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Flashcards in Operative Dentistry Deck (137):
1

What is the origin of the Oral Cavity and teeth in the developing embryo?

Neural Crest Cells

2

How does the tooth form developmentally?

Crown to Root

3

Dentinogenesis occurs when?

Before Amelogenesis (enamel formation)

4

_____ formation occurs in a crown down fashion after Dentinogenesis and Ameliogenesis.

Root

5

Primordial Root 3 Terms:

Cervical Loop

Hertwig's Epithelial root sheat

Epithelial diaphragm

6

What are epithelial cells that remain in the periodontal space during root formation?

Rests of Malassez

7

T/F
Lateral and Accessory Canals contain pulp tissue

False

*CT only

8

T/F
Accessory canals are more numerous apically

True

9

Why does the Apical Foramen move and/or narrow throughout life?

Cementum growth

10

What is the most prominent cell in the pulp?

Where are they located?

What do they differentiate into?

Fibroblasts

Cell Rich Zone

Odontoblasts

11

What types of Collagen do Fibroblasts of the pulp make?

Type I and III

12

T/F
Odontoblasts are unique to pulp tissue and make Dentin, they are more organized in the apical region

True

13

Shape of Odontoblasts Coronal:

Middle:

Apical:

Columnar

Cuboidal

Squamous

14

2 Afferent Sensory Fibers of the Pulp:

A-Delta fibers

C fibers

15

T/F
Efferent Motor Fibers of the Pulp are associated with Sympathetic contractions of smooth muscles in the capillaries.

True

16

***What type of Fibers are associated with Reversible Pulpitis clinically?

A (alpha) Pain Fibers

*sharp, non-lingering type pain
*myelinated

17

The low conduction velocity Fibers associated with Symptomatic Irreversible Pulpitis of the pulp are what?

C Fibers

*dull, throbbing, lingering pain

18

What are the 3 primary theories of Dentin Sensitivity?

Direct innervation

Odontoblastic Receptor

Hydrodynamic (accepted theory)

19

What is the origin of the Blood Supply to all the Pulp?

Internal Maxillary Artery

20

Blood flow is greater in the _____ pulp

Coronal

21

What bypasses the capillary bed during inflammation of the pulp (this decreases interpulpal bp).

A-V shunt

22

What are the 5 functions of the Pulp?

Induction

Formation (continuously forms secondary dentin)

Nutrition

Defense

Innervation

23

T/F
Reparative, Irritational, and Tertiary are all terms that form in response to an irritant

True

24

What are the 4 Zones of the Pulp?

Pulp Proper

Cell Rich Zone

Cell Free Zone

Odontoblastic Layer

25

T/F
Pulp Stones are always an indication of needing a root canal

False

26

What is another name for Pulp Stones in the pulp Chamber?

What are pulp stones occurring along nerves, vessels, or collagen bundles called (in CANALS)?

Denticles

Diffuse/Linear Calcifications

27

What is the consequence of bacteria reaching the pulp?

Necrosis

***requires endodontic extraction

28

T/F
Do not perform a direct pulp cap of a carious lesion

True

*However, new substances may change this

29

T/F
Three is a 13% success rate after a direct pulp cap of a carious lesion

True

30

T/F
Crowns cause damage and can lead to root canals

True

31

T/F
Pulpal rxns are vascular and neural

True

32

T/F
Increased flow will cause painful inflammation

Decreased blood flow will cause necrosis

True

True

33

What are 4 Defense mechanisms of the Pulp?

AV shunting

Secondary Dentin

Reparative (tertiary) Dentin (caused by irritant)

Immune response

34

Within the Caries Balance (in CAMBRA), what are 3 Pathological Factors and 3 Protective Factors?

Acid-producing bacteria, low salivary rate, frequent consumption of fermentable carbs

Saliva, Fluoride, Antibacterials (CHX, xylitol)

35

What 4 Disease Indicators (clinical observations) immediately put someone in a High Risk Category?

Visible Cavities present

Caries restored in last 3 years

Interproximal lesions

White spots on enamel surfaces

36

What are the 9 risk factors, any of which will put a pt at Moderate Risk?

Mutans/Lactobacilli medium/high in culture

Heavy plaque

Frequent snacks

Deep pits/fissures

Recreational drugs

Inadequate Saliva

Meds, radiation, Sjogren's (reducing saliva)

Exposed Roots

Orthodontics

37

In the absence of disease indicators, what are the 11 Protective factors automatically putting someone at Low Risk?

Fluoridated community, Fluoride toothpaste (once), Fluoride toothpaste (twice), Fluoride mouthrinse

5000 ppm F toothpaste, F varnish last 6 mo., Office topical F last 6 mo., CHX (once week, last 6 mo.)

Xylitol gum (4x daily 6 mo.), MI past 6 mo., Adequate Saliva Flow

38

What are the 4 Risk Assessment Procedures?

Diet Analysis

Plaque pH measurment

Saliva Flow

Bacterial Test

39

High Dietary Risk (like a frequent snacker) puts on at a ______ Risk for caries

Moderate

40

What is the cutoff Salivary Flow Rate that defines Xerostomia?

Less than 0.7 ml/min

(greater thatn 1.4 ml/min is normal)

*this may be wrong - thought he said 1 ml, and there was no grey area

41

Decreased Salivary flow can inhibit remineralization because _____ and _____ ions are reduced.

Calcium

Phosphate

42

What cancer therapy can cause Xerostomia?

Radiation to head and neck

43

Above 1500 bacterial test is "at risk," putting the pt in what category?

Medium risk category

44

CAMBRA guidelines, Frequency of Radiographs Low Risk:

Moderate Risk:

High Risk:

Extreme Risk:

18-24 months

18-24 months

6-12 months

6 months

45

Frequency of Periodic Oral Exams Low Risk:

Moderate Risk:

High Risk:

Extreme Risk:

12 months

12 months

6-12 months

3-6 months

46

T/F
Sealants for deep pits and fissures are recommended for all CAMBRA risk levels.

False

*none for Low Risk

47

For CAMBRA, when are Bacteria Test and Saliva Flow tests done for Low Risk:

Moderate Risk:

High Risk:

Extreme Risk:

Baseline for New pts

Baseline for New pts/high bacterial challenge suspicion

Every POE (periodic oral exam)

Every POE

48

CAMBRA intervention CHX (chrorhexidine) are used how at Low Risk:

Moderate Risk:

High Risk:

Extreme Risk:

No

No

1 min/day, 1 week/month

1 min/day, 1 week/month

49

What can't CHX be combined with?

Fluoride

*1 hour gap required

50

T/F
The Bacterial cell is positively charged, and CHX is negatively charges

False

CHX+ and Bacterial Cell -

51

CHX is effective against ______, but _____ are resistant in the mouth

S. mutans

Lactobacilli

52

T/F
CHX and Betadine (Iodine) stain

True

53

Fluoride CAMBRA interventions for Low Risk:

Moderate Risk:

High Risk:

Extreme Risk:

F toothpaste 2x daily

F toothpaste 2x daily/0.5% NaF rinse daily

Varnish/1.1% NaF toothpaste

Varnish/F toothpaste/F trays (Prevident gel)

54

What is the Therapeutic Concentration of Fluoride in the mouth?

.04-.1 ppm

55

What does Fluoride Varnish form on enamel surfaces?

Calcium Fluoride "time bomb"

56

Xylitol/Baking Soda CAMBRA intervention for Low Risk:

Moderate Risk:

High Risk:

Extreme Risk:

None

gum/mints 2x/day

gum/mints 4x/day

gum/mints 4x/day Baking Soda rinse 4-6x/day

57

T/F
Xylitol easily penetrates biofilm and alters the way bacteria stick to surfaces

True

58

The use of Xylitol Gum by mothers reduced colonization in infants. Xylitol was better than _____, which was better than ______.

CHX

F varnish

59

What are 7 diagnostic tests we can run with Saliva?

Myocardial Infarction (C-reactive protein)

Renal disease

Breast cancer (CA 15-3 cancer antigen)

Type II Diabetes

Sjogren's

Forensics

Bacterial, fungal, viral (in future)

60

Name 5 Antibacterial Functions of Saliva:

sIgA: inhibits S. mutans attach

Histatin: pellicle

Lactoferrin: binds Fe, competes w/ S.mutans

Salivary Peroxidase

Amylase

61

What Salivary component is important for Lubrication?

Mucin

62

Buffering in Saliva is dependent on what 2 components:

Remineralization in Saliva is dependent on what 2 components:

Phosphate, Bicarb

Phosphate, Calcium

63

What protein is involved in pellicle formation and inhibits precipitation of Calcium by binding to it?

PRP - Proline Rich Proteins

64

What in Pellicle formation inhibits the primary precipitation of Calcium and Phosphorus?

Statherins

65

What is the normal pH of Saliva?

6.8-7.3

66

T/F
A biofilm lives at the interface between a solid and liquid

True

67

In Caries Risk Assessment, what 4 conditions requires a mandatory bacteria test?

Visible cavities

Caries restored last 3 yrs

Interproximal caries/lesions/radiolucencies

White spots on enamel surfaces

68

Visible cavities, Caries restored in the last 3 yrs, Interproximal caries, or white spots on enamel surfaces will automatically put the pt in what Risk Category?

High Risk

69

dmfs:

DMFS:

decayed/missing/filled surfaces (primary dentition)

decayed/missing/filled surfaces (permanent dentition)

70

What are the 4 requirements to produce Dental Caries?

Substrate

Bacteria

Tooth/host

Time

71

How does F enter the bacterial cell?

How does F ion damage the bacteria?

HF under Acidic Conditions

Interferes with enzymes (enolase)

72

T/F
F combines with Ca and phosphate to make a low solubility veneer of Fluoroapatite like mineral and enhances mineralization

True

73

What is the mottling of tooth enamel caused by a developmental consumption of excess fluoride?

When is this risk the highest?

Fluorosis

20-30 months

74

What are current fluoridation levels in the water?

1.0 ppm

75

ATP bioluminescence activity of S.mutans is done by what marker?

Luciferin

*test takes one minute

76

Bacterial Test 0-1500 =

1500 and above =

Low risk

At risk

77

T/F
Brushing reduces caries

False

78

T/F
Caries is an infectious disease

True

79

Name 4 Chemotherapeutics:

Fluoride

Baking soda

CHX

Xylitol

80

What is the percentage of carbonate associated with hydroxyapatite crystals?

20%

81

What bacterial species first colonizes the pellicle?

S. sanguinis

*low colonization threshold

82

pH at which enamel dissolves?

5.5

83

What bacterial species is Acidogenic, Aciduric, Adherent, uses Bacteriocins, and has a High Colonization Threshold?

S. mutans

84

Where does S. mutans live in the mouth?

Everywhere - furrows of tongue as well as teeth

85

Name 3 Cariogenic Bacteria:

S. sobrinus

S. mutans

Lactobacilli

86

What primarily remineralizes enamel?

Calcium and phosphate in solution

*F blocks demineralization

87

What is the most soluble apatite structure?

Medium soluble?

Least soluble?

Carbonated apatite

Hydroxyapatite

Fluoroapatite

88

High dietary risk is _____ risk for caries and they are not directly correlated

Moderate

89

What is the reduction in caries rates with F varnish?

46%

90

Xylitol Gum > CHX > Fluoride Varnish in what?

Vertical S.mutans transmission

91

____ canals are found in the Coronal 2/3 of the tooth

____ canals are found in the Apical 1/3 of the tooth

Lateral

Accessory

92

T/F
The apical foramen changes with age due to cementum deposition and contains a Neurovascular Bundle

True

93

What is used to lower interpulpal bp (making blood flow greater in the Coronal Pulp)?

A-V shunts

94

What are the 4 zones of pulp from inside out?

Pulp proper

Cell rich zone

Cell free zone

Odontoblasts lining predentin

95

T/F
There is no correlation between pulp calcification due to age and symptoms

True

96

Where are Linear Pulpar Calcifications found?

Root

97

T/F
Pulpal Calcifications require root canals

False

98

What is a Dentricle?

Pulp stone/calcification

99

A small Carious exposure will have what immune response?

APC (antigen presenting cells) and random migration of T cells

100

A large Carious exposure will have what immune response?

PMN's and B cell activation

101

A prolonged Carious exposure will have what immune response?

Specific T cells in effector phase

102

What are the 4 defense mechanisms of the pulp to insult?

AV shunting

Secondary Dentinal Mechanisms

Reactionary/reparative dentin formation

Immune

103

A clinical diagnostic category in which the pulp is Symptom Free and Normally Responsive to pulp testing?

Normal Pulp

104

A clinical diagnosis based upon subjective and objective finding indicating that the inflammation should resolve and the pulp return to normal

Reversible Pulpitis

105

A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing.

Additional descriptors: Lingering thermal pain, spontaneous pain, referred pain.

Symptomatic Irreversible Pulpitis

106

A clinical diagnosis based on the subjective and objective findings indicating that the vital inflamed pulp is incapable of healing.

Additional descriptors: No clinical symptoms but inflammation produced by caries, caries excavation, trauma, etc.

Asymptomatic Irreversible Pulpitis

107

A clinical diagnostic category indicating death of the dental pulp. The pulp is usually nonresponsive to pulp testing.

Pulp Necrosis

108

A clinical diagnostic category indicating that the tooth has been endodontically treated and the canals are obturated with various filling material other than intracanal medicaments.

Previously Treated

109

A clinical diagnostic category indicating that the tooth has been previously treated by partial endodontic therapy (e.g., pulpotomy, pulpectomy)

Previously Treated Therapy

110

Teeth with normal perriadicular tissues that are not sensitive to percussion or palpation testing. The lamina dura surrounding the root is intact and the periodontal ligament space is uniform.

Normal Apical Tissues

111

Inflammation, usually of the apical periodontium, producing clinical symptoms including a painful response to biting and/or percussion of palpation. It may or may not be associated with an apical radiolucent area.

Symtomatic Apical Periodontitis

112

Inflammation and destruction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area, and does not produce clinical symptoms.

Asymptomatic Apical Periodontitis

113

An inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation and swelling of associated tissues.

Acute Apical Abscess

114

An inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little or no discomfort, and the intermittent discharge of pus through an associated sinus tract.

Chronic Apical Abscess

115

Diffuse radiopaque lesion representing a localized bony reaction to a low-grade inflammatory stimulus, usually seen at apex of tooth.

Condensing Osteitis

116

Normal pulp

A clinical diagnostic category in which the pulp is Symptom Free and Normally Responsive to pulp testing?

117

Reversible Pulpitis

A clinical diagnosis based upon subjective and objective finding indicating that the inflammation should resolve and the pulp return to normal

118

Symptomatic Irreversible Pulpitis

A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing.

Additional descriptors: Lingering thermal pain, spontaneous pain, referred pain.

119

Asymptomatic Irreversible Pulpitis

A clinical diagnosis based on the subjective and objective findings indicating that the vital inflamed pulp is incapable of healing.

Additional descriptors: No clinical symptoms but inflammation produced by caries, caries excavation, trauma, etc.

120

Pulp Necrosis

A clinical diagnostic category indicating death of the dental pulp. The pulp is usually nonresponsive to pulp testing

121

Previously Treated

A clinical diagnostic category indicating that the tooth has been endodontically treated and the canals are obturated with various filling material other than intracanal medicaments.

122

Previously Treated Therapy

A clinical diagnostic category indicating that the tooth has been previously treated by partial endodontic therapy (e.g., pulpotomy, pulpectomy)

123

Normal Apical Tissues

Teeth with normal perriadicular tissues that are not sensitive to percussion or palpation testing. The lamina dura surrounding the root is intact and the periodontal ligament space is uniform.

124

Symptomatic Apical Periodontitis

Inflammation, usually of the apical periodontium, producing clinical symptoms including a painful response to biting and/or percussion of palpation. It may or may not be associated with an apical radiolucent area.

125

Asymptomatic Apical Periodontitis

Inflammation and destruction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area, and does not produce clinical symptoms.

126

Acute Apical Periodontitis

An inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation and swelling of associated tissues.

127

Acute Apical Abscess

An inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation and swelling of associated tissues.

128

Chronic Apical Abscess

An inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little or no discomfort, and the intermittent discharge of pus through an associated sinus tract.

129

Condensing Osteitis

Diffuse radiopaque lesion representing a localized bony reaction to a low-grade inflammatory stimulus, usually seen at apex of tooth.

130

***Maxillary 1st Molars: _____ have 4 canals

_____ have 3 canals

***94%

6%

131

What is the most variable tooth?

Maxillary 1st molars

132

Mandibular C.I. has 1 canal ____ %

2 canals _____%

70

30

*cingulum has 2nd canal

133

T/F
Quality Restoration is key in the prevention of Root Canal Failure

True

134

Where is the pulp always at the Center of the Tooth?

CEJ

135

The Maxillary Lateral Incisor's Root usually takes a _____ curve

Distal

136

What is the longest tooth in the mouth?

Maxillary Canine

*facio-lingually very broad

137

The Mandibular lateral incisor is usually longer by ___ mm

2 mm

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