2. Diagnosis of pulpal and periapical pathologies Flashcards
What causes irritation to the pulp?
-Dental caries (bacteria )
-Dental trauma >cracks, fractures> bacteria
-Cavity preparation
-Bacterial leakage at the interface between tooth and restorations
-Exposure of dentine > bacteria
what is dentine hypersensitivity?
quite prevalent and triggered by cold and hot drink sweets.
It tends to happen when the gum has receded or you’ve lost a considerable amount of enamel.
for example, if a patient had an acidic diet or gastric reflux, the enamel is going to be eroded away over time and we’ll be exposing the dentine leading to sensitivity
what is the prevalence of dentine hypersensitivey?
quite prevalent. 15% of the population suffers from dentine hypersensitivity
More frequent in women than in men
triggered by cold and hot drink sweets.
How does dentine hypersensitivity develop?
-Direct Innervation (DI) Theory
-Odontoblast Receptor (OR) Theory
-Fluid Movement/Hydrodynamic Theory
what is the hydrodynamic theory?
There are changes in the direction of the flux of dentinal fluid within the dentinal tubules.
The movement of dentinal fluid leads to mechanical deformation and activation of the sensory nerve terminals of Aδ fibreslocated in close contact withodontoblasts
What are the symptoms of dentine hypersensitivity?
Short, sharp pain provoked by hot and cold (mostly cold), acidic foods and drinks, sweet foods
the pain starts as soon as the stimulus is applied and disappears as soon as the stimulus is removed (may last a couple of seconds)
no medication needed.
What are the causes of dentine hypersensitivity?
-Periodontal disease
-Periodontal treatment
-Excessive brushing or flossing
-Leaking restorations
-Cracked teeth
-Abfractions
-Erosions
how do you a Exposure of dentine in the cervical area due to periodontal disease?
gingival graft
look at slide 18
what is the prevelance of patients suffering from peridontisits?
The prevalence among patients suffering from periodontal disease is above 75%.
can occlusal problems exacerbate periodontal problems?
yes, You often find together periodontal disease and occlusal problems
What are other causes of sensitivity?
bruxism and tooth wear in general (not frequent). the tooth wears down and tertiary dentine forms, the pulp has responded to the aggressions hence not a frequency cause.
why are Fillings, crown preparations are a frequent cause of dentine sensitivity?
bacterial leakage
dentine and tubules exposed.
can all lead to sensitivity.
how does a cracked tooth lead to sensitivity?
what do you do if the cracked tooth is below the gumline?
extraction if not as deep filling or cuspal coverage
how can you identify if a patient has a crack on their tooth?
tooth slooth
what is the Treatment of tooth cracks?
-Use the microscope to see them
-Warn the patients regarding prognosis of the tooth
-Check their depth
-Remove them if possible
-Prevent extension of the crack by placing an orthodontic band
-Make a composite filling
-Monitor the tooth for 6 months-one year (including periapical radiographs)
-Place a crown
what is a frequent cause of pulpal inflammation and tooth pain?
Caries is a frequent cause of pulpal inflammation and tooth pain
what do you do when a patient has reversible pulpitis?
Reversible pulpitis (tooth needs filling, dentine protection, pulp capping) >
sharp non-spontaneous Pain and triggered by cold and sweets (symptoms very similar to the dentine hypersensitivity)
what do you do when a patient has irreversible pulpitis?
Irreversible pulpitis( tooth needs root canal treatment)
Pain is spontaneous and lingering and hot temperature will trigger it.
Pulp necrosis (tooth needs root canal treatment)
A. Necrosis of the pulp with normal periapical tissues (tenderness on biting sometimes)
B. Chronic apical periodontitis (tenderness on biting sometimes)
C. Chronic apical periodontitis with associated sinus (tenderness on biting sometimes)
D Acute periapical abscess > Pain
what happens during a clinical examination?
-Inspection
-Palpation
-Percussion
-Periodontal probing
what is palpation?
Palpation is a method of feeling with the fingers or hands during a physical examination. checking for tenderness.
what is a Percussion test?
In the percussion test, the dentist is looking to replicate your pain on biting down. They will apply pressure the occlusal, or chewing, surface of the teeth, first with their finger and then with the handle end of an instrument.
what are other special tests that can be done by dentists?
Thermal Test:
-Cold test: ethylchloride, dichlorodifluoromethane (DDM)
-Heat test: (heated gutta-percha)
Electric pulp test:
Periapical radiograph
CBCT radiographic images
LDF and Pulse Oximetry: Assessment of pulpal blood flow (unavailable in most surgeries and more often used only for scientific purposes)
Cavity test: Cavity preparation without anaesthesia
are these clinical tests reliable?
None of these tests is totally reliable so the diagnosis of tooth pain is always an educated guess.
All of these tests make sense if you compare the response of the suspected tooth with the adjacent teeth and with the corresponding tooth on the other side.
Pain killers modify significantly the response to hot and cold tests (non steroid and steroid)
