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78 Cards in this Set
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• Tooth #3 has a history of spontanteous pain that lasted three weeks, then subsided for several months. Teeth #2, 4, 5 & 6 are normally responsive to cold, percussion and palpation. #3 is sensitive to percussion and palpation but nonresponsive to cold. A periapical view of the area shows an intact lamina dura on all teeth. The diagnosis for this presentation is:
1. ? Irreversible pulpitis with acute apical periodontitis 2. ? Necrotic pulp with acute apical periodontitis 3. ? Reversible pulpitis with acute apical periodontitis 4. ? Healthy pulp with acute apical periodontitis |
2. ? Necrotic pulp with acute apical periodontitis
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• In pulpal and periapical disease, the occurrence of pain:
1. ? Is the common presentation 2. ? Is the exception rather than the rule 3. ? Is diagnostic of an irreversible pulpitis 4. ? Indicates nonodontogenic etiologies |
2. ? Is the exception rather than the rule
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• If a patient reports sharp radiating pain that is diffuse it is likely not the result of:
1. ? A neuralgia 2. ? Acute exacerbation of chronic apical periodontitis 3. ? An irreversible pulpitis 4. ? A cracked tooth |
2. ? Acute exacerbation of chronic apical periodontitis
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• Clinical sign and symptoms will correlate with histology in pulpal disease.
1. ? True 2. ? False |
2. ? False
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• A negative response to vitality tests indicates:
1. ? Pulpal necrosis 2. ? Pulpal hyperemia 3. ? Acute apical periodontitis 4. ? Lesions of nonendodontic origin |
1. ? Pulpal necrosis
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The correct terminology for a channel that forms between an area of pathology and an anatomic space is a:
1. ? Fistula 2. ? Perforation 3. ? Operculum 4. ? Sinus tract |
4. ? Sinus tract
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• The radiographic view most often employed in endodontic diagnosis and treatment is the:
1. ? Bitewing view 2. ? Water's view 3. ? Occlusal view 4. ? Periapical view |
4. ? Periapical view
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Pulpal diagnosis that fall under the category of "Vital Pulp" include:
1. ? Reversible pulpitis 2. ? Irreversible pulpitis 3. ? Necrotic pulp 4. ? A & B |
4. ? A & B
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• When the patient presents with multiple teeth that are painful the clinician should consider:
1. ? That multiple teeth need root canal therapy 2. ? Conditions that affect multiple teeth 3. ? Conditions that cause referred pain 4. ? B & C |
4. ? B & C
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A standard method for determination of the origin of a patent sinus tract is:
1. ? A periapical film 2. ? Periodontal probing 3. ? Threading of the sinus tract with a gutta percha point and making a radiograph 4. ? Percussion |
3. ? Threading of the sinus tract with a gutta percha point and making a radiograph
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2. Referred pain from a pulpitis:
A. ? Can affect teeth in the same quadrant B. ? Can affect teeth in the opposing quadrant C. ? Never crosses the midline D. ? All of the above |
D. ? All of the above
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The vitality test chosen for a particular case should aim to:
A. ? Reproduce the chief complaint B. ? Inflict pain C. ? Avoid what hurts the patient the most D. ? Stimulate nerve endings in the Plexus of Raschow |
A. ? Reproduce the chief complaint
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5. A negative response to vitality tests indicates:
A. ? Pulpal necrosis B. ? Pulpal hyperemia C. ? Acute apical periodontitis D. ? Lesions of nonendodontic origin |
A. ? Pulpal necrosis
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8. Standardized sensor/film holders are used for initial and final radiographs because they:
A. ? Are easier to use B. ? Maintain the same angulation each time C. ? Minimize radiation to the patient D. ? Fit with the rubber dam better |
B. ? Maintain the same angulation each time
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11. A reversible pulpitis does not demonstrate:
A. ? Thermal sensitivity B. ? An onset related to a recent restoration C. ? Association with a carious lesion D. ? True spontaneous pain |
D. ? True spontaneous pain
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15. Percussion sensitivity in a tooth indicates:
A. ? An irreversible pulpitis B. ? Focal abscesses in the pulp C. ? Inflammation in the periodontal ligament space D. ? A ranula |
C. ? Inflammation in the periodontal ligament space
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16. Palpation sensitivity indicates:
A. ? A sinus tract B. ? Inflammation of the periosteum C. ? A reversible pulpitis D. ? Chronic apical periodontitis |
B. ? Inflammation of the periosteum: Correct! Yes- it indicates that the disease process has eroded the facial cortical plate and the inflammation has spead into the overlying periosteum
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19. Referred pain from a pulpitis:
A. ? Can affect teeth in the same quadrant B. ? Can affect teeth in the opposing quadrant C. ? Never crosses the midline D. ? All of the above: |
D. ? All of the above: Each of these points is true- referred pain can make teeth in the same and opposing quadrants feel painful but it will not cross the midline.
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20. Heat sensitivity indicates:
A. ? Dentin is exposed in an otherwise healthy tooth B. ? Sensitization of the deeper C-fibers of the pulp C. ? Referred pain D. ? Sinusitis |
B. ? Sensitization of the deeper C-fibers of the pulp
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21. Thermal tests for vitality elicit a reponse by:
A. ? Stimulating electrical nerve impulses in the Plexus of Rashcow B. ? Inducing dentinal fluid flow that stimulates nerve endings in the odontoblast layer C. ? Conducting impulses through the dentinal tubules D. ? Causing vascular contraction |
B. ? Inducing dentinal fluid flow that stimulates nerve endings in the odontoblast layer
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23. Chronic apical periodontitis is:
A. ? Symptomatic B. ? Associated with a vital tooth C. ? Always associated with a sinus tract D. ? A radiographic diagnosis |
D. ? A radiographic diagnosis
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26. periodontal defect can be differentiated from a sinus tract draining through the sulcus by:
A. ? Vitality tests and probing B. ? Threading of the tract with a gutta percha point C. ? Palpation D. ? Percussion |
A. ? Vitality tests and probing: If not previously root canal treated vitality tests should be positive; Probing period defects are often broad where sinus tracts are narrow
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• The primary function of pulpal dendritic cells is to:
1. ? Phagocytize foreign antigen that makes it to the pulp 2. ? Produce the organic matrix of dentin 3. ? Give rise to fibroblasts or odontoblasts 4. ? Present antigen and initiate an immune response |
4. ? Present antigen and initiate an immune response
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Dentinal tubules:
1. ? Form "Z" structures as they course pulpally 2. ? Are up to 10 microns in diameter 3. ? Are found 8000 to 57,000 per mm2 4. ? Have no lateral branches |
3. ? Are found 8000 to 57,000 per mm2
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The first protective response to dentinal irritation is:
1. ? Dentinal sclerosis 2. ? Reparative dentin 3. ? Reactionary dentin 4. ? Dead tract formation |
1. ? Dentinal sclerosis
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Reparative dentin is formed by:
1. ? Resident odontoblasts 2. ? Endothelial cells 3. ? Newly differentiated odontoblasts 4. ? Perivascular cells in the coronal pulp |
3. ? Newly differentiated odontoblasts
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• The pain of an irreversible pulpitis qualifies as:
1. ? Allodynia 2. ? Hyperalgesia 3. ? Allodynia and hyperalgesia 4. ? Neither allodynia nor hyperalgesia |
3. ? Allodynia and hyperalgesia
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• Allodynia is defined as a(n):
1. ? Reduction in the pain threshold so that previously non-noxious stimuli are perceived as painful 2. ? Increasse in the perceived magnitude of a painful stimulus 3. ? Increase in the pain threshold so that perviously non-noxious stimuli are perceived as painful 4. ? Decrease in the perceived magnitude of a painful stimulus |
1. ? Reduction in the pain threshold so that previously non-noxious stimuli are perceived as painful
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• Hyperalgesia is due to:
1. ? Peripheral mechanisms 2. ? Central mechanisms 3. ? Referred pain 4. ? Peripheral and central mechanisms |
4. ? Peripheral and central mechanisms
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• Dentinal tubules are inverted cones with the largest diameter:
1. ? In the middle of the tubule 2. ? At the dentino enamel junction 3. ? On the dentin pulp border 4. ? Occurring alternately on pulpal or enamel sides |
3. ? On the dentin pulp border
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• The odontoblastic layer is located immediately subjacent to the predentin. It contains:
1. ? Cell bodies of fibroblasts 2. ? Dentritic cells 3. ? Cementum 4. ? Ameloblasts |
2. ? Dentritic cells
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• Which of the following nerve fibers are thought to be primarily responsible for mediating dentinal hypersensitivity?
1. ? A alpha fibers 2. ? A gamma fibers 3. ? A delta fibers 4. ? C fibers |
3. ? A delta fibers
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1. Odontoblasts are:
A. ? Post-mitotic cells B. ? Responsible for sensory input in dentin C. ? Only responsible for dentinogenesis and are therefore not needed after tooth development is complete D. ? Formed from the inner enamel epithelium |
A. ? Post-mitotic cells: if one dies a progenitor cell must migrate into the area and differentiate into an odontoblast to replace it
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2. The granular layer of root dentin found in the root adjacent to the cementum is called:
A. ? Epithelial rests of Mallaisez B. ? The hyalinized layer of Marsh C. ? The Granular Layer of Tomes D. ? Contour Lines of Owen |
C. ? The Granular Layer of Tomes: This is also technically secondary dentin
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6. Peritubular dentin is more mineralized than intertubular dentin.
A. ? True B. ? False |
A. ? True
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9. Pulp lymphatics have not been demonstrated in the dental pulp.
A. ? True B. ? False |
B. ? False
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11. A delta fibers are:
A. ? Located peripherally in the pulp B. ? Located centrally in the dental pulp C. ? Provide sympathetic innervation to the pulpal vasculature D. ? Responsisble for dull throbbing pain |
A. ? Located peripherally in the pulp: They are concentrated in the Plexus of Raschow and are responsible for the sharp pain caused by an air blast over vital dentin
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15. Lateral branches of neuronal bundles in the dental pulp end in a dense plexus of nerves referred to as the:
A. ? Solar plexus B. ? A-delta afferent plexus C. ? Plexus of Raschow |
C. ? Plexus of Raschow
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16. Myelinated nerve fibers in the dental pulp:
A. ? Conduct the action potential slower than unmeylinated nerves B. ? Conduct the action potential in the same manner as unmyelinated nerves C. ? Conduct the action potential faster than unmyelinated nerves D. ? Are predominantly A-beta fibers |
? Conduct the action potential faster than unmyelinated nerves
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17. Arterio-venous anastomoses and Arterio-venious shunts are pulpal vascular configurations that:
A. ? Predispose the pulp to necrosis secondary to inflammation B. ? Allow compartmentalization of tissue pressure increases during inflammation C. ? Perfuse odontoblasts in the pulp horns D. ? Collapse in response to increase intrapulpal pressure |
B. ? Allow compartmentalization of tissue pressure increases during inflammation: Tissue pressure increases if unchecked could result in collapse and hypoxia with certain necrosis for the pulp because it exists in non-compliant hard tissue ; A-V shunts direct blood away from areas of high tissue pressure;
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The major difference between 5.25% sodium hypochlorite (NaOCl) and 0.5 % sodium hypochlorite is
1. ? 5.25% NaOCl dissolves vital tissue and 0.5% does not 2. ? 0.5% NaOCl is not bactericidal 3. ? 0.5% NaOCl does not dissolve necrotic tissue 4. ? nothing - they perform the same |
1. ? 5.25% NaOCl dissolves vital tissue and 0.5% does not
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• Clinical therapies for dentin hypersensitivity center on
1. ? anesthetizing the irritated nerves 2. ? raising the firing threshold of A delta fibers 3. ? decreasing the firing threshold of A delta fibers 4. ? occluding the exposed dentinal tubules |
4. ? occluding the exposed dentinal tubules
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• Pulpectomy is the
1. ? removal of all pulp tissue from the root canal system 2. ? amputation of the coronal pulp 3. ? treatment of choice for a necrotic tooth 4. ? none of the above |
1. ? removal of all pulp tissue from the root canal system
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The appropriate vital pulp therapy for a complicated crown fracture in an immature permanent tooth is
1. ? partial pulpotomy (Cvek Pulpotomy) 2. ? pulpectomy 3. ? pulp cap 4. ? indirect pulp cap |
1. ? partial pulpotomy (Cvek Pulpotomy)
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Apexigenesis is the formation of the root end by medicament stimulation.
1. ? True 2. ? False |
2. ? False
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The quoted success rate for a Cvek pulpotomy is
1. ? 60% 2. ? 70% 3. ? 90% 4. ? 100% |
3. ? 90%
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• One significant aspect of bacterial penetration into the dentinal tubules in the infected root canal is that
1. ? they become entombed by the filling material and die 2. ? proper disinfection of the root canal must involve removal of infected dentin and not just surface disinfection 3. ? bacterial titers decrease in the main canal 4. ? apical periodontitis regresses |
2. ? proper disinfection of the root canal must involve removal of infected dentin and not just surface disinfection
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• Evidence of dentin bridge formation on a radiograph is a guarantee of success for a Cvek pulpotomy and is the goal of this therapy.
1. ? True 2. ? False |
2. ? False
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• Treatment of an irreversible pulpitis relies on
1. ? maintenance of asepsis 2. ? the right type of file system 3. ? disinfecting irrigants like sodium hypochlorite 4. ? the antibacterial capacity of chlorhexidine |
1. ? maintenance of asepsis
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2. The major goal of vital pulp therapy is to
A. ? prevent pain B. ? retain as much tooth structure as possible C. ? prevent apical periodontitis D. ? save the patient money |
C. ? prevent apical periodontitis
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5. Requirement(s) for success in pulp capping is (are)
A. ? an uninflamed pulp B. ? bacteria-tight coronal seal C. ? an appropriate pulp capping material like calcium hydroxide or mineral trioxide aggregate (MTA) D. ? all of the above |
D. ? all of the above
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8. Rubber dam isolation of a tooth during root canal therapy
A. ? is the standard of care B. ? protects the patient's airway C. ? prevents contamination of the canals with saliva D. ? all of the above |
D. ? all of the above
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10. Complete pulpotomy is recommended in permanent teeth only in the case of
A. ? an elderly patient with calcified canals B. ? a cariously exposed molar with immature apices C. ? a necrotic pulp D. ? acute apical abscess formation |
B. ? a cariously exposed molar with immature apices
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12. One significant aspect of bacterial penetration into the dentinal tubules in the infected root canal is that
A. ? they become entombed by the filling material and die B. ? proper disinfection of the root canal must involve removal of infected dentin and not just surface disinfection C. ? bacterial titers decrease in the main canal D. ? apical periodontitis regresses |
B. ? proper disinfection of the root canal must involve removal of infected dentin and not just surface disinfection
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14. Treatment refractory cases in endodontics have been found to harbor Streptococcus faecalis in 30% of the cases sampled.
A. ? True B. ? False |
A. ? True: Nasty bugs and they are resistant to calcium hydroxide alone
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16. Inflammation secondary to a reversible pulpitis is effectively and most appropriately treated by
A. ? root canal therapy B. ? extraction C. ? removal of the irritating stimulus D. ? direct pulp capping |
C. ? removal of the irritating stimulus
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18. In a traumatically-exposed pulp, the top 1-2 mm of tissue is removed because
A. ? more extensive removal of the pulp is painful B. ? young patients are difficult to control C. ? it will extrude beyond the wound surface D. ? inflammation does not extend beyond this level |
D. ? inflammation does not extend beyond this level
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19. A complicated crown fracture is
A. ? a fracture that involves the crown and the root B. ? a fracture that involves enamel and dentin and exposes the pulp C. ? a fracture that involves enamel and dentin but does not expose the pulp D. ? a fracture that causes loss of the tooth |
B. ? a fracture that involves enamel and dentin and exposes the pulp
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20. Hard setting calcium hydroxide is preferred as a pulpotomy dressing in Cvek pulpotomies because the zone of necrosis is thinner and the dentin bridge forms more coronally than with calcium hydroxide paste.
A. ? True B. ? False |
A. ? True: The zone of necrosis with calcium hydroxide paste is wider and the resultant bridge forms more apically making vitality testing difficult
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• Reactionary dentin is made by:
1. ? Resident odontoblasts 2. ? Newly differentiated odontoblasts 3. ? Fibroblasts 4. ? Undifferentiated mesenchymal cells |
1. ? Resident odontoblasts
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Dentin sclerosis occurs:
1. ? After tertiary dentinogenesis is completed 2. ? As a result of the precipitation of mineral crystals in the tubule lumen 3. ? As a result of deposition of peritubular dentin 4. ? B & C |
4. ? B & C
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• Interglobular dentin is that dentin formed:
1. ? Between the dentinal tubules 2. ? In response to a strong stimulus 3. ? In the apical 1/3 of the root 4. ? In response to mild but persistent stimuli |
4. ? In response to mild but persistent stimuli
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• A superfamily of growth factors known to play a central role in all forms of dentinogenesis is the:
1. ? Angiogenic growth factor family 2. ? Platelet derived growth factor family 3. ? Angiotensin family 4. ? Transforming growth factor family |
4. ? Transforming growth factor family
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• Bacteria cannot typically invade the dentinal tubules because of size exclusion.
1. ? True 2. ? False |
2. ? False
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• TGF-beta is a growth factor known to be involved in tertiary dentin formation. One source for this factor in tertiary dentinogenesis is:
1. ? Perivascular cells in the pulp 2. ? Schwann cells on A-delta fibers 3. ? Monocytes and macrophages in the odontoblastic layer 4. ? Degraded dentin matrix |
4. ? Degraded dentin matrix
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• The neurogenic response to caries includes:
1. ? The release of neuropeptides 2. ? Depolarization of sensory afferents 3. ? Nociceptive input 4. ? Phagocytosis |
1. ? The release of neuropeptides
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• Tertiary dentin is:
1. ? Physiologic dentin 2. ? Always atubular and fibrous 3. ? Highly permeable 4. ? Further divided into reactionary and reparative dentin |
4. ? Further divided into reactionary and reparative dentin
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• In carious dentin, the highest proportion of bacteria are:
1. ? Gram (+) Rods 2. ? Gram (+) cocci 3. ? gram (-) cocci 4. ? gram (-) rods |
1. ? Gram (+) Rods
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• A histologic examination of pulps under dentinal carious lesions shows:
1. ? Nerve sprouting in response to the impinging infection 2. ? Neuronal necrosis 3. ? Little to no inflammation 4. ? A decrease in the numbers of dendritic cells |
1. ? Nerve sprouting in response to the impinging infection
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18. Pulpal inflammation in response to caries is:
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A. Chronic until there is a near or frank exposure and then it becomes acute (why even large lesions can be relatively asymptomatic)
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19. Reparative dentin is a reaction to a strong stimulus that is cytocidal.
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A. True (made by newly differentiated odontoblasts that are replacing killed odontoblasts)
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21. Interglobular dentin is:
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A. A form of reparative dentin that has inclusions of organic material, is disorganized and more permeable than primary dentin
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22. During caries progession, if the odontoblast is quickly killed, the result can be:
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A. Dead tracts (note: can’t kill the odontoblast and still get reactionary dentinogenisis, and must have a vital odontoblast to mediate dentinal sclerosis)
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24. The most common etiologic factor for pulpal and periapical disease is:
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A. Caries
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25. Reactionary dentin is made by:
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A. Resident odontoblasts "reacting" to a stimulus
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28. The humoral response of the pulp to caries includes:
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A. Odontoblast expression of chemokines (a scientist here at UNC-CH (that would be Dr. L) showed that odontoblasts make IL-8, a potent chemitactic agent for neutrophils)
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30. Due to the noncompliant environment of the dental pulp, it deals with the increased tissue pressures of inflammation by:
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A. Shunting of blood away from inflammed areas (A-V shunts and arteriovenous anastomoses allow inflammation to be compartmentalized in the dental pulp)
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35. Lateral branches of neuronal bundles in the dental pulp end in a dense plexus of nerves referred to as the:
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A. Plexus of Raschow
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