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105 Cards in this Set
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What is the main sign that can be used to determine the severity of pulpal inflammation?
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PAIN
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What are some causes of pulpitis? (general causes)
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Chemical irritations, thermal changes, mechanical damage, bacterial effects, cracks in crown, root fractures. . .
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What is the main etiology of pulpitis?
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Bacterial invasion of dentin and pulp from caries.
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Which is worse/more symptomatic- bacterial or virus invasion in the apical area?
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Viral is more symptomatic!
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What is one big difference in the tooth as compared to other tissues? think edema . . .
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The tooth has enclosed walls which leads to compression of venous return which leads to strangulation of the arterial in flow. All this leads to pulpal damage.
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what are the 2 types of pulpitis & definitions?
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reversible = pulp can return to normal state after noxious timuli is removed.
irreversible = damage to the pulp is beyond the point of recovery. Pulpitis may be acute or chronic. |
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Pulp hyperemia is another name for what type of pulpitis?
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Reversible pulpitis.
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what is the typical main cause most of the time for reversible pulpitis?
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large carious destruction of tooth which exposes dentin!
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etiology of what condition?
-large carious destruction of tooth -replacement of large metallic fillings -contact with sweets -cracks in crown |
reversible pulpitis
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how do you distinguish reversible from irreversible pulpitis?
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1. irreversible = spontaneous pain vs reversible = pain brought on by thermal change.
2. percussion of tooth 3. duration of each episode of pain- irreversible = lingering vs reversible = a few seconds 4. history of pain as described by patient |
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what condition is sensitive to cold and possible sweets, with pain that subsides withing seconds (5-10 second), responds to electrical stimuli and is sensitive to percussion when tooth is cracked?
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Reversible pulpitis
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T/F: in reversible pulpitis there is dilation of pulp vessels & engorgement resulting in pulp showing hyperemia, edema and acute/chronic inflammatory cells.
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T
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how do you treat reversible pulpitis? what's the prognosis?
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remove irritant with possible sedative medication. if not, could lead to death.
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what is the clinical condition associated iwth subjective and objective findings indicating severe inflammation of the pulp. there is inability of the pulp to revoer regardless of the attempts to treat it?
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Irreversible pulpitis
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etiology = usually large restorations or caries, often recurrent decay & may be progression of focal reversible pulpitis. is this acute or chronic irreversible pulpitis?
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acute
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clinical features = very sensitive to thermal change (especially cold), sharp severe pain, pain persists after stimuli are removed (several seconds), spontaneous pain, can also be sensitive to heat, severity of pain is only partially related to severeity of inflammatory response, can't sleep at night bc all the pain, may not be sensitive to percussion, may not be able to localize tooth within quad, may respond to electric pulp test at lower levels of current in earlier stages but higher levels in later stage. what condition is this?
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acute pulpitis- irreversible.
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in what type of condition is the pt not able to localize tooth within the quadrant?
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acute pulpitis- irreversible.
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in acute pulpitis- irreversible: why may the pt not be sensitive to percussion?
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bc inflammation is starting to get down to the apex already.
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histology = increased vascular dilation with edema, EXUDATION & NEUTROPHIL CHEOMTAXIS, WBCs leave blood vessls and can be seen in pulp and especially in areas of carious lesion, some odontoBLASTS destroyed (and they are forced in dentinal tubules where the get broken down and produce more irritants hence more inflammation occurs), may see pulp abscess and within a few days spreads to whole pulp?
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acute pulpitis-irreversible
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how many days does it take for acute irreversible pulpitis to spred to the whole pulp?
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within a few days
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what clinical condition may a fistulous tract be identified with?
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chronic pulpitis- irreversible
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what may arise as acute pulpitis and die down, or may be chronic from the beginning (resulting from long-term, low-grade injury) where pain is not the prominent featrues, only grumble.mild intermittent dull aching? it is usulaly relived by aspirin and may be initated by lying down?
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chronic pulpitis- irreversible
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pt comes in and complains of a dull ache that occurs whenever she lays down. she says that aspirin helps relieve sypmtoms. what do you tell her she prob has?
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chornic pulpitis- irreversible
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as you are looking through a histology slide you see that the entire pulp is involved with an inflitration of lymphocytes and plasma cells with only a few neutrofils. there is also increased fibroblastic activity. what are you looking at?
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chronic pulpitis- irreversible
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how do you treat chronic irreversible pulpitis?
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endo or extraction
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your pt comes in and when you ask for her symptoms, she can't give you any true symptoms. sometimes she feels vague pain, but sometimes she feels no pain. you decide to do a pulp test on her, and there is no reaction. but you notice there is discoloration of her crown. why is it discolored and what clinical condition does she have?
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discoloration is due to the breakdown of blood vessels, so make sure you clean out the chamber well when doing procedures. she has necrotic pulp.
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what's the tx for necrotic pulp?
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endo or extaction.
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what's another name for pulp polyp?
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chronic hyperplastic pulpitis.
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what's another name for chronic hyperplastic pulpitis?
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pulp polyp
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overgrown of inflammed granulation tissue coming from the pulp is known as what?
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pulp polyp
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in pulp polyp there is an overgrowth of what type of tissue coming from the pulp?
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inflammed granulation tissue
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what age group is mostly affected wtih pulp polyps?
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children and young adults
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is the pulp vital or non vital in pulp polyps? is the process reversible or not?
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vital, but the process is not reversible.
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in chronic hyperplastic pulpitis is there pain?
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usually not expept when biting on area.
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which teeth are normal affected in chronic hyperplastic pulpitis?
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Usually DECIDUOUS molars and first PERMANENT molars.
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which deciduous teeth are affected in pulp polyps?
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molars
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which permanent teeth are affected in pulp polyps?
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first molars
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why does chronic hyperplastic pulpitis usually occur?
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due to large carious exposure (that open into coronal pulp chamber) = tissue grows out of pulp.
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where does the granulation tissue and chronic inflammatory infiltrate come from in pulp polyps?
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adjacent tissue.
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in pulp polyps how does the surface become epithelized?
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squamous epi cells from cheek slough off and land on exposed pulp with growing granulation tissue
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what are the diagnostic procedures that are commonly used to assess the status of a symptomatic tooth and pulp?
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oral questions (history and nature of pain- use direct questions and also reaction to thermal changes)
hands-on (rxn to electric stimulation, percussion, xray, visual exam, palpation) |
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are pulp vitality tests final and accurate tests to help us interpret in light of other clinical findings?
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no, they are only METHODS to help- they are not final or accurate all the time
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percussion is a useful method in helping to ascertain whether the acute pulpal inflammation has spread to involve what region?
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apical periodontal region
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transillumination may show if there is pulpal death. what will you see?
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discoloration! it is very good way to detect EARLY carious lesion sin anterior teeth too!
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what is a very good way to detect EARLY carious lesion sin anterior teeth ?
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transillumination
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reversible & early acute pulpitis: is more or less current needed to respond? is this reliable?
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less current needed. not too reliable.
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your pt came in with reversible & early acute pulpitis. you performed the thermal test on her. what was she sensitive to?
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particularly sensitive to COLD
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reversible & early acute pulpitis- which 2 tests have normal findings?
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precussion & transillumination
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Later stages of Acute Pulpitis- is more or less current needed to respond?
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more
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your pt comes in with pain, so you do a few tests. Thermal test- pintesified by heat, relived by cold at times. you percussed her and found that it was tender. the electric test needed way more current to respond. what do you think she has?
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later stages of acute pulpitis
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your pt comes in with chronic pulpitis and she responds to the electrical test at very high levels. when you percussed her she says the tooth felt "different." transillumination showed a slight change in color, otherwise normal. when she asked for you to do the thermal test what did you tell her?
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sorry, but the thermal test is of LITTLE VALUE, you MAY respond to a little heat though. . .
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in a pt with necrotic pulp, what's a good test to perform? and what is the result?
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electric test- there will be no repsonse.
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what is there no response to cold when doing the thermal test on your pt with necrotic pulp? but why is there sometimes response to heat?
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bc the tooth is necrotic, there is no nerve tissue, thus no response to cold.
-response to heat bc of expansion of gases at times. |
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when you transilluminate your pt's necrotic pulp what do you see?
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change of color, more opaque.
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fluticasone
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Flovent HFA
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anti-asthmatic
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T/F: periapical Dz meets a less effective resistance than pulpal dz?
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F. periapical dz meets a more effective resistance than pulpal dz. repair is more often achieved in periapical pathosis.
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acute apical periodontitis = inflammation around the apex. is it localized or generalized?
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localized.
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your pt comes in with a spontaneous, excruciating, throbbing pain on her lower right quadtrant. as you try to touch the area she says NO, bc it is extermely painful to touch. so, you just tell her to open her mouth so you can inspect. there is no overt swelling, but you see that tooth # 29 is in supra occlusion - why is this? what does she have?
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supra occlusion = bc excudate and neutrophilic infiltrate of abscess causes pressure on the tissues = extrusion of tooth from the pocket! she has acute apical periodontitis.
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in acute apical periodontitis there is inflammation to the PDL. Is there gross death of tissue as well?
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no
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in acute apical periodontitis you see a central zone of necrotic tissue around apex of outer zone that is surrounded by what type of tissue?
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granulation
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acute apical periodontitis- has a central zone of necrotic tissue around apex of outer zone surrounded by granulation tissue- T/F?
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T
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your pt has acute apical periodontitis. upon looking at an xray you notice a slight thickening/no change of Periodontal membrane. why is this?
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in acute apical periodontitis, lesion is rapidly occuring, hence there is insufficient time for significant amounts of bone resorption to occur.
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if a periapical abscess develops as a result of an acute exacerbation of a chronic periapical granuloma, what type of lesion will be seen?
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radiolucent
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frank death and pus formation in ligament and bone with exudate extending into the adjacent soft and hard tissue- condition known as?
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periapical abscess
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if there is an accumulation of acute inflammatory cells at the apex of the tooth with pain & swelling what is this known as?
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periapical abscess
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a very painful with rapid onset with adjacent teeth painful as well, may get sinus tract formation , can be potentially dangerious, not as localized- what is this?
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periapical abscess.
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t/f: for periapical abscess xrays may vary from widened periodontal space to large alveolar radiolucecy.
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t- you can't dx abscess from xray alone, you need to examine the pt
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what are a few potential sequella of an untreated abscess?
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celluitis, osteomyelitis, parulis, ludwig's angina and cavernous sinus thrombosis
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an infection traveling facial planes (path of least resistance) is known as?
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celluitis
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osteomylitis is infx of bone along the medullary spaces. t/f
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t
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gum boil is also known as?
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parulis
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when the floor of mouth and neck is affected, tongue elevates and blocks the airway- pt has what?
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ludwig's angina
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your pt has an infx from his maxilary anterior premolar and molar teeth. it extends into the maxillary sinus, travels to the orbit and drains into the cranial vault. what does your pt have? is this serious?
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cavernous sinus thrombosis. very serious
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which teeth are most involved in cavernous sinus thrombosis?
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maxillary anterior premolar and molar teeth
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where is the most common spread of infection in an untreated abscess? and why?
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buccal plate - bc bone is thinner.
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your pt comes in with edematous periorbital enlargement involving the eyelids and conjunctiva. she says that she had a sore in her upper right jaw. what does she have?
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cavernous sinus thrombosis
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t/f: abscess associated wtih parulides are often asymptomatic?
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t
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your pt comes in with a big swelling near her neck and she can't breathe. what does she have?
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ludwig's angina
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what are 2 other names for periapical granuloma?
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dental granuloma
chronic apical periodontitis |
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a mass of chronically inflammed granulation tissue at apex of non vital tooth is known as?
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chronic apical periodontitis = periapical granuloma = dental granuloma
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a common, painless, slow growing mass seen on an xray as a radiolucency up to 1 cm could be 2 things. what are they?
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periabpical granuloma (dental granuloma = chronic apical periodontitis) or a periapical cyst.
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what type of lining does a cyst have?
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epithelial lining
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what is the most common cyst of jaws?
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apical periodontal cyst (periapical cyst = radicular cyst)
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what is the source of the epithelium in apical periodontal cysts?
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rest of malassez
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when looking at an apical periodontal cyst, is it:
radiolucent/opaque? well/not well circumstrbed? |
radiolucent, well circumscribed
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what appears identical to periapical granulomas with loss of lamina dura?
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apical periodontal cyst
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t/f : there is no loss of lamina dura in apical periodontal cyst?
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f. there is a LOSS of lamina dura in apical periodontal cyst
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what type of epithelium is involved in apical periodntal cyst? does it have keratin or no keratin? what is the connective tissue like- dense or not dense?
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stratified squamous epithelium is associated with apical periodontal cyst usually WITHOUT keratin. has dense CT
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when looking at the histology of a certain condition, there may also be seen- cholesterol slits, multinucleated ginat cells, macrophages, hemosiderin. what condition is this?
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apical periodontal cyst
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when talking about apical periodontal cysts, what are 2 associated cysts we talked about?
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lateral radicular cyst
and residual periapical cyst |
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t/f: squamous cell carcinoma have occured in periapical cysts?
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t
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your pt with am apical periodontal cysts has come to you for treatment. what 2 options do you do? and after picking one option to do, you tell her g'bye & that you'll see her for her follow up in how many months-yr?
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extraction or endo.
6 months to 1 yr |
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your pt has apical periodontal cysts- you can't decide if you should do surgery or not. how large does the lesion have to be to make the surgery call? and your pt is worried about scarring after surgery - should she be? you tell her that if we don't remove the cyst, there is a chance of a carcinoma occuring- which one is it?
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surgery is indicated for a lesion 2.0 cm or larger in addition to biopsy. she may get a fibrous scar after tx. you should remove it so she won't get squamous cell carcinoma- which have occured in periapical cysts!
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T/f: chronic osteomyelitis is a potential sequella of untreated abscesses?
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T
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What are the other names for Condensing Osteitis?
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Periapical Osteosclerosis
and Chronic Focal Sclerosing Osteomyelitis |
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bone sclerosis associated with apieces of tooth with pulpitis occuring bc of high tissue resistance to low grade infection is known as what?
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chronic focal sclerosing osteomyelitis
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what are clinical features of chronic focal sclerosing osteomyelitis?
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usually young (children & young adults),
usually mandibular first molar, usually has large caries/restoration, no clinical symptoms |
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usually young (children & young adults),
usually mandibular first molar, usually has large caries/restoration, no clinical symptoms describes what condition? |
chronic focal sclerosing osteomyelitis
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on an xray for chornic focal sclerosing osteomyelitis what will yousee?
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a circumscribed area of radioapque sclerotic bone (no radiolucent border),
entire root outline is visible, may disappear after extraction of tooth (85% will regress partially or totally) |
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a circumscribed area of radioapque sclerotic bone (no radiolucent border),
entire root outline is visible, may disappear after extraction of tooth (85% will regress partially or totally) describes an xray of what? |
chronic focal sclerosing osteomyelitis
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dense bony trabeculation can be seen in chronic focal sclerosing osteomyelitis. t/f
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t
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the residual area of condensing osteitis that remains after resolution of inflmmation is termed what?
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BONE SCAR
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your pt has chronic focal sclerosin osteomyelitis. what differential diagnosis did you have for this condition?
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1. idiopathic osteosclerosis
2. periapical cemental dysplasia |
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what's the difference btwn idopathic osteosclerosis and chronic focal sclerosing ostemyelitis?
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iodiopathic does not have restoration or caries. it's the most common bony lesion in mandible!
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is periapical cemental dysplaisa common?
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yes, espically apices of aniterio teeth in the mandible
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