3 - Diagnosis in endodontics Flashcards
What nerve fibres produce sharp pain?
A-delta fibres
What nerve fibres produce dull aching pain?
C fibres
What is referred pain?
- perception of pain in a part of the body distant from the source of pain
- invoked by intense stimulation of C fibres
- radiates to ipsilateral side
What teeth are commonly involved in referred pain?
- mandibular posterior teeth often radiate pain to the ear
- posterior teeth often refer pain to the opposing arch
What is involved in an endodontic examination?
- EO
- IO (soft tissues, hard tissues, swellings)
- sinus tracts
- palpation
- percussion
- mobility
- periodontal exam
What can be used to sensibility test teeth?
- thermal
- electric
- laser doppler flowmetry
- pulse oximeter
What special investigations can be used to identify teeth that are causing pain?
- sensibility test
- bite test
- test cavity
- staining/transillumination
- selective anaesthesia
What are the different pulpal diagnoses in endodontics?
- normal
- reversible pulpitis
- symptomatic irreversible pulpitis
- asymptomatic irreversible pulpitis
- pulp necrosis
- previously treated
- previously initiated treatment
Describe a normal pulp.
- symptom free and normally responsive to pulp testing
- clinically normal pulp results in mild or transient response to cold testing which lasts a few seconds
Describe reversible pulpitis.
- inflammation that resolves after appropriate management
- discomfort is experienced when stimulus applied
- caused by exposed dentine, caries or deep restorations
- no radiographic changes in periapical region
Describe symptomatic irreversible pulpitis.
- vital pulp that is inflamed, and is incapable of healing
- RCT indicated
- sharp pain upon thermal stimulus that lingers, spontaneous pain and referred pain are common
- analgesics are usually ineffective
- caused by deep caries, deep restorations or fractures
Describe asymptomatic irreversible pulpitis.
- vital pulp that is inflamed, and is incapable of healing
- RCT indicated
- no clinical symptoms
- respond normally to thermal testing
- caused by trauma or deep caries
Describe pulp necrosis.
- death of pulp
- RCT indicated
- non-responsive to pulp testing, usually asymptomatic
Describe previously treated.
- tooth has previously been RCT
- radiographs should show all canals obturated
- tooth does not respond to pulp testing
Describe previously initiated treatment.
- tooth has previously been partially treated, ie pulpotomy or pulpectomy
- depending on level of treatment, tooth may or may not respond to testing modalities
What are the different apical diagnoses?
- normal apical tissues
- symptomatic apical periodontitis
- asymptomatic apical periodontitis
- chronic apical abscess
- acute apical abscess
- condensing osteitis
Describe normal apical tissues.
- not TTP
- radiographically lamina dura is intact and PDL space is uniform
Describe symptomatic apical periodontitis.
- inflammation of the apical periodontium
- TTP and painful response to biting
- can be accompanied with radiographic changes (widening of PDL or a radiolucency)
- severe TTP is indicative of a degenerating pulp and requires RCT urgently
Describe asymptomatic apical periodontitis.
- inflammation and destruction of the apical periodontium that is of pulpal origin
- radiographically appears as apical radiolucency
- no clinical symptoms including TTP
Describe a chronic apical abscess.
- inflammatory reaction to pulpal infection/necrosis
- gradual onset, little to no pain
- intermittent discharge of pus via sinus tract
- radiographs show signs of osseous destruction (ie radiolucency)
Describe an acute apical abscess.
- inflammatory reaction to pulpal infection/necrosis
- rapid onset, spontaneous pain, extreme TTP, pus formation, swelling of associated tissues
- radiographs may not show changes due to rapid onset
- patient may present with malaise, fever and lymphadenopathy
Describe condensing osteitis.
Diffuse radiopaque lesion representing localised bony reaction to low grade inflammatory stimulus at the apex of the tooth
