3 - Diagnosis in endodontics

Question 1

What nerve fibres produce sharp pain?

Answer 1

A-delta fibres

Question 2

What nerve fibres produce dull aching pain?

Answer 2

C fibres

Question 3

What is referred pain?

Answer 3

• 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

Question 4

What teeth are commonly involved in referred pain?

Answer 4

• mandibular posterior teeth often radiate pain to the ear
• posterior teeth often refer pain to the opposing arch

Question 5

What is involved in an endodontic examination?

Answer 5

• EO
• IO (soft tissues, hard tissues, swellings)
• sinus tracts
• palpation
• percussion
• mobility
• periodontal exam

Question 6

What can be used to sensibility test teeth?

Answer 6

• thermal
• electric
• laser doppler flowmetry
• pulse oximeter

Question 7

What special investigations can be used to identify teeth that are causing pain?

Answer 7

• sensibility test
• bite test
• test cavity
• staining/transillumination
• selective anaesthesia

Question 8

What are the different pulpal diagnoses in endodontics?

Answer 8

• normal
• reversible pulpitis
• symptomatic irreversible pulpitis
• asymptomatic irreversible pulpitis
• pulp necrosis
• previously treated
• previously initiated treatment

Question 9

Describe a normal pulp.

Answer 9

• 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

Question 10

Describe reversible pulpitis.

Answer 10

• 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

Question 11

Describe symptomatic irreversible pulpitis.

Answer 11

• 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

Question 12

Describe asymptomatic irreversible pulpitis.

Answer 12

• 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

Question 13

Describe pulp necrosis.

Answer 13

• death of pulp
• RCT indicated
• non-responsive to pulp testing, usually asymptomatic

Question 14

Describe previously treated.

Answer 14

• tooth has previously been RCT
• radiographs should show all canals obturated
• tooth does not respond to pulp testing

Question 15

Describe previously initiated treatment.

Answer 15

• tooth has previously been partially treated, ie pulpotomy or pulpectomy
• depending on level of treatment, tooth may or may not respond to testing modalities

Question 16

What are the different apical diagnoses?

Answer 16

• normal apical tissues
• symptomatic apical periodontitis
• asymptomatic apical periodontitis
• chronic apical abscess
• acute apical abscess
• condensing osteitis

Question 17

Describe normal apical tissues.

Answer 17

• not TTP
• radiographically lamina dura is intact and PDL space is uniform

Question 18

Describe symptomatic apical periodontitis.

Answer 18

• 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

Question 19

Describe asymptomatic apical periodontitis.

Answer 19

• inflammation and destruction of the apical periodontium that is of pulpal origin
• radiographically appears as apical radiolucency
• no clinical symptoms including TTP

Question 20

Describe a chronic apical abscess.

Answer 20

• 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)

Question 21

Describe an acute apical abscess.

Answer 21

• 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

Question 22

Describe condensing osteitis.

Answer 22

Diffuse radiopaque lesion representing localised bony reaction to low grade inflammatory stimulus at the apex of the tooth