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 causes reversible pulpitis?

Incipient caries

exposed dentin

defective restorations

recent treatment

What are the symptoms of reversible pulpitis?

No spontaneous pain, sharp transient pain to cold/hot/air that resolves immediately

What is the treatment for reversible pulpitis?

Remove irritant and seal exposed dentin

What causes pulp hyperemia?

Vascular congestion leading to cold sensitivity

What causes dentin hypersensitivity?

Exposed dentin from abrasion, erosion, or SRP

What is the treatment for dentin hypersensitivity?

Tubule sealants (e.g., potassium nitrate)

What are the symptoms of symptomatic irreversible pulpitis?

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

Where may pain from mandibular molar irreversible pulpitis refer?

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 usually normal; later show periapical lesions

What is the treatment for irreversible pulpitis?

Root canal treatment (RCT) or extraction (EXT)

What is asymptomatic irreversible pulpitis commonly associated with?

Pulp exposure

What is chronic hyperplastic pulpitis (pulp polyp)?

A painless 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, radiolucent pulp chamber enlargement on X-ray, and crown may show a pink spot

What is the treatment for internal resorption?

Immediate pulpectomy

What type of pain characterizes reversible pulpitis?

Sharp and fleeting pain that dissipates after stimulus removal

What type of pain characterizes irreversible pulpitis?

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

What stimulates pain in reversible versus irreversible pulpitis?

Reversible: external stimulus (heat, cold, sugar); Irreversible: dead/injured pulp tissue acts as secondary stimulant

Which condition presents with pain at night or in a postural position?

Irreversible pulpitis

What history commonly supports reversible pulpitis?

Recent dental procedure

How is pain localized in reversible versus irreversible pulpitis?

Reversible: only with applied cold or PDL inflammation; Irreversible: only with applied heat or PDL inflammation

Is referred pain common in reversible pulpitis?

Usually not found (common finding in irreversible pulpitis)

What is the history typically associated with irreversible pulpitis?

History of deep caries

What are the EPT and cold test responses in reversible pulpitis?

Normal EPT, exaggerated with cold

What is the heat response in reversible pulpitis?

Normal to exaggerated

What are the EPT and cold test responses in irreversible pulpitis?

Normal to elevated EPT response; pain occasionally relieved by cold

What radiographic finding may accompany reversible pulpitis?

Caries or defective restoration

What radiographic finding may accompany irreversible pulpitis?

PDL-space enlargement

What causes pulp necrosis?

loss of pulp vitality

What are two major causes of pulp necrosis?

irreversible pulpitis or trauma leading to

What are the symptoms of pulp necrosis?

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

Can pulp necrosis still respond to heat?

yes in early necrosis

What is the radiographic appearance of pulp necrosis?

PDL widening to periapical radiolucency

What is the treatment for pulp necrosis?

RCT or extraction

What defines a previously treated root canal?

Canals already filled (not medicated), may require retreatment (nonsurgical or surgical)

What defines previously initiated therapy?

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

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

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 treatment for symptomatic apical periodontitis?

Remove irritants and adjust occlusion

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 radiographic sign of asymptomatic apical periodontitis?

Apical radiolucency

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 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 inflammation that may be asymptomatic or painful

How does condensing osteitis differ from enostosis?

Condensing osteitis is tied to periapical inflammation; 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

swelling or cellulitis

systemic fever

malaise, lymphadenopathy

What is the histology of an acute apical abscess?

Liquefaction necrosis, PMNs, and pus surrounded by granulation tissue

What is the radiographic progression of an acute apical abscess?

Normal to PDL widening to radiolucent lesion

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 clinical test differentiates 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?

A usually painless, long-standing necrotic lesion with a draining sinus tract (fistula)

How is a chronic apical abscess diagnosed on a radiograph?

Gutta-percha tracing

What is the treatment for a chronic apical abscess?

RCT or EXT (fistula heals after RCT without special treatment)

What is an apical scar?

Dense collagenous connective tissue filling bone near the apex after successful RCT/apicoectomy where cortical plates 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, presenting with a V-shaped wide radiolucency

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, reversible, heals with cementum and new PDL, and is not visible on radiographs

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 are progressive if untreated

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

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

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

Longitudinal root fracture; "Halo" or "J-shape" radiolucency with an isolated deep narrow pocket

What is the treatment for a vertical root fracture (VRF)?

Extraction