AAE Diagnosis

Question 1

Pulpal Diagnosis

Answer 1

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

Question 2

Apical diagnosis

Answer 2

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

Question 3

Answer 3

• pulp necrosis
• symptomatic apical periodontitis with condensing osteitis

Question 4

Answer 4

• Symptomatic irreversible pulpitis, normal apical tissues

Question 5

Normal pulp

Answer 5

• symptom free
• responsive to pulp testing
• compare to adjacent/ contralateral teeth

Question 5

Reversible pulpitis

Answer 5

• inflammation should resolve and pulp return to normal
• sensitive to stimulus such as cold/ sweet
• sensation goes away within a couple of seconds following removal of stimulus
• return to normal status after management

Etiology
- exposed dentine
- caries
- deep restorations

Management
- caries removal
- covering exposed dentine

Question 6

Symptomatic irreversible pulpitis

Answer 6

• vital inflamed pulp incapable of healing
• need RCT
• sharp pain upon stimulus
• lingering pain (30s or longer) after stimulus is removed
• spontaneous and referred pain
• affected by postural changes, ie: lying down/ bending
• painkillers/ analgesics are not helpful
• no pain/ discomfort to TTP

Aetiology
- deep caries
- extensive restorations
- fracture exposing pulp

**difficult to diagnose as inflammation has not reached periapical tissues

Question 7

Asymptomatic Irreversible Pulpitis

Answer 7

• vital inflamed pulp incapable of healing
• RCT indicated
• no clinical symptoms
• respond normally to thermal testing
• may have trauma/ deep caries which would result in exposure following XLA

Question 8

Pulp necrosis

Answer 8

• death of dental pulp
• need RCT
• pulp is non- responsive to pulp testing
• asymptomatic
• does not cause apical periodontitis unless canal is infected
• may be non- responsive to pulp testing because of calcification/ trauma/ tooth just not responding

Question 9

Previously treated

Answer 9

• tooth has been endodontically treated
• canals are obturatedwith filling materaisl other than intracanal medicaments
• do not respond to thermal/ electric pulp test

Question 10

Previously initiated therapy

Answer 10

• tooth has been previously treated by pulpotomy/ pulpectomy
• may/may not respond to pulp testing

Question 11

Normal apical tissues

Answer 11

• not sensitive to percussion/ palpation testing
• lamina dura surrounding root is intact
• PDL space is uniform
• comparative testing, such as percussion and palpation should always begin with normal teeth as baseline for pt

Question 12

Symptomatic Apical Periodontitis

Answer 12

• inflammation of the apical periodontium
• painful response to biting/ percussion/ palpation

**severe pain to percussion/ palpation is highly indicative of degenerating pulp, RCT needed

Question 13

Asymptomatic Apical Periodontitis

Answer 13

• inflammation and destruction of apical periodontium
• apical radiolucency present
• no clinical symptoms

Question 14

Chronic apical abscess

Answer 14

• inflammatory reaction to pulpal infection and necrosis
• gradual onset
• little/ no discomfort
• Intermittent discharge of pus through associated sinus tract
• radiolucency radiographically
• Gutta percha can be placed through stoma/ opening until it stops and radiograph taken

Question 15

Acute Apical Abscess

Answer 15

• inflammatory reaction to pulpal infection and necrosis
• rapid onset
• spontaneous pain
• extreme tenderness of tooth to pressure
• pus formation
• swelling of associated tissues
• experience malaise, fever, lympadenopathy

Question 16

Condensing Osteitis

Answer 16

• diffuse radiopaque lesion
• localized bony reaction to low grade inflammatory stimulus seen at apex of tooth