Pulp and Periapical Disease Exam 2

Question 1

What is pulpitis ?

Answer 1

Starts w/ an injury to the tooth

Question 2

What are the most common bacteria in pulpititis?

Answer 2

• Mutans group streptococci
• Streptococcus mutans and streptococcus sobrinus

Question 3

What is the pulp ?

Answer 3

• Connective tiisue that reacts to injury with inflammatory response
  Accessory canals may lead to inflammation on the lateral portion of the root

Question 4

What causes a pulpitis ?

Answer 4

• Caries (PRIMAY CAUSE)
• Cracks in corwn or root
• Periodontal pockets
• Trauma from blows
• Bruxism, abrasion, erosion
• Latrogenic

Question 5

What is Reversible Pulpitis and what is its treatment ?

Answer 5

• Tooth is asymptomatic unless stimulated
• Pain sharp and intense 5-10 min
• Temp changes
• Treatment: protect pulp from further thermal stimulation

Question 6

What is irreversible pulpitis?

Answer 6

• Spontaneous Pain lasting 20 min
• Pulpal tissue exhibits acute and chronic inflammatory changes
• Less intense pain as granulation tissue replaces pulp during healing
• Pain may become initiated or worsen when PT lays down
• Difficult to know which tooth

Treatment: Root canal or extraction

Question 7

What is acute pulpitis?

Answer 7

Result of rapid bacterial invasion (mostly in kids)
No drainage

Question 8

What is chronic pulpitis?

Answer 8

• Usually the result of chronic, loawgrade irritant.
• Reparative dentin acts as a barrier

Question 9

What is Pulpal Necrosis?

Answer 9

• Pulp tissue no longer living
• result from sudden trauma in blood supplyy is severed
• Result of untreated pulpitis
• Tissue being replaced by granulation tissue
• First sign tooth discoloration
• asymptomatic

Question 10

What are the common diagnostic techniques?

Answer 10

• History and nature of pain
• Reaction to thermal
• Reactionn to electrical stimulation
• REaction to percussion
• Radiographic examination
• Visual exam

Question 11

What is chronic hyperplastic pulpitis?

Answer 11

Rare condition seen in childrens molars
Result of rampant acute caries
Crown disintegrates before the pulp
Also known as Pulp polyp

Question 12

What is a periapical lesions?

Answer 12

Lesions that forms depends on:
virulence of microorganis,
Extent of sclerosis of dentinal tubules,
Host immune response

Question 13

What are the factors for a chronic pulpitis ?

Answer 13

Low virulence bacteria
Older tooth with sclerotic dentin
Healthy patient= mild, chronic symps, healing= granulation tissue, scare tissue and dense bone

Question 14

What are the factors for acute pulpitis?

Answer 14

• Virulent bacteria, young tooth with open dentinual tubles = rapid intense destruction

Question 15

What are common lesions follwoing pulpitis?

Answer 15

• Periapical granuloma
• Periapical cyst
• Periapical abscess
• Osteomyelitis
• Cellulitis

Question 16

What is the map for chronic?

Answer 16

Chronic apical periodontitis –> Periapricall granuloma —> Periapical cyst

Question 17

What is the map for actue?

Answer 17

Periapical abscess –> Osteomyelitis –> Chronic osteromyelitis, cellulitis, Garre osteomyelitis

Question 18

What lesions can turn into each other?

Answer 18

Abscess (Pus), Cyst (epithellial lining) and Granuloma (Granulation tissue)

Question 19

What is a periapical abscess?

Answer 19

initial lesion that develops when acute pulpitis extends into adjacent tissue
- Can have elevated temperature and malaise
- Tooth extruded in the socket, great pain, elevated temo, malaise, swelling and redness at apex
- Pus seeks drainage along the path of least resistance
- Treatment: incise and drain, antibiotics then extraction/root canal

Question 20

What is a periapical Granuloma?

Answer 20

• Most common lesion that occurs after necrosis
• Occurs as chronic pulpitis progresses into the periapical region
• can show slight vitality with pul test
• widened PDL
• Pulp now consists with granulation and dense fibrous
  Treatment: Root canal, apioectomy or extraction

Question 21

What is periapical cyst ?

Answer 21

Common development in a long-standing untreated periapcal granuloma
* Stimulated by low grade inflammation
* Develops continously intil it destroys large portion of alveolar bone

*Treatment: Surgical removal

Question 22

What is osteomyelitis?

Answer 22

An inflammatory process within trabecular bone
** Most commonly caused by direct extension of an untreated periapical abscess

Treatmet: radiation therapy to the head

Question 23

What is acute osteomyelitis?

Answer 23

• Severe pain
• Elevated temp
• Lympnadenopathy
• Island of dead bone surronded by purluent exudate

Question 24

What is Chronic Osteomyleitis?

Answer 24

• Occurs in response to low grade inflammatory process
• osteocytes stimulate dense trabecular bone
• Little to no pain

Question 25

What are the two types of chronic osteomyelitis?

Answer 25

Sclerosing osteomyelitis Garre Osteomyelitis

Question 26

Who does Garre osteomyelitis occur in ?

Answer 26

Children as a hyperplastic reaction to chronic osteomyelitis

Question 27

What are the treatments for Sclerosing and Garre OSteomyelitis?

Answer 27

Sclerosing- none, dense bone remians Garre- Reverts to normal after source eliminated

Question 28

What is Cellulitis?

Answer 28

* Painful swelling of head and face * Enzymes exudate bacteria break decrease fascia surrounding muscle bundles allows exudate to spread and cavise swelling

Question 29

What is the cause of cellulitis?

Answer 29

* spread of purelent exudate along fascial planes * Extension of periapical abscess into soft tissue

Question 30

What is the symptoms of cellulitis?

Answer 30

* Pain * Increase temp * Malase * Lymphadenopathy

Question 31

What are the resulting conditions for cellulitis

Answer 31

* Pulp Stones- often in chronic pulpitis * No pain/clinical signifance * No tx necessary * maxillary involvement: spread to eye and brain * Luduig angina- spread to FOM and Neck= suffocation

Question 32

What are the different types of resorption ?

Answer 32

Types: external and internal

Question 33

What is external resorption ?

Answer 33

Loss of structure that begin on outside caused by : pressure form tumors, cysts, occlusal/mechaniacal forces, impaction

Question 34

What is the internal resorption ?

Answer 34

* Begins within pulp

Question 35

What are root fractures?

Answer 35

- Tooth=brittle (after root canal) - More prone to fracture

Question 36

What is pericontitis?

Answer 36

Inflammation of mucosa around partially erupted tooth- mand 3rd=most common -operculum: Tissue flap Tx: Irrigate Antibitoics Extraction Trim operculum

Question 37

What is Alveolar osteoitis ?

Answer 37

"Dry socket" post op complication of tooth extraction clot lost by healed raw denuded bone=exposed

Question 38

What are the symptoms of alveolar osteoitis?

Answer 38

Very painful Bad odor/taste ***not an infection***

Question 39

What are facial disturances ?

Answer 39

* Failure of palatine process to fuse w/ premaxilla= cleft

Question 40

What are the different Soft tissue abnormalities?

Answer 40

* Lip pits * Double lip

Question 41

What are the different abnormalities of the tongue ?

Answer 41

* Ankyloglossia * Macroglossia * Bifid tongue * Median rhomboid glossitis * Fissured tongue * Erythema migrans * Hairl tongue

Question 42

What are the abnormalities of the teeth?

Answer 42

Anodonta Hypodontia/oligontia Supernumerary--> mesiodens

Question 43

What are the abnormalities of the size of teeth?

Answer 43

Microdontia