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BDS3 R+M - CONs > 2. Tooth pain, diagnosis + management > Flashcards

2. Tooth pain, diagnosis + management Flashcards

1
Q

Different pulpal pathologies that will be covered in this lecture slide 37

A
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2
Q

What causes irritation of the pulp? (That then triggers toothache)/ pulpal disease?

A
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3
Q

DENTINE HYPERSENSITIVITY \

Prevalence?
More likely in men or women?

A
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4
Q

DENTINE HYPERSENSITIVITY?

How does dentine hypersensitivity develop - what are the theories?

HINT - names of the theories? + which is the most accepted one?

A
  • hydrodynamic theory = most accepted theory
  • 1st proposed in 1966
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5
Q

What is the hydrodynamic theory?

A

EG OF STIMULI
- thermal stimuli (hot, cold)
- osmotic stimuli (eating sugary food)
- mechanical stimuli (chewing)
- evaporative stimuli (air blast)

  • cold, osmotic + evaporative stimuli cause an outwards movement of fluid
  • hot and mechanical stimuli cause an inward movement of fluid
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6
Q

1
EG of stimuli that cause hydrodynamic theory to occur?

2
What direction of dentinal fluid movement do they cause?

A

1
- thermal stimuli (hot, cold)
- osmotic stimuli (eating sugary food)
- mechanical stimuli (chewing)
- evaporative stimuli (air blast)

2
- cold, osmotic + evaporative stimuli cause an outwards movement of fluid
- hot and mechanical stimuli cause an inward movement of fluid

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7
Q
A
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8
Q

DENTINE HYPERSENSITIVITY

Symptoms?

A
  • Short, sharp pain
  • Provoked by:
  • hot and cold (mostly cold)
  • acidic foods and drinks
  • sweet foods
  • short duration of pain
  • starts as soon as the stimulus is applied + disappears as soon as stimulus is removed
    (may last a couple of seconds)
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9
Q

DENTINE HYPERSENSITIVITY

Causes?

A
- tooth prep
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10
Q

DENTINE HYPERSENSITIVITY
EXTRA

1
Why may periodontal disease cause dentine hypersensitivity?

2
Prevalence in patients suffering from PD?

A

1
- usu when ongoing Perio disease, there is gingival recession at cervical area + root dentine is exposed

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11
Q

DENTINE HYPERSENSITIVITY
EXTRA

Why may periodontal treatment cause dentine hypersensitivity?

A
  • any periodontal surgical procedure (eg root surface debridement) can lead to exposure of dentinal tubules + patient can experience dentine hypersentivity
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12
Q

DENTINE HYPERSENSITIVITY

Causes (EXTRA PICTURES)

A
  • abfraction - caused because of the lateral or flexural forces as once they are concentrated at the cervical area, it can lead to the disruption of the tooth structure around that area and thus dentine hypersensitivity
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13
Q

DENTINE HYPERSENSITIVITY

Causes (EXTRA PICTURES)

  • sometimes can be a combo of diff things (eg PD + occlusal problems
A
  • erosion = another form of tooth surface loss (can be external or internal
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14
Q

DENTINE HYPERSENSITIVITY

Causes (EXTRA PICTURES)

A
  • crack/ fracture in restoration in last pic
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15
Q

DENTINE HYPERSENSITIVITY

1
How to carry out test to investigate cracked teeth?

2
Symptoms of cracked teeth?

A

1
- would carry out bite test on these teeth using a tooth slooth

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16
Q

Treatment of tooth cracks?

A
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17
Q

Pulpal irritation
(Extra photos)

A
  • as caries progresses, there will be involvement of the dentinal tubules
  • even before caries bacteria reaches pulp, toxins can travel through dentinal tubules + trigger inflamm response within the pulp tissue
  • due to this inflamm in pulp, the patient can present with symptoms of irreversible?? Or reversible?? pulpitis
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18
Q

PULP INFLAMMATION + PAIN

  • If tooth has healthy pulp, no pain associated with that
  • when there is inflamm within pulp, depending on extent of inflamm, the patient can present with symptoms of irreversible or reversible pulpitis

— — — — — — — — — — —

1
How is reversible pulpitis usu treated?

2
How is irreversible pulpitis usu treated?

A

1
- tooth needs filling
- dentine protection
- pulp capping (usu indirect)

2
- tooth needs RCT

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19
Q

PULP INFLAMMATION + PAIN

1
What can irreversible pulpititis lead to + why?

2
Make q

A

1
- can lead to pulp necrosis
- as persistent inflammation of the pulp can lead to necrosis of the pulp

2
- If there is persistent inflammation of the pulp, it can lead to the necrosis of the pulp + the microorganisms which form the biofilm within the root canal system + their toxins can eventually emanate from the root canal apex + once the do that they can illicit an inflam response in the periapical tissue
- this eventually leads to the loss of the bone around the apex of the toot
- this develops into chronic apical periondontitis

  • in the cases with more virulent proteolytic bacteria present within the root canals it can lead to the formation of puss + abscess can develop
  • abscess would try to drain through area of least resistance = through a sinus tract
  • the sinus tract, when it develops can be intraoral or extra oral (less common)
20
Q

PULP INFLAMMATION + PAIN

1
How can pulp necrosis be treated?

2a
What can pulp necrosis lead to?

2b
Are the tender to biting?

A
21
Q

PHOTOS

A
22
Q
  • When examine patient experiencing pain, pain history is V important
  • essential to take a detailed pain history (SOCRATES)

— — — — — — — — — — —

What does SOCRATES stand for?

Important Q’s to ask?

A

SOCRATES
- Site
- Onset
- Character
- Radiation
- Associated symptoms
- Time/ duration
- Exacerbating/ relieving factors
- Severity

(Disturbing patients sleep, how long pain lasts for, pain subsides once stimuli is removed?, pain killers taken?, pain killers effective?, pain score?)

  • gather as much info as you can from the patient history so you can come to a diagnosis
23
Q

What clinical examination should you carry out for pain examination?

A
24
Q

CLINICAL EXAMINATION

1
What is the palpation test?

2
What are you looking for?

A

1
- palpation of attached buccal mucosa + palatal aspect of tooth
- run your finger from the non involved teeth to the involved teeth

2
- see if the patient is involving any pain or has any fluctuant swelling present

25
Q

CLINICAL EXAMINATION

1
How do you carry out percussion test?

2
When may it not be necessary to percuss?

A

1
- percussion test on teeth

  • use end of mirror
  • percuss in all areas to see comparison with non painful areas

2
- not always necessary to percuss with end of mirror if tooth already tender and obvious (eg with actuate abscess already quite tender)
- can just use finger pressure

  • if patient is in too much pain, then don’t give any unnecessary pain by percussing
26
Q

CLINICAL EXAMINATION

1
What does a single isolated deep pocket indicative of?

2
Is a tooth with a root fracture restorable?

A
  • detailed periodontal status of involved tooth

1
- may indicate root fracture or crack

2
- sometimes with root fracture, tooth is not restorable + need to extract the tooth

27
Q

Along with clinical examination can also carry out other special tests

What special tests are there?

A
28
Q

SPECIAL TESTS

1
How to carry out cold test?

A

1
- use endo frost
- spray on small cotton roll (spray a good amount)
- ALWAYS start with placing the cotton round on the non-suspected tooth
- also do the contra lateral tooth
- then the actual tooth

  • see what tooth causes pain to the patient
29
Q

SPECIAL TESTS

1
How to carry out hot test?

2
Why are hot tests rarely carried out?

A

1
- heat gutta percha + place on tooth
- ALWAYS start with placing the cotton round on the non-suspected tooth
- also do the contra lateral tooth
- then the actual tooth

  • see what tooth causes pain to the patient

2
Causes strong severe pain

30
Q

SPECIAL TESTS

1
How to use electric pulp testing?

A
  • have good isolation
  • ALWAYS start with placing the cotton round on the non-suspected tooth
  • also do the contra lateral tooth
  • then the actual tooth
  • see what tooth causes pain to the patient
31
Q

SPECIAL TESTS

1
What is the cavity test

A
  • can do in certain situations
  • cutting a cavity without anaesthesia
  • as burr goes beyond dentoenamel junction + dentinal tubules are irritated, the patient can give a response
  • can give a higher or lower response + from that you can get an assessment
32
Q

TIP for percussion + hot and cold test (picture)

TIP for diagnosis

A
  • 1 test is not enough to reach a diagnosis, important to combine results of all investigations carried out in order to come to the correct diagnosis
33
Q
  • need to combine findings of several tests to come to a diagnosis
A
34
Q

REVERSIBLE PULPITIS

Symptoms + pain history?

1 - Food related pain?
2 - how long does it last?
3 - pain killers?
4 - how long may the pain have been there?
5 - can patient identify where pain is coming from?

A
35
Q

REVERSIBLE PULPITIS

Test results for:
1 - Hot + cold tests
2 - Electric test
3 - Percussion + palpation
4 - Radiograph examination
5 - Cavity prep without anaesthesia

A
36
Q

IRREVERSIBLE PULPITIS

Symptoms + pain history?

1 - Food related pain?
2 - how long does pain last?
3 - Pain killers taken?
4 - how long has the pain been happening?
5 - can patient indenting where pain is coming from?
6 - spontaneous pain? Provoked by stimulus?

A
  • spontaneous pain
37
Q

IRREVERSIBLE PULPITIS

Test results for:
1 - Hot + cold tests
2 - Electric test
3 - Percussion + palpation
4 - Radiograph examination
5 - Cavity prep without anaesthesia

A
38
Q

ACUTE PERIAPICAL ABSCESS

Symptoms + pain history

1 - pain caused by?
2 - drinks affect pain?
3 - provoked by stimulus?
4 - how long does the pain last?
5 - pain killers help?
6 - how long has the pain been there?
7 - patient can identify what tooth is causing pain?
8 - …

A
39
Q

ACUTE PERIAPICAL ABSCESS

Test results for:
1 - Hot + cold tests
2 - Electric test
3 - Percussion + palpation
4 - Radiograph examination
5 - Cavity prep without anaesthesia

A
40
Q
A
41
Q

1
What may be done in addition to PA radiographs when diagnosing?

2
Why?

3
Advantage of this additional scan

A

1
Cone beam CT scan

2
CBCT done in more complex cases

3
- advantage of cone beam CT scan
= 3-D view of tooth + surrounding tissue, rather than 2-D view with PA radiograph
= avoids superimposition + anatomical noise
= helps shows pathology present associated with roots better

42
Q

EXTRA
EXAMPLE 1 OF WHY CBCT IS USEFUL IN ADDITION TO CBCT RADIOGRAPH

  • PA of upper right quadrant
  • UR6 = root canal filled
  • root filling is adequate up until the radiographic apex
  • can see radiolucency around mesial root
  • when the patient presented with symptoms of chronic periapical periodontitis

CBCT
- was helpful as was able to show that one of the mesial root canals was infilled and there was a radiolucency associated with that
- from the PA radiograph we were unable to get this information

A
  • axial view of the scan
  • can see in mesial root canals was not filled
  • was the main cause of the failure of the treatment
43
Q

EXTRA
EXAMPLE 2 OF WHY CBCT IS USEFUL IN ADDITION TO CBCT RADIOGRAPH

  • PA radiograph of 3 unit bridge
  • in bridge abutment (molar), it’s not clear if there is ant PA radiolucency
A

EXTRA
EXAMPLE 3 OF WHY CBCT IS USEFUL IN ADDITION TO CBCT RADIOGRAPH

  • PA radiographs taken
44
Q

EXTRA
EXAMPLE 3 OF WHY CBCT IS USEFUL IN ADDITION TO CBCT RADIOGRAPH

PA radiograph
- PA radiographs taken to investigate PA radiolucencies associated with bridge abutments (premolar + molar)
- some indication of PA radiolucency but not V clear

CBCT scan
- was able to reveal radiolucency associated with molar + premolar
- RCT of these teeth were carried out

A
45
Q

EXTRA
EXAMPLE 3 OF WHY CBCT IS USEFUL IN ADDITION TO CBCT RADIOGRAPH

A
46
Q

EXTRA
EXAMPLE 4 OF WHY CBCT IS USEFUL IN ADDITION TO CBCT RADIOGRAPH

  • tooth was diagnosed with chronic apical periodontitis
  • UL6
  • subsequent RCT was carried out
A
  • follow up appt, patient still had symptoms
  • once investigations were carried out using CBCT scan, revealed there was a filled MB2 root (one mesial root canal was filled but other root was not filled)

BDS3 R+M - CONs (3 decks)

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