NBDE Part II + ADATs - Endo UPDATED ACTUAL Questions
and CORRECT Answers
Endodontics
What are factors that make the pulp unique it response to a. The pulp is almost completely surrounded by
irriation? hard tissue (dentin), which limits the available room for expansion and thus
restricts the pulp's ability to tolerate edema.
b. The pulp lacks collateral circulation, which severely limits its ability to cope with
bacteria, necrotic tissue, and inflammation.
c. The pulp possesses unique, hard-tissue-secreting
cells, or odontoblasts, as well as mesenchymal cells that can differentiate into
osteoblasts that form more dentin in an attempt to protect itself from injury.
Dentinal pain a. A-delta fibers are larger, myelinated nerves that enter the root canal and divide
into smaller branches, coursing coronally through the pulp.
Explain A-delta fiber innervation of the pulp b. A-delta fiber pain is immediately perceived as a quick, sharp, momentary pain
that dissipates quickly on removal of the inciting stimulus (cold liquids or biting on
an unyielding object).
c. The intimate association of A-delta fibers with the odontoblastic cell layer and
dentin is referred to as the pulpodentinal complex.
,Pulpitis pain a. In pulpal inflammation, the response is exagger-
ated and disproportionate to the challenging stimulus (hyperalgesia). This
what fiber is involved response is induced by the effects of inflammatory mediators that are released in
the inflamed pulp.
what stimulates these fibers b.Progressionofpulpalinflammationcanchangethe quality of the pain response. As
the exaggerated A-delta fiber pain subsides, pain seemingly remains and is
how is the pain perceived perceived as a dull, throbbing ache. This second pain symptom is from C nerve
fibers.
what does this pain represents c. C fibers are small, unmyelinated nerves that course centrally in the pulp stroma.
d. Unlike A-delta fibers, C fibers are not directly involved with the pulpodentinal
how might this end complex and are not easily provoked.
e. C fiber pain occurs with tissue injury and is medi- ated by inflammatory
mediators, vascular changes in blood volume and blood flow, and increases in
tissue pressure.
f. When C fiber pain dominates, it signifies irre- versible local tissue damage.
g. With increasing inflammation of pulp tissues, C fiber pain becomes the only
pain feature.
h. Hot liquids or foods can raise intrapulpal pressure to levels that excite C fibers.
i. The pain is diffuse and can be referred to a dis- tant site or to other teeth.
j. The sustained inflammatory cycle is detrimental to pulpal rec
Define a normal pulp asymptomatic
mild-mod transient response to thermal or electric stimuli
no pain on percussion or palpation
Reversible pulpitis thermal stimuli usually causes quick, sharp, hypersensitive response that subsides
soon after stimulus is removed
define
early caries/recurrent
stimuli SRPs
deep restorations w/out bases
symptom or disease?
symptom - it irritant removed- reverts back to normal
clinically distinguish from symptomatic irreversible
pulpitis if irritant remains, symptoms may lea to irreversible pulpitis
1) Non-lingering pain
2) No spontaneous pain
for aymptomatic, caries into the pulp is the line
,Irreversible pulpitis By definition, the pulp has been damaged beyond repair, and even with removal
of the irri- tant it will not heal.
define
Microscopically:
micrscopically (I) Micro-abscesses of the pulp begin as tiny zones of necrosis within dense, acute
inflam- matory cells.
following IP, what happens to the pulp - the end result (2) Histologically intact myelinated and unmyeli- nated nerves may be observed
in areas with dense inflammation and cellular degeneration.
is pain more common in IP?
Following irreversible pulpitis, pulp death may occur quickly or may require years;
it may be painful or, more frequently, asymptomatic. The end result is necrosis of
the pulp.
Asymptomatic irreversible pulpitis Hyperplastic pulpitis: a reddish, cauliflower- likegrowthofpulptissue
throughandaround a carious exposure. The proliferative nature of this type of pulp
what are two possible consequences is attributed to a low- grade, chronic irritation of the pulp and the generous
vascular supply characteristically found in young people.
Internal resorption:
(a) Most commonly identified during routine
radiographic examination. If undetected, internal resorption will eventually perfo-
rate the root.
(b) Histological appearance: chronic pulpitis
i. Chronic inflammatory cells.
ii. Multinucleated giant cells adjacent to granulation tissue.
iii. Necrotic pulp coronal to resorptive defect
c)Onlypromptendodontictherapywillstop the process and prevent further tooth
destruction.
, Symptomatic irreversible pulpitis (1) Characterized by spontaneous, unprovoked,
intermittent, or continuous pain.
describe (2) Sudden temperature changes (often to cold)
elicit prolonged episodes of pain that lingers
stimuli after the thermal stimulus is removed.
(3) Occasionally, patients may report that a pos- tural change, such as lying down
postural pain or bending
over, induces pain.
radiographs
(4) Radiographs are generally not sufficient for
apical changes diagnosing irreversible pulpitis:
(a) Radiographs can be helpful in identifying
EPT suspect teeth only.
(b) Thickening of the apical portion of the
periodontal ligament may become evi- dent on the radiographs in the advanced
stage.
(5) The electric pulp test is of little value in the diagnosis of symptomatic
irreversible pul- pitis.
and CORRECT Answers
Endodontics
What are factors that make the pulp unique it response to a. The pulp is almost completely surrounded by
irriation? hard tissue (dentin), which limits the available room for expansion and thus
restricts the pulp's ability to tolerate edema.
b. The pulp lacks collateral circulation, which severely limits its ability to cope with
bacteria, necrotic tissue, and inflammation.
c. The pulp possesses unique, hard-tissue-secreting
cells, or odontoblasts, as well as mesenchymal cells that can differentiate into
osteoblasts that form more dentin in an attempt to protect itself from injury.
Dentinal pain a. A-delta fibers are larger, myelinated nerves that enter the root canal and divide
into smaller branches, coursing coronally through the pulp.
Explain A-delta fiber innervation of the pulp b. A-delta fiber pain is immediately perceived as a quick, sharp, momentary pain
that dissipates quickly on removal of the inciting stimulus (cold liquids or biting on
an unyielding object).
c. The intimate association of A-delta fibers with the odontoblastic cell layer and
dentin is referred to as the pulpodentinal complex.
,Pulpitis pain a. In pulpal inflammation, the response is exagger-
ated and disproportionate to the challenging stimulus (hyperalgesia). This
what fiber is involved response is induced by the effects of inflammatory mediators that are released in
the inflamed pulp.
what stimulates these fibers b.Progressionofpulpalinflammationcanchangethe quality of the pain response. As
the exaggerated A-delta fiber pain subsides, pain seemingly remains and is
how is the pain perceived perceived as a dull, throbbing ache. This second pain symptom is from C nerve
fibers.
what does this pain represents c. C fibers are small, unmyelinated nerves that course centrally in the pulp stroma.
d. Unlike A-delta fibers, C fibers are not directly involved with the pulpodentinal
how might this end complex and are not easily provoked.
e. C fiber pain occurs with tissue injury and is medi- ated by inflammatory
mediators, vascular changes in blood volume and blood flow, and increases in
tissue pressure.
f. When C fiber pain dominates, it signifies irre- versible local tissue damage.
g. With increasing inflammation of pulp tissues, C fiber pain becomes the only
pain feature.
h. Hot liquids or foods can raise intrapulpal pressure to levels that excite C fibers.
i. The pain is diffuse and can be referred to a dis- tant site or to other teeth.
j. The sustained inflammatory cycle is detrimental to pulpal rec
Define a normal pulp asymptomatic
mild-mod transient response to thermal or electric stimuli
no pain on percussion or palpation
Reversible pulpitis thermal stimuli usually causes quick, sharp, hypersensitive response that subsides
soon after stimulus is removed
define
early caries/recurrent
stimuli SRPs
deep restorations w/out bases
symptom or disease?
symptom - it irritant removed- reverts back to normal
clinically distinguish from symptomatic irreversible
pulpitis if irritant remains, symptoms may lea to irreversible pulpitis
1) Non-lingering pain
2) No spontaneous pain
for aymptomatic, caries into the pulp is the line
,Irreversible pulpitis By definition, the pulp has been damaged beyond repair, and even with removal
of the irri- tant it will not heal.
define
Microscopically:
micrscopically (I) Micro-abscesses of the pulp begin as tiny zones of necrosis within dense, acute
inflam- matory cells.
following IP, what happens to the pulp - the end result (2) Histologically intact myelinated and unmyeli- nated nerves may be observed
in areas with dense inflammation and cellular degeneration.
is pain more common in IP?
Following irreversible pulpitis, pulp death may occur quickly or may require years;
it may be painful or, more frequently, asymptomatic. The end result is necrosis of
the pulp.
Asymptomatic irreversible pulpitis Hyperplastic pulpitis: a reddish, cauliflower- likegrowthofpulptissue
throughandaround a carious exposure. The proliferative nature of this type of pulp
what are two possible consequences is attributed to a low- grade, chronic irritation of the pulp and the generous
vascular supply characteristically found in young people.
Internal resorption:
(a) Most commonly identified during routine
radiographic examination. If undetected, internal resorption will eventually perfo-
rate the root.
(b) Histological appearance: chronic pulpitis
i. Chronic inflammatory cells.
ii. Multinucleated giant cells adjacent to granulation tissue.
iii. Necrotic pulp coronal to resorptive defect
c)Onlypromptendodontictherapywillstop the process and prevent further tooth
destruction.
, Symptomatic irreversible pulpitis (1) Characterized by spontaneous, unprovoked,
intermittent, or continuous pain.
describe (2) Sudden temperature changes (often to cold)
elicit prolonged episodes of pain that lingers
stimuli after the thermal stimulus is removed.
(3) Occasionally, patients may report that a pos- tural change, such as lying down
postural pain or bending
over, induces pain.
radiographs
(4) Radiographs are generally not sufficient for
apical changes diagnosing irreversible pulpitis:
(a) Radiographs can be helpful in identifying
EPT suspect teeth only.
(b) Thickening of the apical portion of the
periodontal ligament may become evi- dent on the radiographs in the advanced
stage.
(5) The electric pulp test is of little value in the diagnosis of symptomatic
irreversible pul- pitis.
