Reaction which protecs the pulp against caries

A. Increase in the permeability of dentin

B. laying down of new dentin

C.I nflmmatory reactions only

D. Immunologic reactions only

Dentinal tubules become partly or completely filled with mineral deposits in the form of carious crystals or peritubular dentin formation.

A. Dentinal Mineralization

B. Reparative Dentin formation

C. Dentinal Sclerosis

D. Caries Progression

March the terms with their appropriate definitions

A. Primary dentin

B. Secondary dentin

C. Tertiary dentin

1.Formation occurs only in response to stimulu

2.Formation occurs after the completion of tooth development

3. Formation occurs during tooth development

Ans A---->3

B--->2

C--->1

Reparative dentin is a defense mechanism against loss of

A. Enamel and Dentin

B. Dentin and Cementum

C. Enamel, Dentin and Cementum

D. Cementum and Enamel

True or False

Reparative dentin is more tubular and less calcified?

What factors influence reparative dentin formation?

A. nature and magnitude of the stimulus

B. pulpal status

C.  B only

D. A and B

Harphazard deposition of reparative dentin thus trapping soft tissue within the developing matrix producing

A. Swiss cheese pattern

B. Swiss pattern

C. Cheese like pattern

True or False

1)Is the wall between reparative and primary dentin thickened;2) Many of the dentinal tubules are occluded leading to increase in permeability

A. 1 and 2 are false

B. 1 is true and 2 is false

C. 1 is false and 2 is true

D. Both 1 and 2 are true

As soon as bacteria enter the DEJ, changes are occuring in the pulp. Odontoblasts are instructed to_______?

A. produce dentin

B. initate an inflammatory response

C. they do not produce anything as they are occluded

D. produce collagen

Prior to an inflmmatory response, what changes occur in odontoblast

A. no changes

B.  increase in odontoblast number and dentine secretion

 C. decrease in size, number and metabolic activity

D.  none of the above

Fill in the gaps

_____Odontoblast die leading to the formation of _________ which is devoid of _______.

A. secondary, dead tracts, dentin

B. primary,tertiary dentin,odontoblasts

C .secondary,tertiary dentin,dentin

D. primary,dead tracts,odontoblasts

Primary odontoblasts are replaced by what cell type which is responsible for laying down reparative dentin

A. fribroblasts that differentiate into odontoblast

B. surrounding odontoblast cells

B. fibroblasts that do no differentiate

D. none of the above

Of the 4 zones of a carious lesion, which zone is closest to the pulp?

A. zone of demineralization

B.zone of tubular sclerosis

C. zone of infected tubules

D. zone of destruction

True or False. Properties of the zone of infected tubules

1. basic architecture of dentin is not preserved

2. bacteria present in dentinal tubules

3. tubular size decreases due to loss of peritubular and intertubular dentin

4. There is only a slight loss of mineral from and matrix from intertubular dentin

5.confluence of tubules leads to bead and cleft formation

6. infected tubules are interspersed with noninfected tubules

1. fasle

2. True

3. false

4.false

5. true

6. true

Which zone consists of softened,dicolored and partially decomposed dentin, bacteria and complete deimeralization

A. zone of demineralization

B. zone of infected tubules

C. outer zone of destruction

D. zone of tubular sclerosis

Matching

A. active lesion in outer zone of detruction

B. arrested lesion in outer zone of destruction

1. surface is firm, leathery, dark brown or black in color

2. soft surface layer that is light brown in color

A---->2

B--->1

True/False

Pioneering bacteria are found deep within dentinal tubules

Pulpal response to caries begins as a low grade chronic response consisting of which cell types

A. lymphocytes and macrophages

B. lymphocytes, macrophages and plasma cells

C. macrphages, plasma cells and neutrophils

D. neutrophils, macrophages, lymphocytes

True or False? Low grade chronic response of the pulp is accompanied with blood cell and fibroblast proliferation accompanied by collagen deposition

Bacteria converging on the pulp initiates

A. acute inflammatory response

B. chronic inflammatory response

C. delayed response

D. no response

Which cell type causes an abscess to form

A lymphocytes

B. monocytes

C. neutrophils

D. macrophages

Lysosomal enzymes degrade surrounding tissue leading to pus formation. What type of necrosis is this

A. gangrene

B. caseous

C. coagulative

D. liquefactive

Why are abscesses painful?

A. Increased osmotic pressure

B. Increased hydrostatic pressure

C. decreased osmotic pressure

D. decreased hydrostatic pressure

This condition occurs in primary and immature permanent teeth with incompletely formed roots allowing numerous blood vessels to enter through the apical foramen

A. calcific metamorphosis

B. puld necrosis

C. chronic hyperplastic pulpitis

D. Tooth Fracture

Why is a young pulp better able to resist bacterial infection?

A. open apical foramen

B. rich blood supply

C. premature tooth

D. short roots

Carious exposure of the pulp when the exposure increases in size to form a large cavity.

A. calcific metamorphosis

B. puld necrosis

C. Pulp Polyp

D. Tooth Fracture

True/False

Tooth fracture must directly involve the pulp chamber to cause pulpal death

Teeth that are more susceptible to pulp fractures

A. lower anteriors

B. upper anteriors

C. lower posteriors

D. upper posteriors

True/False

 The pulp of a fractured tooth can survive subsequent to tooth fracture

Which roots are more at risk of tooth fracture?

A. endodontically treated roots

B. roots of vital teeth

Types of cracks that may be encountered

A. craze lines, fractured cusps

B. cracked tooth, split tooth

C. vertical root fracture

D. All of the above

Intermittent pain  which is difficult to localize can be caused by

A. incomplete fracture

B. complete fracture

As a crack enlarges, bacteria can get into the puld producing symptoms. Which of these symtoms can occur

1. sensitivity to hot and cold

2. sensitivity to cold only

3. sharp pain during mastication

4. no pain

A. 1,3,4

B. 2,3,4

C.3,4

D.1,3

Which methods are better for identifying a crack

A. palpation and percussion

B. methylene blue

C. biting down on a piece of orangewood or toothpick

D. B and C

Sometimes tooth infections go undetected until the pulp becomes exposed producing symptoms of pulpitis. What developmental structures can cause this?

A. calcified canals

B. dens invaginatus

C. fusion of teeth

D. teeth with open apices

Which is the most common form of iatrogenic injury

A. high occlusion

B. injury during tooth preparation

C. open margins leading to microleakage

D. injury cased during the injection of the anesthetic

Microleakage can result in a persistent chronic inflammatory reaction of abscess formation. When would microleakage not be a problem?

A. If the dentinal tubules are occluded

B. if a better luting agent is used with the restoration

C. removal of the smear layer during tooth preparation

Partial dislocation of teeth due to trauma can result in

A. Tooth fracture

B. pulp necrosis

C. calcified metamorphosis

D. Pulpitis

The yellowish hue observed with calcified metamorphosis is usually seen in

A. vital healthy teeth

B. Teeth with incomplete root formation

C. Endodontically treated teeth

D. Teeth with fractures

Resolution of pulpal infarct is due to

A. proliferation of neighbouring odontoblasts

B. Proliferation of connective tissue from the PDL into cementoblasts/osteoblasts

C.  proliferaton of fibroblasts

D. proliferation of epithelial cells

Irreversible pulpitis involves severe inflammation and degeneration that _____resolve if the cause is removed

A. do not

B. will

What does the pulp, brain and nail bed have in common? Choose the best answer

A. good blood supply

B. they are all housed within mineralized tissue

C. all contain collateral circulation

True/ False.  During inflammation when the pulp is unable to swell there is an increase in intrapulpal pressure to accomadate increase in swelling

Bacterial infection within the pulp is associated with pyogenic bacteria. What kind of necrosis results

A. coagulative

B. gangrene

C. liquefactive

D. caseous

Which cell type is not influneced by endotoxins released in the pulp

A. fibroblasts

B. lymphocytes and platelets

C. phagocytes

D. neutrophils

Matching

A. gangrene necrosis

B. liquefactive necrosis

C. coagulative necrosis

1.produced when organisms within the pulp are saprophytic

2. occurs due to hypoxia

3. Results from heterolysis and is associated with suppuration and abscess formation

A ---->1

B --->3

C --->2

"Putrefaction" involves a more extensive degradation of pulp tissue. In this form of ______ necrosis a variety of solid, liquid, and gaseous substances form including mercaptans, methane and carbon dioxide

A. coagulative

B. gangrene

C. liquefactive

D. caseous

Chronic inflammation is seen

A. beneathe leaky restorations

B. beneathe large restorations

C. progressive carious lesions

D. A and C

E. B and C

1 Bundles of dense collagen can frequently be observed in chronically inflamed pulps. 2 This may be accompanied by a increase in vascular and neural elements within the pulp

A. Both 1 and 2 are true

B. 1 is true and 2 is false

C. 1 is false and 2 is true

D. Both 1 and 2 are false

This type or resorption has unknown etiology and involves the pulp chamber and the root.

A. internal resorption

B. external resorption

This type of resorption is diagnosed radiographically and often occurs in healthy teeth and unerupted teeth.

A. Internal resorption

B. External resorption

Periapical lesions due to pulpal infections are mainly caused by

A. periodontal disease

B. caries

C. gingivitis

D. tooth fracture

What disease results in apical migration of the epithelial attachment?

A. periodontal disease

B. caries

C. gingivitis

D. tooth fracture

Spread of disease from the pulp to the periapical tissues is mainly caused by

A. Bacteria migrating from the pulp to the periapical tissues

B. Pulp being enclosed within a closed environment

C. connective tissue of the pulp is continuous with that of the periodontal ligament

D. none of the above

Radiographic changes associated with a periapical lesion

A. bone loss

B. increase in bone density

C. Both A and B

D. none of the above

Inflammatory lesions within the pulp depend on

A. bacterial virulence

B. blood supply

C. status of the pulp

D. A and C

E. B and C

Matching

A. periapical granuloma

B. abscess

1. produced by organism during a cell mediated response

2. suppuration due the prsence of pyogenic organisms

3. produced due to pulpal necrosis

A---->1

B--->2

Properties of periapical granulomas

1. a true granuloma

2. not a true granuloma

3. lacks a a central area of epitheliod cells

4. lacks multinucleated giant cells

A. 1 only

B. 2,3 only

C. 2,3,4 only

D. 2 only

A circumscribed accumulation of chronic inflammatory tissue

A. periapical granuloma

B. periapical abscess

The major cell type in s a periapical granuloma

A. foam cells

B. foreign body giant cells

C. macrophages

D. neutrophils

Radiographic examination of a small granuloma

A. circumsribed radiolucency

B. enlarged PDL

C. both A and B

Hyperostosis

A. thickening of the PDL

B. thickening of bone

C. both A and B

D. neither A or B

What type of pulpal response(s)  is/are observed with abscess formation

A. response to hot/cold

B. tenderness with palpation

C. pain with percussion

D. A and B

E. B and C

If a lesion persist, bone loss will be seen on a radiograph in a _______pattern

A. spider web

B. diffuse

C. moth eaten

D. scattered

trauma associated with instrumentation of the canal system coupled with the introduction of pyogenic bacteria into the chronic inflammatory tissue at the root apex results in suppuration and pain. What does the above refer to

A. flare-up

B. trauma

C. pulpitis

D. periapical abscess formation

Pus within an absecess seeks drainage to to

A. decreased vascularity

B. increased pressure

C. decreased pressue

D. increase in bacterial contents and debris

An abscess will discharge its contents by

A.ejecting

B. dispersal

C. slow release

D.pointing

A small sessile nodule  (“gum boil") on the mucosa  signifies the presence of a sinus tract communicating with the abscess.

A. purule

B. pustule

C. parulis

D. mass

It is composed of chronic inflammatory tissue through which pus flows

A. purule

B. pustule

C. parulis

D. mass

Pus drainage leads to the appearance of erythematous granulation tissue otherwise known as

A.acute periapical abscess

B. chronic periapical abscess

C. periapical granuloma

D. chronic periapical granuloma

Healing is accomplished by

A. proliferation of fibroblasts

B. blood vessel formation

C. lymphocytes

D. proliferation of granulation tissuex

An epithelium-lined cavity within a tissue that may be either developmental or inflammatory in origin

A. abscess

B. cyst

C. pustule

D. nodule

What kind of epithelium lines a cyst?

A. pesudostratified columnar

B. columnar

C.  keratinized cuboidal

D. non-keratinizing stratified squamous

How does a cavity of a cyst develop

A. epthelial proliferation within periapical granulomas leading to tissue break down

B.tissue breakdown within a periapical lesion might induce epithelium to migrate across the surface of the adjacent intact connective tissue

C. proliferation leads to the formation of a large mass of epithelial cells. Because the inner cells of the mass may eventually be cut off from essential nutrients, a cavity could form as these cells die

D. All of the above

Fluid within a cyst contains

A. high con. of proteins

B. high con of red blood cells

C. low con. of proteins

D. high con. of ions

Why is the fluid within a cavity brown?

A. presence of iron

B. breakdown of red blood cells

C. hemoseridin

D. A and C

The presence of cholesterol in the fluid within a cyts produces what appearance

A. gold/straw color

B. white and cheeselike

C. black in color

D. greasy appearance due to fat accumulation

How can a cyst be distinguished from a periapical radiolucency

A. large amounts of fluid

B. large number of epithelial cells

C. large amounts of albumin

D. large number of inflammatory cells

True/False

Most periapical cysts are large and asymptomatic

______is a localized lesion that represents reactive hyperplasia of bone. It is generally regarded as a mild form of chronic inflammation that develops in response to long-standing, low grade pulp infection. Most cases occur in patients who are under 30 years of age, and the vast majority develop in the mandible with the mandibular first molar the predominant site.

A. acute osteomyelitis

B. Focal Sclerosing Osteomyelitis

C. Chronic Osteomyelitis

Radiographically condensing osteitis will appear

A. radiopaque

B. radiolucent

The etiology of this type of osteomyelitis is infection and does not occur in normal, healthy individuals

A. acute osteomyelitis

B. Focal Sclerosing Osteomyelitis

C. Chronic Osteomyelitis

Inflammation develops in the _____ and extends into the _______, then along the _______ and eventually into the _________.

A. cancellous bony space, marrow space, periosteum, pathway of blood vessels

B. marrow space, cancellous bony spaces, pathway of blood vessels, periosteum

C. periosteum, marrow space, cancellous bony space, pathway of blood vessels

Are osteoclasts successful in resorbing bone within a sequestrum

A. yes

B. No

Marrow spaces during acute osteomyelitis is filled with which cell type

A. lymphocytes

B. plasma cells

C. osteocytes

D. neutrophils

E. B and C

Which cell types are present at the periphery of a lesion in acute osteomyelitis

A. lymphocytes

B. plasma cells

C. osteocytes

D. neutrophils

E. B and C

Signs and Symptoms of acute osteomyelitis

1. pain

2. swelling

3. malaise

4. decrease in white blood cell count

5. affected teeth sore to percussion

A. 1,2,4,5

B. 2,3,4

C. 1,2,3,5

D. 1,2,3,4

Chronic osteomyelitis is similar to acute osteomyelitis but inflammation is usually ______ and clinical symptoms are ______

A.more intense, more severe

B.more intense, milder

C.less intense, more severe

D. less intense, milder

A form of reactive hyperplasis occuring in young patients

A. acute osteomyelitis

B. chronic osteomyelitis

C. Garre’s Osteomyelitis

D. Focal sclerotic Osteomyelitis

Inflammation in the bone extends outward to the periosteum, stimulating it to thicken and lay down new layers of bone. These layers produce an _____ appearance in radiographs

A. onion skin

B. orange peel

C. rippled

D. smooth

Garre’s Osteomyelitis is

A. symptomatic

B. asymptomatic