9/17: Pulpal and Apical Diagnosis Flashcards
1
Q
A pulpal diagnosis is UNLIKELY to often present as a
A
Purely pulpal
2
Q
What 2 diagnoses do each tooth need?
A
Pulpal
Peri-radicular
3
Q
What is the objective of clinical testing?
A
Find chief complaint
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
5
Q
What kind of testing is cold and heat?
A
Thermal (pulp vitality)
6
Q
This clinical test is only done when the pulpal status is in question
A
EPT
7
Q
Is an EPT routinely done?
A
No
8
Q
This clinical test is tapping with a mirror
A
Percussion
9
Q
Percussion shows what?
A
PDL sensitivity
10
Q
This is digital touching of gingival
A
Palpation
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
12
Q
Answering what question leads to an accurate diagnosis?
A
Why
13
Q
What 3 conditions does the Pulp exist in?
A
Normal
Inflamed
Infected
14
Q
This is when the pulp is healthy
A
Normal
15
Q
This is when the pulp could recover or deteriorate
A
Inflamed
16
Q
What kinds of inflammation are there?
A
Reversible
Irreversible (pain lingering and spontaneous)
17
Q
Is asymptomatic irreversibly common?
A
No it is rare
18
Q
This is when the infected pulp will proceed to necrosis
A
Infected
19
Q
What are the 5 pulpal diagnostic boxes?
A
Normal
Reversible pulpitis
Symptomatic irreversible
Asymptomatic irreversible
Necrosis
20
Q
If the pulp is WNL and their are minimal damage, and no axial cracks then you should
A
Leave tooth alone
21
Q
If a patient has non-ligering cold sensitivity, then it is
A
Reversible pulpitis
22
Q
If a patient has a lingering cold sensitivity, then it is
A
Irreversible pulpitis
23
Q
Are normal teeth sensitive to hot?
A
No
24
Q
Hot sensitivity usually indicates what?
A
Deteriorating pulp
25
Hot sensitivity is only normal on
Gums, on teeth = bad
26
Will deep caries produce any symptoms?
Yes, but rarely they do not
27
This is when the pulp is symptom free with normal response to pulp tests
WNL
28
This is inflammation of the pulp that will resolve itself and return to normal
Reversible pulpitis (RP)
29
This is vital inflamed pulp that is incapable of healing
Symptomatic irreversible pulpitis (SIP)
30
You have this when you got linger pain to cold, heat, and spontaneous pain
SIP
31
This is vital inflamed pulp incapable of healing with no clinical symptoms
Asymptomatic irreversible pulpitis (AAP)
32
Inflammation associated with AIP is often due to
Caries, caries excavation, trauma
33
This is the death of the dental pulp and you have no response to pulp tests
Pulpal necrosis (necrosis)
34
In pulpal necrosis, do you have responses to pulp tests?
No
35
How do you know the difference between necrotic or AIP?
You don’t until you open (AIP = blood, Necrosis = no blood)
36
This tooth has been previously treated endodontically with canal obturated with final root canal filling material other than medications
Previously treated (PT)
37
This is a tooth that has been previously treated by partial endodontic therapy. AKA RCT not complete
Previously initiated treatment (PIT)
38
What are examples of PIT?
Pulp cap
pulpotomy/pulpectomy
39
Is a diagnosis continually changing?
Yes
40
If you cannot arrive at a supportable diagnosis, you cannot
Do any treatment
41
In cases of pure pulpitis or even early necrotic pulp, we RARELY see
Apical radiographic changes
42
Do you have changes in the radiographs between each pulpal diagnosis
No
43
Is there a lot or little correlation between clinical symptoms and histopath reality?
Little correlation
44
A diagnosis must have 2 things for it to have tx planning?
Supported and documented
Clinically examined and testing
45
Following pulpal necrosis, the disease does what?
Extends periapically
46
Following pulpal necrosis, the tooth will often become what?
Percussion
47
Following pulpal necrosis, the tooth will often become percussion and or spontaneous pain may appear _____ radiographic evidence is clear
Before
48
Radiographic evidence will develop but it takes
Time
49
If 100% of the medullary bone is gone, you can still see no what?
PARL on radiograph
50
A visible PARL is only visible when how much of the cortical bone is destroyed?
40%
51
What is the progression of RC system infections?
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
What are the portals of exit?
Apical foramen
Lateral canals
53
All periradicular inflammation is sensitive to
Percussion
54
Purely pulpal pain is _________ to percussion
Not sensitive
55
If you can point to a specific tooth in pain, what specific structures allow this to happen?
PDL
56
Mechanoreceptors are present in what?
PDL
57
Mechanoreceptors are
Proprioceptors
58
What receptors does the pulp have?
Nociceptors
59
If a patient can point to the tooth in pain, it means that the inflammation/infection has
reached the apical tissues
60
What does WNL mean?
Within normal limits
61
What does SAP mean?
Symptomatic apical periodontitis
62
What does AAP mean?
Asymptomatic apical periodontitis
63
What does AAA mean?
Acute apical abscess
64
What occurs in a AAA?
Swelling + fever
65
What is the only diagnostic option if there is a DST present?
CAA
66
What is a CAA?
Chronic apical abscess
67
What is a DST?
Draining sinus tract
68
Condensing osteitis has what kind of appearance on x-ray?
Radiopaque
69
This is when teeth are NOT sensitive to percussion or palpation. Lamina dura is intact and PDL is uniform and unbroken
WNL
70
This is inflammation of the periodontium producing a painful response to biting/percussion/palpation
Symptomatic apical periodontitis
71
This is inflammation and destruction of the periodontium that is of pulpal origin appearing as a radiolucent area with no clinical symptoms
Asymptomatic apical periodontitis
72
Can you see AAP on a radiograph?
Yes
73
This is a inflammatory reaction to pulpal infection with rapid onset, spontaneous pain, tooth tender to pressure, pus formation and swelling and fever
AAA
74
This is a inflammatory reaction to pulpal infection with gradual onset, little or no discomfort and draining sinus tract
CAA
75
This is a diffuse radiopaque lesion representing a localized boney reaction to a low-grade inflammatory stimulus
Condensing osteitis
76
What other situations may result in SAP?
High restoration
Occlusal habits
Trauma
77
In AAA with severe cellulitis, you may need
Incision and drainage
78
Is CAA an emergency?
No
79
Do you get extra-oral swelling in AAA or CAA?
AAA
80
You should always trace out a draining sinus tract (DST) with what?
Gutta percha cone and radiograph
81
What if the ostium of the DST doesn’t point to a PARL?
Always trace and radiograph
82
Is it accurate and ethical to attempt to diagnose from radiographs alone?
No
83
Treatment of condensing osteitis is based upon
Symptoms
84
In asymptomatic and no apparent pathology, what should you do?
No tx
85
the only way to determine a vertical root fracture is to
expose it surgically
86
can you see horizontal fractures on a radiograph?
yes
87
how can we see a VRF on a radiograph?
you cannot most of the time, but if we do. J-halo with a perio drop off
88
are crazy lines a concern for endodontics?
No
89
If a radiograph does not look correct, you should consider a
Different angulation
90
What should the radiograph include?
All of tooth and 5 mm apical to the root tip
91
All posterior teeth requires what x-rays?
2 PA, normal and shift shot
92
What is the SLOB rule?
Same lingual opposite buccal
93
Modern diagnostic radiographs are without risk when
Appropriate radiation hygiene techniques are taken
94
Can you make a diagnosis from a radiograph alone?
No
95
What are the 3 biggest risks in endo radiology?
Dx from radiograph alone
Seeing something that is not there
Not seeing something that is there
96
These fractures are confined to the enamel
Crazy lines
97
Are crazy lines important?
No
98
This is an oblique shearing FX that involves undermined cusp
Fractured cusp
99
This is an “incomplete greenstick Fx”, that involves 1 or both marginal ridges
Cracked tooth
100
This crack involves crown, root, and pulp
Split tooth
101
A vertical root fracture begins where?
Internally
102
if you can point to the source of pain, then it is probably not
pulpal
103
you see percussion in what?
peri-radicular
104
do you get a thickened PDL in AAP?
yes
105
what should you do if a patient presents with a AAA?
I&D
106
do you have pain and extraoral swelling in a CAA?
no
107
What is the most common site for cracked teeth?
Mandibular 2nd molars
Maxillary premolars
108
What may tip off that a longitudinal crack may extend to the root?
Drop-off pocket
109
What can you see with a VRF?
J-shaped halo
110
Are VRFs easy to see on a radiograph?
No
111
This is simply a drainage path of a CAA along the PDL
J-shaped halo
112
The only way to be certain about a VRF is to
Expose it surgically
113
what is the most important testing for pulpal? how about peri-radicular?
pulpal = thermal
peri-radicular = percussion
114
If you get no response on MOST or ALL TEETH, you are probably dealing with a
Elderly individual → should do EPT
