Pulp Flashcards
4 causes of pulp inflammation?
- mechanical injury (drilling)
- thermal injury (need water with drilling)
- chemical injury (acid etch on dentin)
- bacterial injury (MOST COMMON)
5 signs of inflammation?
Heat
redness
swelling (edema) - fluid from vasculature
pain (b/c fluid is puttin pressure on nerve endings
loss of function
Why is it when people say a tooth is dead its actually usually not completely dead?
because the cementum is still alive because it recieves its blood supply from PDL
5 components of pulp
- blood vessels
- lymphatic channels (removes edema/swelling)
- nerves
- odontoblasts (@periphery)
- undifferentiated connective tissue cells (mesenchymal cells)
What are the predominant cells histologically in ACUTE irreversible pulpitis? (2 types)
- PMN’s (polymorphonuclear neutrophils)
2. macrophages
What are the predominant cells histologically in CHRONIC irreversible pulpitis? (3 types)
- macrophages
- lymphocytes
- plasma cells
Can you get spontaneous pain with chronic irreversible pulpitis?
NO
If pain lingers for 1 minute or more with removal of stimulus what is the diagnosis?
acute irreversible pulpitis
Will a patient reach 80 on EPT for acute/chronic irreversible pulpitis?
NO
What is treatment for acute and chronic irreversible pulpitits?
RCT/EXO
will a patient be sensitive to percussion with reversible and irreversible pulpitis?
No (rare cases yes, such as multi rooted teeth, one with complete necrosis and the other may still have some viable pulp remaining)
Can apical periodontitis secondary to pulpal pathosis occur on a viable tooth?
NO
What does Granulation Tissue consist of? (2 things)
1- increase in fibroblasts/fibrous tissue
2- increase in endothelial cells and blood vessels
A periapical abscess is what type of infalammation?
Acute inflammation
why may we not be able to properly use LA for a periapical abcess?
Because LA only works in a certain range of pH, often these periapical abscesses alter the pH so much that LA is not effective.,
How do we treat periapical abscess?
IAD - incision and drainage
What is a scenario where a patient would not feel a periapical abscess?
Parulis has formed. elevated soft tissue lesion where puss is draining. Patient may not feel this because the puss is draining and not putting pressure on nerve endings
How do we treat a periapical abscess?
First, IAD. Then we need to deal with the infection by performing a RCT or EXO
How can we determine the source of infection with a periapical abscess?
We can often use gutta percha to enter the abscess and it will lead to the source of the infection. Than we will treat that tooth (RCT/EXO)
What would we see histologically if we biopsied periapical abscess?
“Sea of Neutrophils”
What is present in a parulis?
Granulation tissue - increase in firboblasts/fibrous tissue and an increase in endothelial cells/blood vessels.
Is a periapical abscess painful?
YES, may not be if a parulis has formed (because puss is draining)
What is the FIRST THING we would see with apical periodontitis secondary to pulpal pathosis?
Widening of PDL space (Lamina Dura may still be intact)
What is a Granuloma? (+ 3 things seen histologically)
A chronic inflammation (granulomatous inflammation) characterized by:
1- epithelioid histiocytes
2- multinucleated giant cells
3- peripheral mantle of lymphocytes/plasma cells
