue
-debris
response to thermal EPT testing

no fluid, no mass
dry necrotic debris
none

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Pulp tissue damage leads to ____in regards to blood flow

cut of pulp blood circulation

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Oxygen Tension | _____ bacteria predominate early followed by____ then _____ in necrotic pulp

facultative anaerobic strict anaerobes

Types of Pulp Infections mixed polymicrobial infection of 10-30 bacterial species and 10^3-10^8 bacterial cell counts per canal that predominately contains anaerobic with some facultative bacteria

Primary Intraradicular infection

Types of Pulp Infections microorganisms not present in primary infection, introduced after access opening

Secondary Intraradicular infection

Types of Pulp Infections microorganisms that resist treatment, 1-3gram positive facultative anaerobes

Persistance Intraradicular infection

Types of Pulp Infections outside of the roots

Extraradicular infection

Chronic Hyperplastic Pulpitis - caused by - pathophysiology - symptoms

- large exposures of the pulp - pulp proliferates out from the chamber and the epithelium from saliva seeds onto the pulp tissue, proliferates to form keratinized stratified squamous epithelial lining - may be asymptomatic

Hyperplastic Pulpitis - pathology - symptoms

- overgrowth of a chronic inflamed young pulp onto the occlusal surface - often asymptomatic

Teeth with caries into dentin have pulp_____

pulpal inflammation

Neural Structure of the Pulp - thermal receptors? types - pressure receptors?types - pain receptors?types

- none - none - 2, a delta fibers and C fibers

A Delta Fibers - endings lie - concentration - responsible for___ pain - type of pain - localization of pain - threshold - effected by inflammation? - Fluid movement process works via

- pulp dentin boarder - pulpal horn - dentinal pain - sharp - well localized - low threshold - none - fluid movement within the dentinal tubules caused by thermal or osmotic changes stimulates

C Fibers - speed of conduction - type of pain - response to dentinal stimulation - concentration - localization - threshold - effected by inflammation? - Can fire spontaneously as a result of _____

- slow - dull throbbing for long duration - not found - deeply seated in the pulp - poorly localized - inflammatory mediators stimulate them - irreversible pulpitis

True or False | There is a correlation between symptoms and the histological status of the pulp

False

What % of teeth with caries were asymptomatic | What % of patients with pulp inflammation are asymtomatic?

36% | 60%

True or False | Pain occurs during times of inflammation and after damage is done as pulp is in a necrotic state

First statement is true, second is false because necrotic tissue will have a limited impulse conduction capacity

Severe pulpal pain indicated ____ necrosis with _____ intrapulpal pressure of ____mm Hg

liquefaction necrosis | 34.5

What is the normal intrapulpal pressure

10 mm Hg

Crown fractures cause ____ pulp irritation

direct

the superficial ___mm of an exposed pulp is inflamed one week after crown fracture

2mm

After one month ____% of injured teeth with non exposed pulps and ____% of teeth with exposed pulps have irreversible inflammation

50% | 100%

Disruption of Apical Blood Supply internal Resorption occurs in ___% of cases and calcific metamorphosis occurs in ___% of the cases

2% | 24%

Tenderness to percussion with no mobility or displacement

concussion

Loosening with no displacement

subluxation

Central displacement into alveolar bone

intrusive

Peripheral displacement out of alveolar bone

extrusive

Peripheral displacement

lateral

Necrosis Prognosis of Luxated Teeth - subluxation - extrusive luxation - intrusive luxation

- 26% - 64% - 96%

Calcific Metamorphosis - loses regulatory mechanisms and continues to produce dentin - pulp chamber and root canal appearance radiographically - color of tooth - time for occurrence - more___ and less___ - pulp inflammation

- odontoblasts - totally calcified - yellow - rapidly - fibrous and cellular - rare

a condition associated with either a physiologic or pathologic process resulting in a loss of dentin cementum and bone

resorption

Internal Resorption - initiation location - loss of - invasion of - may or may not perforate____

- within the pulp - dentin - cementum - the external root surface

Internal Resorption - pulp undergoes ___ changes - becomes___ - macrophage giant cells differentiate into___ - ____resorb the internal dentinal wall - pulp tissue is - ____requried to halt the resorption process

- metaplastic changes - vascular granulation tissue - dentinoclasts - irreversibly inflamed - RCT

External Resorption - initiation location - initially only affects______ - more or less common than internal - may or may not invade_____

- periodontium - external root surfaces - more - pulp

Three types of External Resorption

inflammatory replacement surface

A pathologic loss of cementum, dentin and bone

inflammatory resorption

Replacement Resorption - result from - pathology - fusion of - loss of - lack of clinically

- inflammatory resorption - loss of cementum, dentin and periodontal ligament with subsequent ingrowth of bone into the defect - bone to cementum and or dentin - physiologic mobility - radiolucency

Surface Resorption - type of process - part of normal _____

- physiologic not pathologic | - dentin/cementum disposition

Two primary types of necrosis from dental trauma

infection and ischemic infarction

Ischemic Infarction - type of necrosis - do bacteria invade pulp - type of necrosis cells undergo - what remains - macrophages/lysosomal enzymes present - resulting color

- sterile necrosis - no - coagulation necrosis - collagen skeleton - no - red crystals discolor pulp and tooth

Atropic Pulp - odontoblasts - fibroblasts - increased volume of____ - type of calcification

- none - few - collagen - dystrophic

Why are root canals of necrotic pulp a safe haven for bacteria

no circulation of blood to carry antibacterial cells or antibiotics to infection

The periapical lesions clinical presentation is dependent upon what?

the pathogenicity of the invading microorganisms

4 portals of exit of the root canal and pulp

furcal canals lateral canals accessory canals apical foramen

Types Of Endodontic Infection Intra-radicular (3 types) -initial colonization of canal -invade canal during treatment, not present to start but from contamination - lasting after ^^ Extra-radicular -invation of peri-radicular tissues from ______

- primary - secondary - persisting - intra-radicular infection

Type of bacteria in dental carries | Type of bacteria in root canals

- Gram + cocci | - Facultative cocci and anaerobic rods and endotoxin

True or False | Bacteria are present in PA lesions and cause focal infections

First is true, second is false

2 Patterns of Microbial Colonization | How are biofilms formed

Suspended (planktonic state) and Adhered (Sessile state) Planktonic organisms enter the root canal, pulpal inflammatory lesion moves vertically providing a fluid vehicle and allowing multiplication and adherence

Biofilm is only found on roots of teeth with ____ ____

chronic infection

Cellular Composition of Asymptomatic Apical Periodontitis Lesions -most prominent cell

-fibroblasts

Periapical pathology is _____

multifactorial

Apical periodontitis is a _____ ______ infection where | _____ is required

polymicrobial opportunistic infection no single or unique pathogen is required

Cell that plays the leading role in forming the first line of defense in apical periodontitis

neutrophil

To provide sufficient space for the inflammatory lesion the _____ and ____ are broken down

PDL and alveolar bone

Process of Bone Resorption - carried out by - what stimulates the bone resorbing osteoclasts: 3 - in early phase of apical periodontitis ____ are abundant and outnumber ____ resulting in bone ____ - Bone loss results in ____ on a radiograph

- osteoclasts - cytokines, Interleukin-1 and prostaglandins - osteoclasts, osteoblasts, resorption - radiolucency

Zones of Infection - microorganisms and PMNs - toxins, Lymphocytes and plasma cells - histiocytes and osteocytes - fibroblasts, osteoblasts and collagen fibers

- Zone of Infection - Zone of contamination - Zone of irritation - Zone of stimulation

Zones of Infection - bacteria do not penetrate beyond the zone of _____ - repair occurs form the zone of ___ in the ___ direction

- contamination - stimulation - inward

Zones of Infection (order them) necrotic zone exudative zone granulomatous zone fibrous zone

``` Bone fibrous zone exudative zone granulomatous zone necrotic zone apex ```

Over time the neutrophil decreases while ____ and ___ increasingly predominate

macrophages and T/B cells

Fibrovascular elements mix with inflammatory mediators in an attempt at repair in the _____ zone

exudative zone

fibroblastic activity increases with distance as well as formation of new vessels in the ____ zone

granulation

FYI | Due to continual invasion, repair and healing cannot occur so the lesion enters the chronic phase

Histological term used to describe tissue formed adjacent to the apex of a tooth with pulp pathosis

periapical granuloma

An odontogenic cyst associated with a necrotic pulp that develops within a peri-radicular inflammatory lesion. This cyst derives its epithelium form_____

Radicular cyst | cell rests of malassez

3 Types of Cysts

Epithelial granuloma Bay Cyst True Cyst

cyst with a proliferating epithelium which does not form a cavity

epithelial granuloma

cyst with epithelium attached to the root

Bay or Pocket cyst

cyst with unbroken epithelial lining

True cyst (10%)

What % of periapical lesion attached to extracted roots were cysts?

15%

what % of cysts identified by electrophoresis healed following NSRCT?

70-80%

What causes facial swelling with acute apical abscesses

anaerobes inhibit PMN phagocytosis and produce enzymes and endotoxin (lipopolysaccharide or LPS)

Inflammation of bone marrow and adjacent bone. Inflammation may remain localized or spread to the marrow, cortex, cancellous tissue and periosteum

Osteomyelitis

Why is palpation necessary in diagnosing in endo?

indicates that inflammation has spread through the facial or lingual cortical plate involving the overlying mucoperiosteum

True or False | Percussion indicates the health or integrity of the pulp and reveals inflammation in the PDL

first is false | second is true

use of periodontal probing

assessment of PDL attachment

Mobility I II III

I: 1mm horizontal movement III: >1mm horizontal movement with vertical depressibility

Thermal Tests | must heat or cool the PDJ by ___ degrees C to get a response.

How is a baseline established for thermal tests

test normal teeth

Normal thermal response is feeling pain when stimulus is applied and pain subsiding ____ secs after stimuli removed

15-30secs

Most accurate pulp tester

bipolar mode tester

FYI- Reasons for False Negative EPT ``` inadequate contact immature apical development traumatic injuries calcification analgesics ```

``` FYI- Reasons for False Negative EPT inadequate contact immature apical development traumatic injuries calcification analgesics ```

FYI- Reasons for False Positive EPT gingival or periodontal stimulation stimulation of adjacent teeth multiple rooted tooth with partial necrosis patient interpretation

``` FYI- Reasons for False Positive EPT gingival or periodontal stimulation stimulation of adjacent teeth multiple rooted tooth with partial necrosis patient interpretation ```

Reversible Pulpal Injury - symptoms - radiographic - pulp tests - periapical tests

- may have slight symptoms to thermal stimulus - none - responds normal - not sensitve

Irreversible Asymptomatic Pulpal Injury - symptoms - radiographic - pulp tests - periapical tests

- diagnosed by caries excavation to reveal exposure - none or very slight - responds normal - no pain

Irreversible Symptomatic Pulpal Injury - symptoms - radiographic - pulp tests - periapical tests

- severe pain to thermal stimulus, possible spontaneous pain - none or slight, exception=osteitis - severe pain with thermal, possible spontaneous pain - often painful

Necrotic Pulpal Injury - symptoms - radiographic - pulp tests - periapical tests

- none to thermal stimulus - radiolucent lesion - depends on periapical status - depends on periapical status

Periapical Symptomatic apical periodontitis - symptoms - radiographic - pulp tests - periapical tests

- significant pain with pressure/masticaiton - none, slight radiolucency - depends on pulp status - not sensitive

Asymptomatic Apical Periodontitis and Apical Cyst - symptoms - radiographic - pulp tests - periapical tests

- none to mild - apical radiolucency - none - none to mild on percussion/palpation

Acute Apical Abscess - symptoms - radiographic - pulp tests - periapical tests

- swelling and significant pain - radiolucency - none - pain on percussion or palpation

Chronic Apical Abscess - symptoms - radiographic - pulp tests - periapical testsf

- draining sinus tract or parulis - radiolucent lesion - none - not sensitive

Condensing Ostelitis - symptoms - radiographic - pulp tests - periapical tests

- depends on pulp status - increased trabecular bone density - depends on pulp status - depends on pulp status

2 Periapical Lesions with Percussion Pain | which has swelling?

symptomatic apical peridontirtis and acute apical abscess | acute apical abscess

Periapical lesion with sinus tract/draining/gum boil

chronic apical abscess

Periapical lesion with radiolucency with NO symptoms

asymptomatic apical periodontitis

Final Exam Flashcards

(115 cards)