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23 Endodontics > 6 - Endodontic Diagnosis > Flashcards

6 - Endodontic Diagnosis Flashcards

1
Q

what goes under dental history

A
  1. present signs and symptoms
  2. past signs and symptoms
  3. past dental treatment
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2
Q

what is the diagnosis sequence?

A

SOAP!
1. subjective symptoms
2. objective signs
3. appraisal (diagnosis)
4. plan (treatment plan)

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2
Q

what are subjective symptoms

A

what the patient tells you

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3
Q

what are chief complaints

A

what problem are you having
document in patient’s own words

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4
Q

first treatment rendered is aimed at resolving what?

A

chief complaing

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5
Q

what to ask during patient interrogation

A
  1. is pain spontaneous
  2. severity and duration
  3. is there something that makes it feel worse or better
  4. do you take pain medication and does it work?
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6
Q

what are tentative diagnoses

A
  1. pulpal
  2. periradicular
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7
Q

what are objective signs

A

what the dentist is able to observe

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8
Q

what are the types of visual examination

A
  1. extraoral exam
  2. intraoral exam
  3. dentition exam
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9
Q

what is done to confirm tentative diagnosis and arrival at final diagnosis?

A

clinical test

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10
Q

what should you always attempt to reproduce during clinical tests

A

patient’s symptoms

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11
Q

limitations of clinical tests

A
  1. cannot be used in all situations
  2. tests often inconclusive
  3. can be technique sensitive
  4. not tests of teeth but patient’s response to given stimulus
  5. can get false positive and neg
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12
Q

clinical tests are [tests of teeth OR patient’s response] to a given stimulus

A

patient’s RESPONSE to a given stimulus

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13
Q

what instrument do you first use during clinical test

A

mirror and explorer

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14
Q

why should you use control teeth during clinical tests

A
  1. patient knows what to expect
  2. dentist can observe how patient reactions
  3. have a basis for comparison
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15
Q

what are good control teeth?

A

adjacent teeth -> best to use contra lateral tooth

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16
Q

what are the periradicular tests

A

percussion and palpation

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17
Q

what tells you if there is inflammation of PDL

A

percussion

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18
Q

what are the different etiology options of percussion inflammation

A

endo, perio, or hyperocclusion

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19
Q

what are the different ways to document intensity of response for percussion

A
  1. severe +++
  2. moderate ++
  3. mild +
  4. negative - (normal)
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20
Q

what determines extent of inflammation by applying pressure with finger over apex

A

palpation

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21
Q

how do you record severity response for palpation

A

same as percussion
1. severe +++
2. moderate ++
3. mild +
4. negative - (normal)

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22
Q

what are the different pulp tests

A

cold test, heat test, electric pulp test (EPT)

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23
Q

what can be used for cold test? include temp

A
  1. ice - 32 F
  2. carbon dioxide -108 F
  3. DDM refrigerants. -21 F
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24
Q

what cold test is used at creighton

A

DDM refrigerants (-21 F)

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25
Q

severe and prolonged response to cold is indicative of what

A

irreversible pulpitis

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26
Q

no response to cold could indicate what? you should be aware of what?

A

pulpal necrosis but beware of calcified teeth (this is why control teeth are important)

27
Q

can you interpret cold test by itself

A

NO!

28
Q

how to you record cold test response charting

A
  1. severe +++
  2. moderate ++
  3. mild + (normal)
  4. no response -
29
Q

are heat tests used routinely

A

NO

30
Q

when are heat tests useful

A

when offending tooth is difficult to localize and major symptom is heat sensitivity

31
Q

exaggerated and lingering response to heat is indicative of what

A

irreversible pulpitis

32
Q

heat tests are also called what

A

reverse test

33
Q

what can be used for heat test

A
  1. hot water (under rubber dam)
  2. warm gutta percha stopping
  3. polishing of existing restorations
  4. special devices
34
Q

how do you complete electric pulp testing

A
  1. use toothpaste as conducting medium
  2. have patient touch with fingers so they have control
35
Q

what should be used as conducting medium for electric pulp testing

A

toothpaste

36
Q

do the numbers on EPT mean anything

A

not much

37
Q

EPT tests what

A

whether the pulp can respond to stimulus or not

38
Q

when can EPT give false neg

A

calcified canals

39
Q

when can EPT give false positives

A
  1. pus in canals
  2. partial necrosis
  3. improper technique
40
Q

can EPT tell you if the pulp is healthy or not?

A

NO!!

41
Q

how do you chart electric pulp tests

A

record number obtained (1-80)

42
Q

how is gutta percha tracing completed

A
  1. insert GP cone into sinus tract between 25-30 size
  2. take xray
  3. remove GP cone
43
Q

what is the purpose of gutta-percha tracing

A

to see origin of sinus tract

44
Q

in gutta-percha tracing what size cone should you use

A

25-30

45
Q

when do you complete anesthetic test

A
  1. when source of pain cannot be identified
  2. to determine if dental pain or not
  3. determine if max or mand pain
  4. selective for offending tooth on max arch only
46
Q

when completing anesthetic test, should you go mesial to distal OR distal to mesial

A

mesial to distal

47
Q

when do you complete a test cavity

A

when all other tests are inconclusive (as far as vitality of tooth)

48
Q

how do you complete a test cavity

A

drill small hole w/ handpiece (highspeed) into dentin WITHOUT ANESTHETIC

49
Q

what should you warn patient of when completing test cavity

A

possible sensitivity

50
Q

what should you do if patient perceives no pain when drilling into dentin without anesthetic (test cavity)

A

proceed deeper until pulpal necrosis is verified

51
Q

what are other diagnostic tests

A
  1. transillumination
  2. diagnostic caries evacuation
  3. tooth slooth
52
Q

what is a tooth slooth

A

diagnostic test that goes thru one cusp at a time. if pain occurs, it is suggestive of cracked tooth

53
Q

___ and ___ mimic each other and are often interrelated

A

perio and endo

54
Q

what do you look for during perio exam

A
  1. probing depths
  2. tooth mobility
55
Q

vital teeth with deep probing depths have what prognosis?

A

guarded prognosis

56
Q

necrotic teeth with deep probing depths have what prognosis?

A

better prognosis (as long as root is not fractured)

57
Q

T/F: the MORE endo and LESS perio, the better the prognosis

A

TRUE! vice versa is also true

58
Q

extensive endodontic involvement can cause what

A

marked mobility

59
Q

can mobility be dramatically improved after endodontic therapy

A

YES!

60
Q

if there is marked mobility of periodontal origin, is the prognosis good or poor?

A

POOR

61
Q

what are limitations of radiographic interpretation

A
  1. most pulp pathology not visible
  2. PA pathology many times not visible
  3. 2D images
62
Q

what shows periradicular lesions of endodontic origin on X-ray

A
  1. loss of lamina dura
  2. radiolucency remains at apex even when xray angles changes
  3. evident etiology
63
Q

what hard tissue lesions are visible on radiograph

A
  1. internal resorption
  2. calcifications
64
Q

what can detect lesions not apparent on conventional radiographs, can see 3D image of tooth, and can examine cross-sections

A

CBCT

65
Q

should you use just a single test to make diagnosis?

A

NO!

66
Q

you should gather information from all tests including ___ and ___ to arrive at diagnosis

A

patient symptoms; radiographs

23 Endodontics (12 decks)

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