2: Systemic Pulpal & Periradicular Diagnosis Flashcards
how is subjective information gained?
talk to patient prior to clinical examination
patient’s chief complaint: how should information be recorded?
in patient’s own words
past medical history:
- keep history updated how often?
- what to remember about older patients?
- each visit to dentist
- older patients tend to have more complicated medical problems
past medical history: conditions that require special consideration for endodontic treatment?
- radiation therapy of oral tissues
- disorders of immune system
- cardiac conditions
- latex allergy
- hepatitis
- bleeding disorders
- steroid replacement therapy
history of present complaint: obtained by?
why should patients be handled with care? in what type of environment?
- questions and answers regarding history of present symptoms
- because of pain, apprehension and altered emotional state. environment should be friendly and compassionate
dental history: what should be noted?
- why patient attended
- any recent treatment?
- when did problem begin
- what factors influence the present complaint?
significant aspects of pain? elaborate on each
location: ask pt to point to the tooth, location can be difficult if inflammation has not spread to pl?
character/intensity: more intense, more disruptive to lifestyle. intense pain: recent onset, no relief from analgesics. can be caused by irreversible pulpitis, acute apical abscess. long standing pain not as intense.
origin: spontaenous or provoked. spontaenous intense pain = severe pulpal/periradicular pathology
duration: intermittent or continuous
continuous pain:
with thermal stimulus - indicates?
with application of pressure - indicates?
- irreversible pulpitis
- periradicular pathology
collection of medical and dental history, identification of signs and symptoms - what diagnosis can the clinician reach?
what else is required to collect more info to confirm diagnosis?
- tentative diagnosis
- will require objective examination to confirm tentative diagnosis
objective examination: gained by? x3
clinical examination
special investigations
radiographs
clinical examination: what are the extraoral and intraoral tissues? what to examine for?
extraoral: general appearance, facial asymmetry, swelling, TMJ, lymph nodes
intraoral:
- soft tissues: lips, oral mucosa, cheeks, tongue, palate, attached gingiva.
check for discoloration, inflammation, sinus tracts
- dentition: check discoloration, fractures, toothwear, caries, large restorations
clinical tests: 4 different types?
- mirror and probe: check discoloration, caries, fracture, defective restorations, sinus/fistula
- periodontal examination
- periapical tests: TTpercussion, TTpalpation, pulp sensibility
- radiographic examination: cone beam, CT
periodontal examination: - differentiates between? probing? - helps detect? mobility? - caused by? - what causes it to decrease?
- differentiate between periodontal and pulpal pathology
- probing is a diagnostic aid to bone and soft tissue destruction. teeth suspected of perio disease should always be probed
- mobility: caused by lack of pl support, or acute infection. successful RCT can decrease mobility
mobility:
specific causes? what kinds of origins?
other causes?
- LOA
- inflammation of PDL
- can be pulpal or periodontal origin
- other causes include root fracture, trauma, occlusal trauma, orthodontic tooth movement, abnormally short roots
periradicular tests: what 3 movement to carry out?
- percussion
- palpation
- mobility
what are control teeth and what is their purpose (x3)?
- healthy teeth that should be tested first
3 reasons: - patient knows what to expect
- dentist can observe patient’s response
- can then determine if stimulus is capable of evoking a response
percussion:
determines what?
severe response: how? indicates?
mild to moderate response: indicates?
- percussion determines the presence of PERIRADICULAR inflammation
- severe pain is sharp, causing patient to withdraw. indicates periradicular inflammation
- mild/moderate: indicates periodontal inflammation, periodontal disease
percussion: how to carry out?
what if there is severe subjective pain?
what must be done first?
- tap on incisal or occlusal surface with mirror handle, held perpendicular to crown
- then only use gentle apical pressure applied digitally
- test control teeth first
palpation: determines what? positive response indicates? how to carry out? what must be done first?
- determines if inflammation has extended periapically
- indicates periradicular inflammation
- firm finger pressure applied to mucosa
- use control tooth
pulp sensibility testing: stimulates what nerve fibres? positive response does not guarantee ___, but indicates what?
- stimulates sensory nerve fibres
- does not guarantee healthy pulp, only indicates presence of some nerve fibres carrying sensory impulses
- use control teeth first
pulp sensibility tests: what 3 types are there?
- thermal
- electric pulp testing
- direct dentine stimulation
pulp sensibility testing:
normal response - occurs in?
intense, prolonged response - suggests?
no response - indicates?
- in vital pulp, or reversible pulpitis
- suggests irreversible pulpitis
- necrotic pulp, or false negative (immature apex, recent trauma, calcified canal)
pulp sensibility tests: cold
what materials are used?
which teeth respond better or worse to cold tests? what is the alternative?
- ethyl chloride
- dichlorodifluoromethane (endofrost)
- ice sticks
- more effective on anterior teeth than posterior teeth - try electric pulp testing instead
pulp sensibility tests: heat
what materials can be used?
- hot water: isolate tooth with rubber dam, syringe one tooth at a time
- gutta-percha heated on a flame
- rotation of rubber prophy cup
electric pulp testing: technique?
- clean, dry, isolate tooth
- place toothpaste on electrode
- place tester on labial/palatal surface of tooth. avoid metal restorations
- increase level of current until sensation is felt by pt
EPT false positives: occur when? x4
- electrode makes contact with gingiva or large amalgam restorations
- patient is anxious
- liquefaction necrosis (gaseous & liquefied elements within pulp can transmit electrical charges to periapical tissues)
- tooth not dry or well isolated
EPT false negatives: occur when?
- patient is premedicated
- inadequate contact with enamel
- trauma
- canal calcified
- apex immature
- partial necrosis
pulp sensibility:
positive response shows?
negative response shows?
response does not reflect the degree of ______?
- presence of sensory nerve fibres
- pulpal necrosis
- does not reflect the degree of health or disease of pulp
pulp vitality test:
measures and assesses what? vascular supply is the most accurate marker of?
- measure/assess pulpal blood flow
- pulp vitality
laser doppler flowmetry: an optical measuring method that enables?
objective test of?
- enables the number and velocity of particles conveyed by a fluid to be measured
- objective test of presence of moving RBCs within tissue
laser doppler flowmetry: how does it work?
laser light transmitted to the dental pulp, by means of fibre optic probe placed against tooth surface
laser doppler flowmetry: indications?
- pulp testing in children
- traumatized teeth
- monitoring revascularization of replanted teeth
- differential diagnosis of periapical radiolucencies
direct dentine stimulation: how to carry out? useful for? how must test be carried out?
cut a test cavity
- useful for crowned teeth
- explain test to patient, carry out preparation without anaesthesia
- if tooth is vital; patient will feel a sudden, sharp pain when dentine is cut
methods of special investigation?
- selective anaesthesia
- transillumination: dentine cracks, fractures
bite test: provides? patient will feel pain upon?
- displacement of fragments and stretching of odontoblastic processes
- patient will feel pain upon release of pressure
radiographic examination:
aids what?
limitations? x3
inflammation must spread where to be visible?
- diagnosis
- pathological changes in pulp not visible, periradicular pathology not visible in early stages, 2D - more than one view often required
- inflammation must spread to involve cortical plates to be visible
radiographic evaluation: crown
- what to look for?
- depth of restoration
- presence of caries/recurrent caries
- presence of tertiary dentine/pulp stones
- size & location of pulp chamber
radiographic evaluation: roots and periradicular area
- number and morphology of roots
- size and shape of root canals
- presence of resorption
- presence of periradicular pathology
- previous root canal treatment: quality, type of material, iatrogenic defects
cone beam CT produces what kind of scans of the maxillo-facial skeleton? what dose of radiation? captures what? how does the x-ray work?
- 3D scans of maxillo-facial skeleton
- lower dose of radiation
- captures cylindrical/spherical volume of data known as field of view
- pulsing x-ray beam gives up to 580 projection images, exposure of 2-5s. software then reconstructs 3D image from data
CBCT can provide?
a more objective and accurate representation of osseous changes over time
