Acute dental care

Question 1

If a patient had reversible pulpitis what symptoms would they complain of?

Answer 1

• Short, sharp pain triggered by cold, hot or sweet
• Often poorly localised
• No spontaneous pain
• No sleep disturbance

Question 2

Clinically what would you see in a patient with reversible pulpitis?

Answer 2

• Caries
• Exposed dentine/cementum
• Large/deep restoration
• Crown

Question 3

Special test results for reversible pulpitis?

Answer 3

• No TTP
• Gives a positive or exaggerated response to ethyl chloride and/or EPT

Question 4

What are the treatment options for reversible pulpitis?

Answer 4

Caries removal and temporary restoration
Seal exposed dentine/cementum

Question 5

What would a patient complain of with irreversible pulpitis?

Answer 5

• Pain may be spontaneous or provoked by stimulus (cold +/- heat) but sometimes alleviated by cold
• Pain lingers after removal or stimulus and may last several hours
• May be difficult to localise to a single tooth
• May be kept awake at night
• Analgesics do not relieve pain effectively

Question 6

Clinically what would you see in a patient with irreversible pulpitis?

Answer 6

Deep caries
Large restoration or crown

Question 7

Special test results for irreversible pulpitis

Answer 7

May have an exaggerated response to EPT
May have no response to ethyl chloride
Usually not TTP

Question 8

Radiograph result for irreversible pulpitis

Answer 8

Radiolucency extending close or into the pulp
Deep restoration or crown
Often no apparent apical changes

Question 9

Treatment options for irreversible pulpitis

Answer 9

RCT - access and dress (ADC)
Extraction

Question 10

What would a patient complain of with acute apical periodontitis?

Answer 10

Pain on biting
Symptoms similar to irreversible pulpitis but pain is well localised

Question 11

Clinically what would you see with acute apical periodontitis?

Answer 11

Deep caries
Large restoration or crown

Question 12

Special test results for acute apical periodontitis?

Answer 12

TTP

Question 13

Radiograph results for acute apical periodontitis?

Answer 13

Radiolucency extending close or into the pulp (caries)
Deep restoration or crown
May show widening of the PDL space or show no apparent changes

Question 14

Treatment options for acute apical periodontitis?

Answer 14

RCT - access and dress
Extraction

Question 15

Symptoms for acute periapical abscess?

Answer 15

Often pain on biting
Swelling adjacent to the tooth
Spontaneous pain that is well localised
May have reduced mouth opening

Question 16

Clinically what would you see with acute periapical abscess?

Answer 16

Deep caries
Large restoration or crown
Retained root
Associated swelling, diffuse or well-localised
Swelling may be visible extra-orally as well as intra
Possible lymphadenopathy

Question 17

Special test results for acute periapical abscess

Answer 17

Often find TTP
Negative response to ethyl chloride and EPT

Question 18

Radiographic findings of acute periapical abscess

Answer 18

Radiolucency extending close or into the pulp
Deep restoration or crown
May show widening of the PDL space or no apparent changes.
May have PA pathology if it is an acute exacerbation of chronic problem

Question 19

Treatment options for acute periapical abscess

Answer 19

RCT - access and dress
Extraction
Incision and drainage - if none of the above have achieved drainage of pus
Antibiotics may be indicated if there are signs of spreading systemic infection

Question 20

What symptoms may chronic periapical abscess present with?

Answer 20

Some pain on biting but could be symptom free
May complain of a swelling that appears on the gum
No worse with hot or cold

Question 21

Clinically what would you see with a chronic periapical abscess?

Answer 21

Deep caries
Large restoration or crown
Retained root
Sinus may be present

Question 22

Special test results for chronic periapical abscess?

Answer 22

Could be TTP
Negative response to ethyl chloride and EPT