Pulpal Pathophysiology

Question 1

susceptibility of the pulp to irreversible injury

Answer 1

yes

1. low compliance system
2. poor collateral circulation
3. pulpal degeneration
4. abundant oral bacteria

Question 2

pulpal response to a carious lesion why?

Answer 2

direct communicaton between dentin and the pulp

pulp reacts to carie before it is infected with bacteria

Question 3

pulp reacts to carie before it is infected with bacteria?

Answer 3

yes because of

• bacterial products
• endotoxins
• immune complexes

Question 4

slcerotic dentin?

Answer 4

a response to a carious lesion

• peri-tubular dentin
• highly mieralized
• initial defense against a low grade lesion

Question 5

initial defense against a low grade lesion?

Answer 5

scleortic dentin

Question 6

describe dead tracts

Answer 6

Acute carious lesion

death of odontoblasts

loss of odontoblastic processes

open pathway for infection of pulp by oral bacteria

Question 7

describe reparative dentin

Answer 7

Tertiary form of dentin

less tubular / more permeable than primary dentin

produced by replacement odontoblasts

‘calciotraumatic line’

Question 8

‘calciotraumatic line’ represented by?

Answer 8

reparative dentin

Question 9

initial response is what type in pulpal inflammation?

desscribe what happens

Answer 9

intital response is a chronic one
- lymphocytes / plasma cells/ macrophages

• deposition of collagen
• proliferation of blood vessels

Question 10

formation of microabscesses?

Answer 10

yes - a pulpal response to inflammation

it is AN ATTEMPT TO WALL OFF INFECTION

Question 11

Circumferential spread of inflammation?

Answer 11

continued tissue destruction
- continued increase in intra-pulpal pressure

VENULAR COLLAPSE
ISCHEMIC NECORIS

Question 12

c- fibers may still be vital in necrosis?

Answer 12

Yes

Question 13

Classificaiotn of Pulpal Pathosis

3

Answer 13

1. reversible pulpitis
2. ireversible pulpitis
3. pulp necrosis

Question 14

reversible pulpitis

Answer 14

Localized inflammation

localized increase in intra-pulpal pressure

threshold for stimulation of A-delta nerve fibers is lowered
- Hyperalgesia
EXAGGERATED but non-lingering response to stimuli (thermal)

no permanent pulpal damage

Question 15

hyperalgesia definition

associated with

Answer 15

reversible pulpitis–

EXAGGERATED but non-lingering response to stimuli (thermal)

no permanent pulpal damage

Question 16

describe irreversible pulpitis

Answer 16

deep throbbing pain, unstimulated pain

circumferential spread of inflammation

threshold for both A-delta and C fibers is lowered

-lingering pain after thermal stimulation

spontaneous, dull, aching pain

IRREVERSIBLE

Question 17

describe pulp necorsis

Answer 17

COMPELTE NECROSIS OF A-DELTA FIBERS
- no response to vitality tests

C-fibers may still be viable

may or may not be symptomatic

Question 18

Periradicular tissue

describe

Answer 18

Direct communication with pulp tissue

inflammation ersponse precedes infection

collateral ciculation presnt

cancellous bone allows for drainage of edematous fluids

proprioceptive fibers present

Question 19

calciotraumatic line from?

Answer 19

reparative dentin

Question 20

intitial defense against low grade carious lesion

Answer 20

sclerotic dentin

- highly mineralized

Question 21

what is the major way bacteria can go through after an acute carious lesion?

Answer 21

dead tract – loss of odontoblastic processes and death of odontoblast

Question 22

describe tertiary dentin in terms of permeability and tubules?

Answer 22

Less tubular and more permeable than primary dentin

Question 23

describe the pulp in an acute inflammatory reaction

Answer 23

vascular changes – vasodilation and increased permeability

• PMNs and leukocytes
• increased intrapulpal fluid (edea)
• increased intrapulpal pressure
• stimulation of C fibers

Question 24

hyperalgesia represents?

Answer 24

reversible pulpitis

when threshold for stimualtion of A delta nerve fibers is lowered
- hyperalgesia

Question 25

circumferential spread of inflammation is represented by?

Answer 25

irreversible pulpitits

Question 26

collateral circulation present where?

Answer 26

in the peri-radicular areas -- NOT PULPAL

Question 27

Implication of cancellous bone in peri-radicualr tissues

Answer 27

allows for drainage of edematous fluids

Question 28

main two reasons we see symptomatic apical perio and main feature

Answer 28

1. pulpal pathosis 2. occlusal trauma PERCUSSION / PALPATION SENSITIVE

Question 29

radiographic ferature in apical perio

Answer 29

widened PDL - break in lamina dura

Question 30

Feature of acute apical abscess

Answer 30

SWELLING

Question 31

Radiolucency associated with Asympotmatic apical perio? describe

Answer 31

yes -- peri-radicular granuloma or cyst

Question 32

describe periradicualr granuloma

Answer 32

granulomatous tissue - macriphage, lymphocytes, plasma cells - fibrous tissue capsule - increased vascularity

Question 33

bay cyst vs true cyst

Answer 33

bay cyst --> opening in the lining - opening in the canal to the apex true cyst -- completely lined with epithelium lumen may / may not communicate with apical foramen - if it does -- bay cyst -- of if does not -- true cyst

Question 34

describe peri-radicular cyst

Answer 34

associated with AAP - stimulation of epithelial rests of Malassez within in the granuloma 3D epithelial lined cavity filled with fluid lumen may/ may not communicate with apical foramen

Question 35

radiographic feature of focal scelorosing osteomyeltits histologically?

Answer 35

increased bone density/ trabeculation histologically - mild inflammatory response with increased bone deposition it is a response to low grade pulpal inflammation