1 - Diseases of the pulp and periodontium Flashcards
What are the clinical symptoms of pulp hyperaemia?
- pain lasting for seconds
- pain stimulated by hot/cold or sweet foods
- pain resolves after stimulus removed
- caries approaching pulp but tooth can be restored without treating pulp
What is pulp hyperaemia also known as?
Reversible pulpitis
What are the clinical symptoms of acute pulpitis?
- constant severe pain
- reacts to thermal stimuli
- poorly localised pain
- referral of pain
- no response to analgesics
- if tooth is broken down, symptoms are less severe
Why are symptoms less severe in a broken down tooth?
The pressure within the pulp chamber has been released so the symptoms are lessened
What can be used during diagnosis of acute pulpitis?
- history
- visual exam
- TTP (negative)
- pulpal testing is ambiguous
- radiographs
- diagnostic LA
- removal of restorations
What are the clinical symptoms of acute periodontitis?
- TTP (patient can describe tooth as high as they can’t bite on it)
- tooth is non vital
- slight increase in mobility
- radiographs show low of lamina dura and widening of PDL
What are the causes of traumatic periodontitis?
- parafunction
- clenching (patient usually aware)
- grinding (patient unaware)
How do you treat traumatic periodontitis?
- occlusal adjustment
- therapy for parafunction
(occlusal splint/ gum shield)
How do you diagnose traumatic periodontitis?
- exam of occlusion (posturing)
- TTP
- normal vitality
- radiographs (generalised widening of PDL)
What are the different types of dental abscess?
- acute apical abscess (most common)
- periodontal abscess
- pericoronitis
- sialadentitis
What is a periodontal abscess?
Infection within the pocket or PDL
What is pericoronitis?
Abscess surrounding a partially erupted tooth, usually the 8
What is sialadenitis?
Infection of a major salivary gland
What organisms are usually involved in dental abscesses?
- polymicorbial
- anaerobes play in important role
What are the symptoms of acute apical abscess (initial stages)?
- severe unremitting pain
- acute tenderness in function
- acute TTP
- no swelling, redness or heat
What are the symptoms of acute apical abscess (that has perforated bone)?
- pain remits (unless palate) as pressure is released
- swelling, redness and heat become apparent
- as swelling increases, as does pain
- initial reduction of TTP as pus escapes into soft tissues
What dictates the site of swelling?
- position of tooth in arch
- root length
- muscle attachments
- potential spaces in proximity to lesion
What are space that infection can spread in to?
- submental space
- sublingual space
- submandibular space
- buccal space
- infraorbital space
- lateral pharyngeal space
- palate
How do you treat an acute apical abscess?
- provide drainage intraorally/extraorally
- remove source or cause (XLA, pulp extirpation, periradicular surgery)
- antibiotics (?)
What determines the need for antibiotics in the treatment of an acute apical abscess?
- severity
- absence of adequate drainage
- patients medical history
What local factors necessitate antibiotics?
- systemic toxicity
- airway compromised
- dysphagia
- trismus
- lymphadenitis
- location (FOM more likely to obstruct airway)
What systemic factors necessitate antibiotics?
- immunocompromised patients
- diabetes
- elderly
What is the aetiology of a periapical radicular cyst?
- caries/trauma/perio
- death of pulp
- apical bone inflammation
- dental granuloma
- stimulation of epithelial rest of malassez
- epithelial proliferation
- periapical cyst formation
What is a periapical granuloma?
- chronic apical periodontitis
- mass of chronically inflamed granulation tissue at apex of tooth
what’s the 5 cardinal signs of inflammation
- heat
- redness
- swelling
- pain
- loss of function
