Diseases of the Pulp and Peri Apical Tissues

338. the condition clinically simulating pulpitis by the occurrence of toothache reported in pilots, aircrews, and submarine crews known as Aerodontalgia is attributed to
a. phenomenon of anachoresis
b. formation of nitrogen bubbles in the pulp tissues and vessels
c. increased capillary permeability
d. all of the above

B

A condition stimulating pulpitis by the occurrence of toothache was reported during World War II in flying personnel and has been called aerodontalgia. Also reported in aircrew flying at high altitudes, astronauts, submarine crews, and in deep sea divers. This pain has been attributed to the formation of nitrogen bubbles in the pulp tissue or vessels.

339. pulpitis aperta is used to designate the pulpitis, where
a. it occurs at higher altitudes due to atmospheric pressure
b. there is no communication of pulp with oral cavity
c. the pulpal tissues directly communicates with oral cavity
d. pulpitis occurs due to phenomenon of anachoresis

C

Pulpitis aperta / open pulpitis has been used to describe the those cases of the pulpitis in which the pulp obviously communicates with oral cavity, in case where no such communication exists are described as closed pulpitis ( pulpitis clausa) . Aerodontalgia is a pulpitis that occur due to high altitude.

Bacteria circulating in the blood stream tends to settle out or accumulate at sites of pulpal inflammation, such as that which might follow some chemical or mechanical injury to the pulp and is known as” anachoretic pulpitis”

340. the permenet tooth most commonly involved with chronic hyperplastic pulpitis is
a. maxillary incisors
b. third molars
c. first molars
d. mandibular canines

C

The teeth most commonly involved by this phenomenon are the deciduous molars and first permanent molars. These have an excellent supply because of the large root opening and this coupled with high tissue resistance and reactivity in young persons, accounts for the unusual proliferation property of the pulp tissue.

341. the pathogenesis behind chronic hyper-plastic pulpitis involving either deciduous molars or first permanent molars is largely because of
a. anatomic location of these teeth
b. excellent blood supply and high tissue resistance
c. inherent nature of pulp of these teeth
d. all of the above

B

Pulp polyp occurs in children and young adults who have large exposure of pulp in which the entire dentinal roof is often missing. Molars account for the unusual proliferative property of the pulp tissue. Mechanical irritation and bacteria invasion result in a level of chronic inflammation that produce hyperplastic granulation tissue that extrudes from the chamber and often fills the associated dentinal defects.

342. the earliest radiographic changes seen in chronic apical periodontitis is
a. resorption of bone around the root apex
b. thickening of the PDL at the root apex
c. increase in radio- opacity at peri apical area
d. discontinuity in lamina dura around root apex

B

The periapical granulomas are asymptomatic and respond negative to vitality testing. On radiographic examination the associated radioucencies are variable ranging from small, barely perceptible lesion to radiolucencies exceeding 2cm in diameter and reveals loss of apical lamina dura. The lesion may be circumscribed or ill defined and may or may not demonstrate a surrounding radiopaque rim. Root resorption is not common.

343. the most common odontogenic cyst encountered in clinical practice is
a. dentigerous cyst
b. odontogenic keratocyst
c. mucocele
d. radicular cyst

D

Radicular cysts are asymptomatic and present no clinical evidence of their presence. Commonly seen at the age of 20-60 yrs and maxillary anterior are most commonly involved teeth. The associated tooth is non-vital or shows deep carious lesion or a restoration which is often painful or even sensitive to percussion.

344. the epithelial lining of peri apical cyst is usually
a. stratified squamous
b. pseudostratified squamous
c. 1 to 2 cell layer thick
d. all of the above

A

Radicular cyst is a true cyst since the lesion consist of pathological cavity that is lined by epithelium and is often fluid filled. The epithelium lining is derived from the epithelium rest of malassez, which proliferate as a result of inflammatory stimulus in a pre-existing granuloma. On occasion the lining epithelium may demonstrate linear or arch shaped calcification known as Ruston bodies. Dystrophic calcification , cholesterol cleft with multinucleate giant cells, RBC and area of hemosiderin pigmentation may be present in the lumen, wall or both.

345. condensing osteitis is seen most commonly in
a. mandibular first molar of a young individual
b. mandibular first molar of an old aged individual
c. mandibular incisors of a young individual
d. mandibular incisors of an old aged individual

A

Chronic focal sclerosing osteomyelitis is an unusual reaction of the bone to mild bacterial infection entering the bone through a carious tooth in person who has a high degree of tissue resistance and tissue reactivity. The tissue react to the infection by proliferation rather than destruction, since the infection acts as a stimulus rather than an irritant.

346. radio graphically lesions of chronic focal sclerosing osteomyelitis may closely simulate
a. peri-apical granuloma
b. benign cementoblastoma
c. ameloblastoma
d. garre’s osteomyelitis

B

The periapical radiograph demonstrates the pathognomic, well circumscribed radiopaque mass of sclerotic bone surrounding and extending below the apex of one or both roots. The entire root outline is nearly always visible with an intact lamina dura. Periodontal ligament space is widened and this is an important feature in distinguishing it from the benign cementoblastoma that is radiographically may closely resemble.

347. the most common cause of dental pain (odontalgia) is
a. dental caries
b. periodontitis
c. pericoronitis
d. pulpitis

D

The dental pulp is a delicate connective tissue liberally interspersed with tiny blood vessels lymphatics, nerve and undifferentiated connective tissue it reacts to bacterial infection, mechanical damage, thermal injury, chemical irritation by an inflammatory response. The enclosure of pulp tissue within rigid calcified walls of the dentine precludes the excessive swelling of tissue that occurs in the hyperaemic phases of inflammation in other tissue. The commonest cause for tooth ache is inflammation of the pulp or pulpitis.

348. the thresh hold for stimulation by electric pulp tester in acute and chronic pulpitis is correspondingly
a. decreased in acute and increased in chronic
b. increased in acute and decreased in chronic
c. increased in both acute and chronic as well
d. decreased in both acute and chronic as well

A

In chronic pulpitis, the sign and symptoms are considerably milder than those in the acute form of disease. The reaction to thermal change is reduced in comparison to that of acute pulpitis because of degeneration of nerve tissue in the affected pulp. That is why the thresh hold for stimulation by electric pulp tester in acute and chronic pulpitis is correspondingly decreased in acute and increased in chronic pulpitis. Also, chronic pulpitis is characterized by infiltration of pulp tissue by varying number of mononuclear cells, chiefly lymphocytes and plasma cells and more vigorous connective tissue reaction.

349. the most commonly involved teeth by a peri apical cyst are
a. mandibular first molars
b. impacted third molars
c. maxillary anteriors
d. mandibular anteriors

C

Cellulitis is acute and edematous spread of an inflammatory process when drainage through the surface of skin or oral cavity is not established. It is due to the result of infection by microorganism that produce significant amount of streptokinase, hyaluronidase and fibrolysins which acts to breakdown or dissolve hyaluronic acid, the universal intercellular cement substance and fibrin.

350. the source of epithelium for origin of peri apical cyst from peri apical granuloma is
a. rests of malassez
b. respiratory epithelium of maxillary sinus
c. oral epithelium from a fistulous tract
d. any of the above

D

The epithelium lining is derived from the epithelium rest of malassez, which proliferate as a result of inflammatory stimulus in a pre-existing granuloma. Also, it may be derived from respiratory epithelium of maxillary sinus or oral epithelium from a fistulous tract.

The lumen of periodontal cyst is lined stratified squamous epithelium which may demonstrate exocytosis, spongiosis and hyperplasia while the wall are made up of condensed connective tissue and contain scattered hyaline bodies. The inflammatory responses appear to increase the production of keratinocyte growth factor by periodontal stroma cells leading to increased proliferation of normally quiescent epithelium in the area.