NBDE Part II + ADATs – Endo Questions
and Answer A+ Guide
Endodontics - correct answers✅✅
What are factors that make the pulp unique it response to irriation? - correct
answers✅✅a. The pulp is almost completely surrounded by
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
Explain A-delta fiber innervation of the pulp - correct answers✅✅a. A-
delta fibers are larger, myelinated nerves that enter the root canal and
divide into smaller branches, coursing coronally through 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
what fiber is involved
,NBDE Part II + ADATs – Endo Questions
and Answer A+ Guide
what stimulates these fibers
how is the pain perceived
what does this pain represents
how might this end - correct answers✅✅a. In pulpal inflammation, the
response is exagger-
ated and disproportionate to the challenging stimulus (hyperalgesia). This
response is induced by the effects of inflammatory mediators that are
released in the inflamed pulp.
b.Progressionofpulpalinflammationcanchangethe quality of the pain
response. As the exaggerated A-delta fiber pain subsides, pain seemingly
remains and is perceived as a dull, throbbing ache. This second pain
symptom is from C nerve fibers.
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 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.
,NBDE Part II + ADATs – Endo Questions
and Answer A+ Guide
j. The sustained inflammatory cycle is detrimental to pulpal rec
Define a normal pulp - correct answers✅✅asymptomatic
mild-mod transient response to thermal or electric stimuli
no pain on percussion or palpation
Reversible pulpitis
define
stimuli
symptom or disease?
clinically distinguish from symptomatic irreversible pulpitis - correct
answers✅✅thermal stimuli usually causes quick, sharp, hypersensitive
response that subsides soon after stimulus is removed
early caries/recurrent
SRPs
deep restorations w/out bases
symptom - it irritant removed- reverts back to normal
if irritant remains, symptoms may lea to irreversible pulpitis
, NBDE Part II + ADATs – Endo Questions
and Answer A+ Guide
1) Non-lingering pain
2)No spontaneous pain
for aymptomatic, caries into the pulp is the line
Irreversible pulpitis
define
micrscopically
following IP, what happens to the pulp - the end result
is pain more common in IP? - correct answers✅✅By definition, the pulp
has been damaged beyond repair, and even with removal of the irri- tant it
will not heal.
Microscopically:
(I) Micro-abscesses of the pulp begin as tiny zones of necrosis within dense,
acute inflam- matory cells.
(2) Histologically intact myelinated and unmyeli- nated nerves may be
observed in areas with dense inflammation and cellular degeneration.
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.
and Answer A+ Guide
Endodontics - correct answers✅✅
What are factors that make the pulp unique it response to irriation? - correct
answers✅✅a. The pulp is almost completely surrounded by
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
Explain A-delta fiber innervation of the pulp - correct answers✅✅a. A-
delta fibers are larger, myelinated nerves that enter the root canal and
divide into smaller branches, coursing coronally through 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
what fiber is involved
,NBDE Part II + ADATs – Endo Questions
and Answer A+ Guide
what stimulates these fibers
how is the pain perceived
what does this pain represents
how might this end - correct answers✅✅a. In pulpal inflammation, the
response is exagger-
ated and disproportionate to the challenging stimulus (hyperalgesia). This
response is induced by the effects of inflammatory mediators that are
released in the inflamed pulp.
b.Progressionofpulpalinflammationcanchangethe quality of the pain
response. As the exaggerated A-delta fiber pain subsides, pain seemingly
remains and is perceived as a dull, throbbing ache. This second pain
symptom is from C nerve fibers.
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 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.
,NBDE Part II + ADATs – Endo Questions
and Answer A+ Guide
j. The sustained inflammatory cycle is detrimental to pulpal rec
Define a normal pulp - correct answers✅✅asymptomatic
mild-mod transient response to thermal or electric stimuli
no pain on percussion or palpation
Reversible pulpitis
define
stimuli
symptom or disease?
clinically distinguish from symptomatic irreversible pulpitis - correct
answers✅✅thermal stimuli usually causes quick, sharp, hypersensitive
response that subsides soon after stimulus is removed
early caries/recurrent
SRPs
deep restorations w/out bases
symptom - it irritant removed- reverts back to normal
if irritant remains, symptoms may lea to irreversible pulpitis
, NBDE Part II + ADATs – Endo Questions
and Answer A+ Guide
1) Non-lingering pain
2)No spontaneous pain
for aymptomatic, caries into the pulp is the line
Irreversible pulpitis
define
micrscopically
following IP, what happens to the pulp - the end result
is pain more common in IP? - correct answers✅✅By definition, the pulp
has been damaged beyond repair, and even with removal of the irri- tant it
will not heal.
Microscopically:
(I) Micro-abscesses of the pulp begin as tiny zones of necrosis within dense,
acute inflam- matory cells.
(2) Histologically intact myelinated and unmyeli- nated nerves may be
observed in areas with dense inflammation and cellular degeneration.
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.
