Dental Pulp Ch16

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  1. Dental pulp and periodontium are connected in three ways:
    1. Exposed dentinal tubules

    2. Smaller portals of exit

    3. the apical foramen
  2. Number of dentinal tubules varies from approx ______mm2 at the CDJ to _______mm2 at the pulpal end.
    • 8000
    • 57000
  3. Cervical area of the root the number of dentinal tubules is about _____mm2
  4. Dentinal exposure at the CEJ occurs in about __% of the teeth in general and in __% of anterior teeth in particular.
    • 18
    • 25
  5. It is estimated that __-__% of all teeth have ancillary canal systems, and the majority are found in the _______.
    • 30-40
    • apical third of root
  6. De Deus reported what?
    17% of teeth presented multiple canal systems in the apical third

    about 9% middle third

    2% coronal third
  7. Kirkham reported what?
    1000 teeth studied with perio disease

    2% of ancillary canals assoc. with perio pocket
  8. Incidence of accessory canals?

    connect to periodontium with connective tissue and vasculature
  9. How can periodontal disease be degenerative on the pulp, findings of pulp?
    Increase in calcification


    Collagen resorption
  10. Kakehashi, Moller, and Korzen?
    Kakehashi: Rats

    Moller: monkeys

    all three found that microorganisms key to pulpal and periradicular infections
  11. What did Jansson find?
    Denuded dentin had 20% more epithelium downgrowth in necrotic canals, augments periodontal disease, deeper pocketing around necrotic teeth
  12. Jansson in 3 year retrospective study findings?
    Patients with endondontic treatment failures had 3 times greater marginal bone loss, assoc with more attachment loss in furcation
  13. Change of microbiota in root canal over time, from what to what?
    Proteolytic to anaerobic
  14. Where are spirochetes usually found?
    subgingival plaque
  15. What spirochete species are usually found in root canals?
    T denticola and T maltophilum
  16. What is the main virulence factor of maltophilum?
    its rotating flagella

    isolated in patients with rapidly progessing periodontitis
  17. Bacteria without cell walls named?
    L-form bacteria
  18. Prevalence of fungi in untreated root canals and in previously treated canals?

    • 33% 
    • highest incidence at 55%
  19. C albicans has been detected in __% of infected root canals.
  20. Name some factors affecting colonization of root canals by fungi

    certain IC meds

    local or systemic abx

    Previous unsuccessful endo

    poor asepsis during tx
  21. __% of patients with adult periodontitis also harbor subgingival fungi

    presence in root canal directly assoc with presence in mouth
  22. Human CMV was observed in __% of period pockets and __% of gingival tissues.

  23. EBV Type I observed in __% period pockets and in __% of gingival tissues

  24. Biofilm microcolonies are composed of __% cells embedded in __% matrix material.


    convective flow, water channels carry bulk fluid
  25. Describe foreign body reaction microscopically?
    giant cells surrounding foreign material in a chronic inflammatory infiltrate.

    Mechanical or surgical removal is tx
  26. What is an epitheliated granuloma?
    rests of Malassez that begin making epithelium attempting to wall off irritants, all surrounded by chronic inflammation
  27. What is a bay cyst?
    Chronic inflammatory lesion in which an epithelial lining surrounds lumen that has DIRECT communication with apical foramen

    a true cyst does not communicate, meaing needs surgery, only 10%
  28. What did Valderhaug find?
    No cyst formation until tooth was 6 months necrotic
  29. Incidence of cholesterol clefts?
  30. How are the cholesterol crystals formed?
    released by dieing blood cells from stagnant BVs, by lymphocytes, plasma cells, plasma lipids, dieing macrophages
  31. What are russel bodies, incidence?

    spherical accumulations, esinophilic substance within or near plasma cells and other lymphoid cells

    caused by production of excess amts of secretroy protein
  32. What are rushton hyaline bodies? Incidence?

    different appearances

    keratinous or blood origin, secreted by odontogenic epithelium, degenerated blood cells
  33. What are charcot-leyden crystals?
    Naturally occuring hexagonal pyramidal crsytals

    intracellular granules of eosinophils and basophils

    activated macrophages may have role
  34. What did Madison and Wilcox find?
    root canals exposed to environment allowed coronal leakage
  35. What did Ray and Trope find?
    Defective restoration and good endo had a high incidence of failure

    AR and GE 9% failure

    PR and PE 82% failure
  36. What did Saunders and Saunders find?
    Packing excess GP and sealer over the floor of pulp chamber did not provide a better seal
  37. Long-term prognosis of endo treatment review of lit factors:
    • 1. post prep/cement RDI
    • 2. heated plugger use for post space
    • 3. min of 3mm material beneath post
    • 4. irrigate post space/ dressing
    • 5. leak-proof restoration ASAP
    • 6. Retx if coronal seal broken >3 months
  38. Root fracture splinting?
    flexible splinting up to 12 weeks. RCT not necessary until vitality testing shows otherwise
  39. Extrusive luxation treatment?
    repositioning and splinting for 2 to 3 weeks
  40. Lateral luxation with bone fragment movement, time of splinting?
    up to 8 weeks
  41. Intrusive luxation?
    Metallic sound, open apex may reerupt

    closed apex, initiate RCT
  42. Prognosis of perforation factors?
    depends on location and size

    degree of perio damage

    time of dx and tx

    sealing ability and biocomp of material used
  43. Pathogens found in CAP and Chronic adult periodontitis
    Actinobacillus actinomycetemcomitans

    Bacteroides forsythus

    Eikenalla corrodens

    Fusobacterium nucleatum

    Porphymonas gingivalis

    Prevotella intermedia

    Treponema denticola
  44. Why are biofilms hard to cultivate using standard methods?
    Prolonged starvation induces loss of culitvability
  45. Presence of viruses in pulp was reported by who with what virus?
    AIDS, Glick 1989
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Dental Pulp Ch16
Dental Pulp Ch16
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