CHAPTER 4 HIGH YIELD

What are the clinical characteristics of a normal pulp?

Asymptomatic, responds mildly and briefly to pulp testing, no signs of resorption, caries, or mechanical exposure

What characterizes reversible pulpitis?

Mild inflammation that resolves when the cause is removed, with no spontaneous pain and sharp transient pain to cold/hot/air that resolves immediately

What is pulp hyperemia?

Vascular congestion leading to cold sensitivity

What causes dentin hypersensitivity and reversible pulpitis?

Sharp pain from exposed dentin caused by abrasion, erosion, or SRP

What are the treatment options for reversible pulpitis and dentin hypersensitivity?

Remove irritant, seal exposed dentin, or use tubule sealants (e.g., potassium nitrate)

What are the symptoms of symptomatic irreversible pulpitis?

Spontaneous or lingering pain (sharp/dull, localized/diffuse, referred) with prolonged pain to cold/heat

Where may mandibular molar irreversible pulpitis refer pain?

To the ear

What is suppurative pulpitis?

The end stage of irreversible pulpitis where pain worsens when lying down and cold may occasionally relieve it

What are early versus late radiographic findings in irreversible pulpitis?

Early radiographs are usually normal; later show periapical lesions

What is chronic hyperplastic pulpitis (pulp polyp)?

A painless, asymptomatic pulp overgrowth in young teeth covered by oral epithelium

What is the histology of chronic hyperplastic pulpitis?

Fibrovascular tissue with neutrophils

What are the clinical signs of internal resorption?

Asymptomatic with normal pulp tests and a radiolucent pulp chamber enlargement on X-ray, potentially showing a "pink spot" on the crown

What is the treatment for internal resorption?

Immediate pulpectomy

What type of pain is characteristic of reversible pulpitis?

Sharp and fleeting pain that dissipates after stimulus removal

What type of pain is characteristic of irreversible pulpitis?

Intense, continuous, and prolonged pain due to pressure of secondary irritants

What stimulates pain in reversible pulpitis?

External stimuli like heat, cold, and sugar

What acts as a secondary stimulant in irreversible pulpitis?

Dead or injured pulp tissue

Which condition presents with pain at night or in a postural (lying down) position?

Irreversible pulpitis

How is pain localized in reversible versus irreversible pulpitis?

Reversible: localized to applied cold stimulus/PDL inflammation; Irreversible: heat stimulus/PDL inflammation

Is referred pain common in reversible or irreversible pulpitis?

Common in irreversible pulpitis (rarely found in reversible)

What are the typical responses to EPT and cold tests in irreversible pulpitis?

Normal to elevated EPT response; pain occasionally relieved by cold

What does pulp necrosis result from?

Untreated irreversible pulpitis or trauma

What are the clinical symptoms of pulp necrosis?

Usually asymptomatic, may have pressure pain or no response to stimuli, and may still be heat-sensitive in early necrosis

What is the radiographic appearance of pulp necrosis?

PDL widening to periapical radiolucency

What defines a previously treated root canal?

Canals are already filled (not medicated) and may require retreatment

What defines previously initiated therapy?

Partial RCT (e.g., pulpotomy, pulpectomy) done during emergency or vital pulp therapy

What are the radiographic findings of normal periapical tissues?

Intact lamina dura and uniform PDL space

What causes symptomatic apical periodontitis?

Inflammation from pulpitis/necrosis, chemical irritation, trauma, hyperocclusion, or over-instrumentation

What are the symptoms of symptomatic apical periodontitis?

Spontaneous pain, pain on biting or percussion

What is the radiographic sign of symptomatic apical periodontitis?

Often normal, or possible PDL widening

What is the etiology of asymptomatic apical periodontitis?

Necrotic pulp

What are the symptoms of asymptomatic apical periodontitis?

No pain, but may "feel different" on percussion

What is the histological difference between a periapical granuloma and a radicular cyst?

Granuloma has immune cell infiltration; radicular cyst is an epithelium-lined cavity originating from Malassez cells

What is the radiographic appearance of a radicular cyst?

Circumscribed radiolucency with a radiopaque border

How are periapical granulomas and radicular cysts definitively diagnosed?

Biopsy

What is condensing osteitis?

Dense bone-formation resulting from chronic periapical inflammation

How does condensing osteitis differ from enostosis?

Condensing osteitis is tied to inflammation/pulp status; enostosis is a normal dense bone island

What causes an acute apical abscess (AAA)?

Necrotic pulp

What are the symptoms of an acute apical abscess?

Rapid onset, spontaneous pain, pain on percussion/palpation, tooth feels "elevated", possible swelling/cellulitis and systemic fever/malaise

What is the histology of an acute apical abscess?

Liquefaction necrosis, PMNs, and pus surrounded by granulation tissue

What is the treatment for an acute apical abscess?

Incision and drainage (I&D), RCT/EXT, and antibiotics only if systemic involvement is present

What is the clinical gold standard used to differentiate an acute apical abscess from a lateral periodontal abscess?

Vitality test (AAA is non-vital; periodontal abscess has normal pulp tests)

What is a chronic apical abscess (CAA)?

Suppurative apical periodontitis, typically a painless long-standing lesion with a draining sinus tract (fistula)

How is a chronic apical abscess diagnosed on a radiograph?

Gutta-percha tracing through the sinus tract

What is an apical scar?

Dense collagenous connective tissue filling bone near the apex after successful RCT/apicoectomy where facial/lingual cortices were perforated; non-pathological, no treatment needed

What is a true combined endo-perio lesion?

A concurrent periapical lesion from a necrotic pulp and a periodontal lesion that meet and merge

What is the treatment sequence for a true combined endo-perio lesion?

Start with endodontic treatment first, followed by periodontal therapy

What is a phoenix abscess?

An acute exacerbation/flare-up of a chronic periapical lesion (e.g., granuloma) due to bacterial invasion or immune compromise

What causes surface root resorption?

Acute injury to the PDL or root surface; it is self-limiting and heals with cementum and new PDL

What is replacement root resorption (ankylosis)?

Root replaced by bone leading to infraocclusion and a metallic percussion sound, often seen after unsuccessful replantation

What is external inflammatory root resorption?

Bowl-shaped resorptions into cementum and dentin that progress if left untreated

What are the affected teeth typically for a cracked tooth versus a vertical root fracture (VRF)?

Cracked tooth: mostly vital molars; VRF: mostly endodontically treated teeth

What is the radiographic sign of a vertical root fracture (VRF)?

"Halo" or "J-shape" radiolucency, with an isolated deep narrow pocket

What is the treatment for a vertical root fracture (VRF) when the pulp/periapex is involved?

Extraction