The diseases of the pulp and periodontium

Question 1

What can caries result in

Answer 1

Question 2

Clinical features of pulp hyperaemia

Answer 2

• sharp pain lasting for seconds
• pain stimulated by hot/cold or sweet foods
• pain resolves after stimulus
• caries approaching pulp but tooth can still be restored without treating pulp (reversible pulpitis)

Question 3

Clinical features of acute pulpitis

Answer 3

• constant severe pain
• reacts to thermal stimuli
• poorly localised pain
• referral of pain
• no/minimal response to analgesics (can’t get into pulp chamber)
• open sumptoms less severe

Question 4

would acute pulpitis show as positive or negative to TTP and why

Answer 4

Negative (usually) as PDL is not inflamed

Question 5

How could you diagnose acute pulpitis

Answer 5

• History - constant severe pain, reacts to thermal stimuli, poorly localised pain, referral of pain, no/minimal response to analgesics
• Visual examination
• negative TTP
• pulp testing equivocal
• radiographs - big cavity maybe but that’s all
• ‘Diagnostic LA’ - numb up and see if pain goes away
• removal of restorations

Question 6

is pulp hyperaemia reversible or irreversible

Answer 6

reversible

Question 7

Is acute pulpitis reversible or irreversible

Answer 7

irreversible

Question 8

What is the diagnosis:
- can pinpoint exactly where pain is
- very TTP
- tooth is non-vital
- slight increase in mobility
- radiographs: loss of clarity of lamina dura, possible radioleucent shadow from old lesion, delay in changes at the apex of the tooth

Answer 8

acute periodontits

Question 9

What causes traumatic periodontitis

Answer 9

parafunction (tooth clenching or grinding)

Question 10

in traumatic periodontitis would teeth have vitality?

Answer 10

yes

Question 11

how would you diagnose traumatic periodontitis

Answer 11

• clinical examination of occlusion (functional positioning, posturing)
• TTP
• normal vitality
• radiographs may show generalised widening of PDL space

Question 12

how would you treat traumatic periodontitis

Answer 12

• occlusal adjustment
• therapy for parafunction

Question 13

what is the most common pus producing infection

Answer 13

acute apical abscess

Question 14

what infections produce pus

Answer 14

• acute apical abscess
• periodontal abscess
• peridoronitis
• sialadenitis (infection of glands)

Question 15

scientific word for pus

Answer 15

suppuration

Question 16

what orgainisms are in a dental abscess

Answer 16

• polymicrobial
• anaerobes play a part

unusual infections:
- staphylococcal lymphadenitis of childhood
- cervico-facial actinomycosis

Question 17

initial symptoms of acute apical abscess

Answer 17

• severe unremitting pain
• acute tenderness in function
• acute tenderness on percussion

before it perforates through bone

Question 18

what are the differences between acute apical periodontitis and acute apical abscess

Answer 18

get answer

Question 19

what are the 5 cardinal signs of inflammation

Answer 19

1. heat
2. redness
3. swelling
4. pain
5. loss of function

Question 20

what are the symptoms once an acute apical abscess perforates through bone

Answer 20

• pain often remits (unless it’s in the palate) (release of pressure)
• swelling, redness and heat (in the soft tissues) become increasingly apparent
• as swelling increases, pain returns
• there is an initial reduction in TTP of the tooth as pus escapes into the soft tissues

Question 21

when do 3rd molars erupt into the mouth

Answer 21

18-24yrs

Question 22

when does crown calcification begin in a 3rd molar

Answer 22

7-10 years old

Upper: 7-9yrs; Lower: 8-10yrs

Question 23

when is root calcification complete for 3rd molars

Answer 23

18-25yrs

Question 24

what is it called when an organ (tooth) fails to erupt

Answer 24

agenesis

Question 25

What does impacted mean

Answer 25

blocked (partial or full)

Question 26

incidence of impacted lower 3rd molars

Answer 26

36-59%

Question 27

nerves at risk during 3rd molar surgery

Answer 27

- inferior alveolar nerve - lingual nerve - nerve to mylohyoid - long buccal nerve

Question 28

anatomy of where the lingual and inferior alveolar nerve lies at 3rd molar

Answer 28

Question 29

what does the IAN supply and what is it a branch of

Answer 29

- mandibular division of trigeminal nerve - supplies all mandibular teeth on that side, skin of lower lip and chin on that side

Question 30

what is the lingual nerve a branch of and what does it supply

Answer 30

- mandibular division of the trigeminal nerve - supplies anterior 2/3 dorsal and ventral mucosa of tongue - also gives off a branch which supplies lingual gingiva of mouth

Question 31

where does the lingual nerve lie

Answer 31

- superior attachment of mylohyoid muscle and mean vertical distance from the crest of the lingual plate is 8.32mm while mean horizontal distance is 3.45mm

Question 32

what is the location of the lingual nerve

Answer 32

close relationship to the lingual plate in mandibular and retromolar area

Question 33

What are the NICE guidelines on whether or not to extract wisdom teeth

Answer 33

Discouraged removal unless there is pathology

Question 34

What are the FDS, RCS 2020 guidelines on whether to extract wisdom teeth

Answer 34

- by not removing we're just postponing inevitable surgery which can make tx more difficult at the time - could affect 7 - complicaitons if older pt more holistic and agreed by pt

Question 35

Indications for extraction

Answer 35

- infections - cysts - tumours - external resorption of 7 or 8