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D2 Fall - Endodontics > 9/17: Pulpal and Apical Diagnosis > Flashcards

9/17: Pulpal and Apical Diagnosis Flashcards

1
Q

A pulpal diagnosis is UNLIKELY to often present as a

A

Purely pulpal

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2
Q

What 2 diagnoses do each tooth need?

A

Pulpal
Peri-radicular

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3
Q

What is the objective of clinical testing?

A

Find chief complaint

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4
Q

What are the strongest predictors of higher levels of endodontic pain?

A

Negative response to cold stimulation on the causative tooth and percussive hypersensitivity on the adjacent tooth

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5
Q

What kind of testing is cold and heat?

A

Thermal (pulp vitality)

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6
Q

This clinical test is only done when the pulpal status is in question

A

EPT

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7
Q

Is an EPT routinely done?

A

No

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8
Q

This clinical test is tapping with a mirror

A

Percussion

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9
Q

Percussion shows what?

A

PDL sensitivity

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10
Q

This is digital touching of gingival

A

Palpation

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11
Q

What is the minimum number of radiographs you need to get of a suspected area?

A

3:
Straight on PA
PA shift shot (20 angulation)
Bite-wing

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12
Q

Answering what question leads to an accurate diagnosis?

A

Why

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13
Q

What 3 conditions does the Pulp exist in?

A

Normal
Inflamed
Infected

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14
Q

This is when the pulp is healthy

A

Normal

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15
Q

This is when the pulp could recover or deteriorate

A

Inflamed

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16
Q

What kinds of inflammation are there?

A

Reversible
Irreversible (pain lingering and spontaneous)

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17
Q

Is asymptomatic irreversibly common?

A

No it is rare

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18
Q

This is when the infected pulp will proceed to necrosis

A

Infected

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19
Q

What are the 5 pulpal diagnostic boxes?

A

Normal
Reversible pulpitis
Symptomatic irreversible
Asymptomatic irreversible
Necrosis

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20
Q

If the pulp is WNL and their are minimal damage, and no axial cracks then you should

A

Leave tooth alone

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21
Q

If a patient has non-ligering cold sensitivity, then it is

A

Reversible pulpitis

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22
Q

If a patient has a lingering cold sensitivity, then it is

A

Irreversible pulpitis

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23
Q

Are normal teeth sensitive to hot?

A

No

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24
Q

Hot sensitivity usually indicates what?

A

Deteriorating pulp

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25
Q

Hot sensitivity is only normal on

A

Gums, on teeth = bad

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26
Q

Will deep caries produce any symptoms?

A

Yes, but rarely they do not

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27
Q

This is when the pulp is symptom free with normal response to pulp tests

A

WNL

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28
Q

This is inflammation of the pulp that will resolve itself and return to normal

A

Reversible pulpitis (RP)

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29
Q

This is vital inflamed pulp that is incapable of healing

A

Symptomatic irreversible pulpitis (SIP)

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30
Q

You have this when you got linger pain to cold, heat, and spontaneous pain

A

SIP

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31
Q

This is vital inflamed pulp incapable of healing with no clinical symptoms

A

Asymptomatic irreversible pulpitis (AAP)

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32
Q

Inflammation associated with AIP is often due to

A

Caries, caries excavation, trauma

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33
Q

This is the death of the dental pulp and you have no response to pulp tests

A

Pulpal necrosis (necrosis)

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34
Q

In pulpal necrosis, do you have responses to pulp tests?

A

No

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35
Q

How do you know the difference between necrotic or AIP?

A

You don’t until you open (AIP = blood, Necrosis = no blood)

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36
Q

This tooth has been previously treated endodontically with canal obturated with final root canal filling material other than medications

A

Previously treated (PT)

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37
Q

This is a tooth that has been previously treated by partial endodontic therapy. AKA RCT not complete

A

Previously initiated treatment (PIT)

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38
Q

What are examples of PIT?

A

Pulp cap
pulpotomy/pulpectomy

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39
Q

Is a diagnosis continually changing?

A

Yes

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40
Q

If you cannot arrive at a supportable diagnosis, you cannot

A

Do any treatment

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41
Q

In cases of pure pulpitis or even early necrotic pulp, we RARELY see

A

Apical radiographic changes

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42
Q

Do you have changes in the radiographs between each pulpal diagnosis

A

No

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43
Q

Is there a lot or little correlation between clinical symptoms and histopath reality?

A

Little correlation

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44
Q

A diagnosis must have 2 things for it to have tx planning?

A

Supported and documented
Clinically examined and testing

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45
Q

Following pulpal necrosis, the disease does what?

A

Extends periapically

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46
Q

Following pulpal necrosis, the tooth will often become what?

A

Percussion

47
Q

Following pulpal necrosis, the tooth will often become percussion and or spontaneous pain may appear _____ radiographic evidence is clear

A

Before

48
Q

Radiographic evidence will develop but it takes

A

Time

49
Q

If 100% of the medullary bone is gone, you can still see no what?

A

PARL on radiograph

50
Q

A visible PARL is only visible when how much of the cortical bone is destroyed?

A

40%

51
Q

What is the progression of RC system infections?

A

Carious lesion or trauma open to tubules
Bacteria inflame pulp locally
Inflammation may overcome defenses
Infection increases in pulp and necrosis begins
Necrosis involves entire RC system
Infection uses portals of exit to invade periradicular tissues
Periradicular infection occurs beyond apex

52
Q

What are the portals of exit?

A

Apical foramen
Lateral canals

53
Q

All periradicular inflammation is sensitive to

A

Percussion

54
Q

Purely pulpal pain is _________ to percussion

A

Not sensitive

55
Q

If you can point to a specific tooth in pain, what specific structures allow this to happen?

A

PDL

56
Q

Mechanoreceptors are present in what?

A

PDL

57
Q

Mechanoreceptors are

A

Proprioceptors

58
Q

What receptors does the pulp have?

A

Nociceptors

59
Q

If a patient can point to the tooth in pain, it means that the inflammation/infection has

A

reached the apical tissues

60
Q

What does WNL mean?

A

Within normal limits

61
Q

What does SAP mean?

A

Symptomatic apical periodontitis

62
Q

What does AAP mean?

A

Asymptomatic apical periodontitis

63
Q

What does AAA mean?

A

Acute apical abscess

64
Q

What occurs in a AAA?

A

Swelling + fever

65
Q

What is the only diagnostic option if there is a DST present?

A

CAA

66
Q

What is a CAA?

A

Chronic apical abscess

67
Q

What is a DST?

A

Draining sinus tract

68
Q

Condensing osteitis has what kind of appearance on x-ray?

A

Radiopaque

69
Q

This is when teeth are NOT sensitive to percussion or palpation. Lamina dura is intact and PDL is uniform and unbroken

A

WNL

70
Q

This is inflammation of the periodontium producing a painful response to biting/percussion/palpation

A

Symptomatic apical periodontitis

71
Q

This is inflammation and destruction of the periodontium that is of pulpal origin appearing as a radiolucent area with no clinical symptoms

A

Asymptomatic apical periodontitis

72
Q

Can you see AAP on a radiograph?

A

Yes

73
Q

This is a inflammatory reaction to pulpal infection with rapid onset, spontaneous pain, tooth tender to pressure, pus formation and swelling and fever

A

AAA

74
Q

This is a inflammatory reaction to pulpal infection with gradual onset, little or no discomfort and draining sinus tract

A

CAA

75
Q

This is a diffuse radiopaque lesion representing a localized boney reaction to a low-grade inflammatory stimulus

A

Condensing osteitis

76
Q

What other situations may result in SAP?

A

High restoration
Occlusal habits
Trauma

77
Q

In AAA with severe cellulitis, you may need

A

Incision and drainage

78
Q

Is CAA an emergency?

A

No

79
Q

Do you get extra-oral swelling in AAA or CAA?

A

AAA

80
Q

You should always trace out a draining sinus tract (DST) with what?

A

Gutta percha cone and radiograph

81
Q

What if the ostium of the DST doesn’t point to a PARL?

A

Always trace and radiograph

82
Q

Is it accurate and ethical to attempt to diagnose from radiographs alone?

A

No

83
Q

Treatment of condensing osteitis is based upon

A

Symptoms

84
Q

In asymptomatic and no apparent pathology, what should you do?

A

No tx

85
Q

the only way to determine a vertical root fracture is to

A

expose it surgically

86
Q

can you see horizontal fractures on a radiograph?

A

yes

87
Q

how can we see a VRF on a radiograph?

A

you cannot most of the time, but if we do. J-halo with a perio drop off

88
Q

are crazy lines a concern for endodontics?

A

No

89
Q

If a radiograph does not look correct, you should consider a

A

Different angulation

90
Q

What should the radiograph include?

A

All of tooth and 5 mm apical to the root tip

91
Q

All posterior teeth requires what x-rays?

A

2 PA, normal and shift shot

92
Q

What is the SLOB rule?

A

Same lingual opposite buccal

93
Q

Modern diagnostic radiographs are without risk when

A

Appropriate radiation hygiene techniques are taken

94
Q

Can you make a diagnosis from a radiograph alone?

A

No

95
Q

What are the 3 biggest risks in endo radiology?

A

Dx from radiograph alone
Seeing something that is not there
Not seeing something that is there

96
Q

These fractures are confined to the enamel

A

Crazy lines

97
Q

Are crazy lines important?

A

No

98
Q

This is an oblique shearing FX that involves undermined cusp

A

Fractured cusp

99
Q

This is an “incomplete greenstick Fx”, that involves 1 or both marginal ridges

A

Cracked tooth

100
Q

This crack involves crown, root, and pulp

A

Split tooth

101
Q

A vertical root fracture begins where?

A

Internally

102
Q

if you can point to the source of pain, then it is probably not

A

pulpal

103
Q

you see percussion in what?

A

peri-radicular

104
Q

do you get a thickened PDL in AAP?

A

yes

105
Q

what should you do if a patient presents with a AAA?

A

I&D

106
Q

do you have pain and extraoral swelling in a CAA?

A

no

107
Q

What is the most common site for cracked teeth?

A

Mandibular 2nd molars
Maxillary premolars

108
Q

What may tip off that a longitudinal crack may extend to the root?

A

Drop-off pocket

109
Q

What can you see with a VRF?

A

J-shaped halo

110
Q

Are VRFs easy to see on a radiograph?

A

No

111
Q

This is simply a drainage path of a CAA along the PDL

A

J-shaped halo

112
Q

The only way to be certain about a VRF is to

A

Expose it surgically

113
Q

what is the most important testing for pulpal? how about peri-radicular?

A

pulpal = thermal
peri-radicular = percussion

114
Q

If you get no response on MOST or ALL TEETH, you are probably dealing with a

A

Elderly individual → should do EPT

D2 Fall - Endodontics (7 decks)

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