0. Diagnosis I Flashcards
Normal apical tissues
Teeth with normal periradicular tissues that are not sensitive to ____ or ____ testing. The lamina dura surrounding the root is ____, and the periodontal ligament space is ____.
palpatation
percussion
intact
uniform
Symptomatic apical periodontitis
____, usually of the apical periodontium, producing clinical symptoms including a ____ response to biting and/or percussion or palpation. It might or might not be associated with an apical ____ area.
Asymptomatic apical periodontitis
Inflammation and destruction of apical periodontium that is of pulpal origin, appears as an apical ____ area, and does not produce ____ symptoms.
inflammation
painful
radiolucent
radiolucent
clinical
Acute apical abscess
An inflammatory reaction to pulpal infection and ____ characterized by ____ onset, ____ pain, tenderness of the tooth to pressure, pus formation, and ____ of associated tissues.
Chronic apical abscess
An inflammatory reaction to pulpal infection and ____ characterized by ____ onset, little or no discomfort, and the intermittent discharge of pus through an associated ____.
necrosis
rapid
spontaneous
swelling
necrosis
gradual
sinus tract
Condensing osteitis
Diffuse radiopaque lesion representing a localized ____ reaction to a low-grade inflammatory stimulus, usually seen at apex of tooth.
bony
You may not see change in periapical area on radiograph (no apical periodontitis) but you tap and pt feels ____. If there is no other explaination for percussion (no swelling periodontal ligaments in the gingiva, foreign body, local periodontal abscess), but no gingival issues and there is pain on percussion, this is ____
May be present but not seen in radiograph. A 3D xray (CBCT) will show the symptomatic apical periodontitis. May not see on normal radiograph if it’s in the ____ where you have thic cortical bone. If you get a positive percussion test when you tap on it but you don’t have buccal abscess/gingival inflammation, then this is ____ even if you don’t see on radiograph
pain
symptomatic apical periodontitis
posterior mandible
apical periodontitis
- Symptomatic - pt has symptoms and reports ____. When you test, you may have response from inflammation or the tooth has had pain or the pt has not described the pain. Strong pain response that lasts ____. If you have a healthy pulp, the response is ____, but this is stronger and longer than normal.
- Asymptomatic irreversible pulpitis (may need to change), but right now, if you open up the tooth and there is large opening of the pulp and had decay and you are now doing RCT, this is asymptomatic irrev pulpitis. Large ____ you are removing and now doing RCT
Asymptomatic - the patient does not report ____
pain
longer
pain
decay
pain
Normal on testing - very ____ painful response goes away
Reversible - ____ and intense
Irreversible pulpitis - stronger and likely ____. If symptomatic (comes with ____, there are other things going on (eg. Central and peripheral sensitization but now everything is firing. Pt in pain and cold is excruciating). If asymptomatic, decay going into ____, bacteria enter superficially and cause inflammation and pulp test it, pt will feel stronger and longer, but not as ____ as someone with history of pain
brief longer longer pain pulp excruciating
Previously treated
A clinical diagnostic category indicating that the tooth has been ____ treated and the canals are obturated with various filling materials other than intracanal medicaments.
Previously initiated therapy
A clinical diagnostic category indicating that the tooth has been previously treated by ____ endodontic therapy (eg, ____, pulpectomy).
endodontically
partial
pulpotomy
Chronic apical abscess
- ____
- mostly ____
Tracing of ST with GP to localized origin of tract
Chronic Apical Abscess - have bacteria going into the periapical areas and may lead to pus formation and have histologic signs of abscess.
• Two types of abscess
• Typical Acute abscess signs: ____, swelling, redness, fever, general malaise
• Chronic apical abscess: patient is not in ____ but abscess present
◦ Clinical sign: ____
sinus tract asymptomatic pain pain sinus tract
- When ever you see a sinus tract, you should use gotta percha to clinically verify this and to see where the origin of the sinus tract is.
- Picture on right: Piece of #30 gotta percha is placed into the bump of the sinus tract and then in the radiograph, can see that it leads to the site of apical periodontitis.
- ** IMPORTANT ** - on an exam, if the question says that there is a sinus tract, then the diagnosis apically is a ____.
- Typically, the patients who have chronic apical abscess - mostly asymptomatic
- Exception: Sometimes, the sinus tract will fill up and release tissue fluids and ____ leading to patient having ____. But, in general a sinus tract does not bother patients with pain.
chronic apical abscess
pus
pain
Acute apical abscess
- ____, pus, tenderness, redness
- ____!!!
- ____ may be necessary!
Typical signs of acute apical abscess : swelling, pus, tenderness, redness
Txt: Open up the root canal system, and see if abscess can be ____ through the root canal system. If severe, then do incision and drainage on top of opening up root canal.
• Ideally, you want pus removed, but currently the method of choice (incision&drainage vs. root
canal drainage) is being debated. Some say always do an incision and drainage even if there is not a lot of pus or abscess isn’t as big because opening up will introduce oxygen to the anaerobic bacteria in the abscess, which is detrimental to the bacteria.
swelling
symptomatic
incision and drainage
drained
Condensing osteitis
- diffuse ____ lesion representing a localized bony reaction to a low-grade inflammatory stimulus, usually seen at apex of tooth
Condensing osteitis : diagnostic label for diffuse radiopaque lesion at the end of the roots
• has been associated with ____ grade inflammatory inside the root canal system —> cause changes at the periapical areas by forming bone —> condensing osteitis.
• Will discuss more later in the course.
• Side note : Phoenix abscess is not a separate diagnosis in endodontics. ____ will be beyond an acute apical abscess.
radiopaque
low
phoenix abscess
Case 16 yr old Caucasian female PMH: NC (non contributory) Meds: patient denies No known drug allergies CC: “it hurts when I bite on my tooth”
1.Ask the patient for chief complaint and medical history 2. Ask Which tooth?
• Patient answers “Lower left side”
3. Clinical exam shows picture below.
- Tap on the tooth (occlusal and laterally)
• “patient feels it more on the occlusal of molar) - Do cold test
• “very brief sharp pain, goes instantly away” on 1st molar, and same thing on premolar 6. X-ray
After changing the contrast of the X ray, see that there is a radiolucent area (circled in purple)
- exaggerated response to cold test on #19
• Possibly take a bitewing radiograph / different angulation
Root canal not needed unless ____ pulpal exposure
Txt: Take out decay, filling, bring patient for follow-up Diagnosis for #19 1. No \_\_\_\_ needed 2. \_\_\_\_ removal 3. Pupal diagnosis - \_\_\_\_ pulpitis 4. Apical diagnosis - \_\_\_\_ apical tissues Diagnosis for #20 1. Normal pulp, normal apical tissues
wide RCT caries reversible normal
30:
- Clinically, you will see there is a swelling in the vestibule
- There are no other medical history issues
- This is the clinical situation, we skip the introduction, etc
- Would you first test the tooth or take a radiograph (student answers, ”Radiograph” )
- Medical history was negative
Percussion: ++
Palpation: ++
Cold: -
Probing: WNL
• Previously treated with an apical diagnosis of acute apical abscess due to the swelling and all of the other signs
• This widening of the PDL is something that is not really an apical periodontitis, it is a small widening that may be due to occlusal contact
• It is just a normal slight widening of the PDL
READ ME!
Case 1
Diagnosis: #30 previously treated + acute apical abscess
Treatment plan: retreatment
Alternative: surgical retreatmetn SRTX, extraction
Prognosis: favorable
• In this case, the diagnosis is previously treated and an acute apical abscess
• The first thing we would try to do in a patient like this is to take out the ____
• There might be a missed canal, you don’t see another filling in the mesial root
• To redo the root canal treatment, maybe we get some pus coming from the periapical area
• We would not finish a RCT in one visit, as we would place ____ inside, and then bring the
patient back after awhile and hope the symptoms/inflammation go away
• The difference between a recurrent and persistent infection:
• RCT in a situation where you have pulp necrosis and an infected root canal system
• The bacteria too over the entire root canal system
• Achieve disinfection of the canal
filling
medication
