6 - Endodontic Diagnosis Flashcards
what goes under dental history
- present signs and symptoms
- past signs and symptoms
- past dental treatment
what is the diagnosis sequence?
SOAP!
1. subjective symptoms
2. objective signs
3. appraisal (diagnosis)
4. plan (treatment plan)
what are subjective symptoms
what the patient tells you
what are chief complaints
what problem are you having
document in patient’s own words
first treatment rendered is aimed at resolving what?
chief complaing
what to ask during patient interrogation
- is pain spontaneous
- severity and duration
- is there something that makes it feel worse or better
- do you take pain medication and does it work?
what are tentative diagnoses
- pulpal
- periradicular
what are objective signs
what the dentist is able to observe
what are the types of visual examination
- extraoral exam
- intraoral exam
- dentition exam
what is done to confirm tentative diagnosis and arrival at final diagnosis?
clinical test
what should you always attempt to reproduce during clinical tests
patient’s symptoms
limitations of clinical tests
- cannot be used in all situations
- tests often inconclusive
- can be technique sensitive
- not tests of teeth but patient’s response to given stimulus
- can get false positive and neg
clinical tests are [tests of teeth OR patient’s response] to a given stimulus
patient’s RESPONSE to a given stimulus
what instrument do you first use during clinical test
mirror and explorer
why should you use control teeth during clinical tests
- patient knows what to expect
- dentist can observe how patient reactions
- have a basis for comparison
what are good control teeth?
adjacent teeth -> best to use contra lateral tooth
what are the periradicular tests
percussion and palpation
what tells you if there is inflammation of PDL
percussion
what are the different etiology options of percussion inflammation
endo, perio, or hyperocclusion
what are the different ways to document intensity of response for percussion
- severe +++
- moderate ++
- mild +
- negative - (normal)
what determines extent of inflammation by applying pressure with finger over apex
palpation
how do you record severity response for palpation
same as percussion
1. severe +++
2. moderate ++
3. mild +
4. negative - (normal)
what are the different pulp tests
cold test, heat test, electric pulp test (EPT)
what can be used for cold test? include temp
- ice - 32 F
- carbon dioxide -108 F
- DDM refrigerants. -21 F
what cold test is used at creighton
DDM refrigerants (-21 F)
severe and prolonged response to cold is indicative of what
irreversible pulpitis
no response to cold could indicate what? you should be aware of what?
pulpal necrosis but beware of calcified teeth (this is why control teeth are important)
can you interpret cold test by itself
NO!
how to you record cold test response charting
- severe +++
- moderate ++
- mild + (normal)
- no response -
are heat tests used routinely
NO
when are heat tests useful
when offending tooth is difficult to localize and major symptom is heat sensitivity
exaggerated and lingering response to heat is indicative of what
irreversible pulpitis
heat tests are also called what
reverse test
what can be used for heat test
- hot water (under rubber dam)
- warm gutta percha stopping
- polishing of existing restorations
- special devices
how do you complete electric pulp testing
- use toothpaste as conducting medium
- have patient touch with fingers so they have control
what should be used as conducting medium for electric pulp testing
toothpaste
do the numbers on EPT mean anything
not much
EPT tests what
whether the pulp can respond to stimulus or not
when can EPT give false neg
calcified canals
when can EPT give false positives
- pus in canals
- partial necrosis
- improper technique
can EPT tell you if the pulp is healthy or not?
NO!!
how do you chart electric pulp tests
record number obtained (1-80)
how is gutta percha tracing completed
- insert GP cone into sinus tract between 25-30 size
- take xray
- remove GP cone
what is the purpose of gutta-percha tracing
to see origin of sinus tract
in gutta-percha tracing what size cone should you use
25-30
when do you complete anesthetic test
- when source of pain cannot be identified
- to determine if dental pain or not
- determine if max or mand pain
- selective for offending tooth on max arch only
when completing anesthetic test, should you go mesial to distal OR distal to mesial
mesial to distal
when do you complete a test cavity
when all other tests are inconclusive (as far as vitality of tooth)
how do you complete a test cavity
drill small hole w/ handpiece (highspeed) into dentin WITHOUT ANESTHETIC
what should you warn patient of when completing test cavity
possible sensitivity
what should you do if patient perceives no pain when drilling into dentin without anesthetic (test cavity)
proceed deeper until pulpal necrosis is verified
what are other diagnostic tests
- transillumination
- diagnostic caries evacuation
- tooth slooth
what is a tooth slooth
diagnostic test that goes thru one cusp at a time. if pain occurs, it is suggestive of cracked tooth
___ and ___ mimic each other and are often interrelated
perio and endo
what do you look for during perio exam
- probing depths
- tooth mobility
vital teeth with deep probing depths have what prognosis?
guarded prognosis
necrotic teeth with deep probing depths have what prognosis?
better prognosis (as long as root is not fractured)
T/F: the MORE endo and LESS perio, the better the prognosis
TRUE! vice versa is also true
extensive endodontic involvement can cause what
marked mobility
can mobility be dramatically improved after endodontic therapy
YES!
if there is marked mobility of periodontal origin, is the prognosis good or poor?
POOR
what are limitations of radiographic interpretation
- most pulp pathology not visible
- PA pathology many times not visible
- 2D images
what shows periradicular lesions of endodontic origin on X-ray
- loss of lamina dura
- radiolucency remains at apex even when xray angles changes
- evident etiology
what hard tissue lesions are visible on radiograph
- internal resorption
- calcifications
what can detect lesions not apparent on conventional radiographs, can see 3D image of tooth, and can examine cross-sections
CBCT
should you use just a single test to make diagnosis?
NO!
you should gather information from all tests including ___ and ___ to arrive at diagnosis
patient symptoms; radiographs
