Contraindication of Pulpotomy

# Pulpotomies are CONTRAINDICATED on primary molars with which of the following?
A. Radiographic evidence of deep caries approximating the pulp chamber
B. Radiographic evidence of internal resorption
C. Sensitivity to sweets
D. Exposure of the pulp during caries excavation

The correct answer is B. Radiographic evidence of internal resorption.

Root canal therapy is indicated to treat
cases involving internal resorption.

When a carious lesion approximates or
extends into the pulp chamber of a
deciduous tooth, removal of coronal pulp is
performed to prevent the spread of the
infection into the radicular pulp.

Pulpotomies are performed on deciduous
teeth to prevent premature tooth loss and
potential loss of space.

Careful clinical and radiographic
assessment along with the child's medical
and dental history are necessary before
performing a pulpotomy.

Pulpotomy is contraindicated where there is:
- Internal resorption (root canal therapy
indicated)
- Perforation of pulp chamber floor
- Over 2 root resorption
- Cellulitis
- Localized abscess
- Draining sinus
- Inability to isolate the tooth
- Inability to properly restore tooth after the
procedure

Severe pain of dentoalveolar abscess

#Sudden relief of severe pain associated with a dentoalveolar abscess can be explained by which of the following?
A. Neutralizing effect of tissue enzymes
B. Walling-off of the infection by the body
C. Rupture of the abscess from the periosteum into the soft tissue
D. Neurotoxic effects of bacterial toxins anesthetize the nocioceptors

The correct answer is C. Rupture of the abscess from the periosteum into the soft tissue.

Dentoalveolar abscesses are an accumulation of pus within the teeth, gums,
and supporting alveolar bone.

The accumulation of pus within the
dentoalveolar abscess creates hydrostatic
pressure, resulting in the sensation of a
severe pain.

Dentoalveolar abscesses are treated
through root canal treatment and possibly
incision and drainage depending upon case
severity.

Drainage of the lesion releases the pressure
caused by the suppuration and results in a
sudden relief of pain is experienced by the
patient.

The major symptom of dentoalveolar
abscess is a severe, intense, and throbbing
pain which worsens with the passage of
time.

Dentoalveolar abscesses can be partially
diagnosed by noting the presence of a
periapical radiolucency.

Cementoblastoma is more often seen

# The cementoblastoma is more often seen:
A. In the mandible than in the maxilla, and more often posterior than in the anterior regions
B. In the mandible than in the maxilla, and more often anterior than in the posterior regions
C. In the maxilla than in the mandible, and more often posterior than in the anterior regions
D. In the maxilla than in the mandible, and more often anterior than in the posterior regions

The correct answer is A. In the mandible than in the maxilla, and more often posterior than in the anterior regions

The cementoblastoma, also known as the true cementoma, is a rare benign neoplasm of cementoblast origin. It occurs predominantly in the second and third decades, typically before 25 years of age. It is more often seen in the mandible than in the maxilla and more often posterior than in the anterior regions. It is intimately associated with the root of a tooth, and the tooth remains vital. It may cause cortical expansion and, occasionally, lowgrade intermittent pain. Radiographically, this is a well-circumscribed radiopaque lesion that replaces the root of the tooth. It is usually surrounded by a radiolucent ring. Because of the intimate association of this lesion with the tooth root, this lesion cannot be removed without sacrificing the tooth. There is no recurrence.

Note: To distinguish this lesion from condensing osteitis - in condensing osteitis, you can distinguish

the root outline.

Odontogenic keratocyst (OKC) is derived from:

# The odontogenic keratocyst (OKC) is derived from:
A. Hertwig's epithelial root sheath
B. The reduced enamel epithelium
C. Remnants of the dental lamina
D. A pre-existing osteoma

The correct answer is: B. Reduced enamel epithelium.

Keratocysts differ from other odontogenic cysts in their microscopic appearance and clinical behavior.

They may resemble periodontal, primordial, or follicular cysts. Usually, they cannot be distinguished

radiographically. 

Clinical features:

• Wide age range. peak occurrence in 2nd and 3rd decades

• Lesions found in children are often reflective of multiple odontogenic keratocysts as a component

of the nevoid basal cell carcinoma syndrome

• More common in males than females

• The chief site of involvement is the mandible, in approximately a 2 to 1 ratio

• In the mandible. most occur within the posterior portion of the body and ramus region

• Typically asymptomatic

Radiographic features:

• Well-demarcated area of radiolucency with a scalloped, radiopaque margin

• Unilocular or multilocular

Microscopicall y:

• The lining epithelium is thin and parakeratinized.

• The basal layer is palisaded with prominent, polarized, and intensely staining nuclei of uniform

diameter

• The lumen may contain large amounts of keratin debris or clear fluid similar to serum transudate

• The parakeratotic type fonns 85 to 95% of all odontogenic keratocysts; the balance is made

up of the orthokeratinized variant.

Most common cause of xerostomia is:

# The most common cause of xerostomia is:
A. Hereditary
B. Medications
C. Tooth decay
D. Mouth breathing

The correct answer is B. Medications.

Xerostomia (dry mouth) is not a disease, however, it can be a symptom of certain diseases. Many times xerostomia is caused by failure of the salivary glands to function normally, but the sensation can also occur in people with normal salivary g lands. Xerostomia can cause health problems by a ffecting nutrition, as well as psychological heal th. At its most extreme, it can lead to rampant tooth decay and periodontal disease.

Perhaps the most prevalent cause of xerostomia is medica tion. The main culprits are antihistamines, antidepressants, anticholinergics (e.g .. atropine and scopolamine) , anorexiants, antihypertensive, antipsychotics {e.g. , chlorpromazine and prochlorperazine), anti-Parkinson agents, diuretics and sedatives.

The most common disease causing xerostomia is Sjogren's syndrome (SS), a chronic inflammatory autoimmune disease that occurs predominantly in postmenopausal women.

Sarcoidosis and amyloidosis are other chronic inflammatory diseases that cause xerostomia.

Other systemic diseases that can cause xerostomia include rheumatoid arthritis, systemic lupus erythema tosus, and scleroderma. 

Remember: Xerostomia is the most common toxicity associated with radiation therapy to the head and neck.

 

Ludwig's angina involves infection of:

# Ludwig's angina is a severe and spreading infection that involves the:
A. Submental and sublingual spaces only
B. Submandibular, submental, and sublingual spaces unilaterally
C. Submandibular and sublingual spaces only
D. Submandibular, submental, and sublingual spaces bilaterally

The correct answer is: D. Submandibular, submental, and sublingual spaces bilaterally

Ludwig's angina often results from an odontogenic infection. As a result, the bacteriology of theses infections generally involves oral flora, particularly anaerobes. Other recognized etiologies of Ludwig's angina include poor oral hygiene, IV drug abuse, trauma, and tonsillitis.

It is characterized by:

• Rapid onset

• The three facial spaces are involved bilaterally

• Board-like swelling of floor of the mouth and no fluctuance is present

• Typical "open-mouthed" appearance

• Elevation of the tongue

• Drooling. trismus, and fever

• Difficulty eating, swallowing, breathing

• Tachycardia, increased respiration rate

• Can lead to glottal edema; asphyxiation

Airway management, massive antibiotic coverage (IV), and surgical incision and drainage are the mainstays of treatment.

Very important: The most serious complication of Ludwig's angina is edema of the glottis (which is a slit-like opening between the true vocal cords).

Epithelioid cells and giant cells are derived from

# Epithelioid cells and giant cells are derived from macrophages and are important in the development of:
A. Initial inflammation
B. Granulomatous inflammation
C. Acute inflammation
D. Subacute inflammation

The correct answer is B. Granulomatous inflammation.

Granulomatous inflammation is a subtype of chronic inflammation and is characterized by granulomas, which are nodular collections of specialized macrophages referred to as epithelioid cells. A rim of lymphocytes usually surrounds granulomas. Granulomas are produced by multinucleated giant cells (Langerhans giant cells and foreign body giant cells). All the other cell types characteristic of chronic inflammation, including plasma cells, eosinophils, and fibroblasts, may also be associated with granulomas.

Note: Granulomatous inflammation is characteristically associated with areas of caseous necrosis produced by infectious agents, particularly Mycobacterium tuberculosis.

• Tuberculosis: caused by the inhalation of Mycobacte1ium tuberculosis. Oral non-healing chronic ulcers follow lung infection. Important: Characterized by caseating granulomas with multinucleated giant cells (Langerhans giant cells and foreign body giant cells).

Etiologic agents associated with granulomatous inflammation:

• Infectious agents

- TB and leprosy, which are mycobacterial diseases

- Fungal infections (blastomycosis, histoplasmosis, and coccidioidomycosis)

- Spirochetes (Treponema pallidum, which causes syphilis)

- Cat scratch disease (caused by an unnamed gram-negative organism)

• Foreign material (e.g., suture or talc)

• Sarcoidosis (unknown etiology; it is non-necrotizing)

• Crohn's disease (it is non-caseating)