Acute dental care Flashcards
If a patient had reversible pulpitis what symptoms would they complain of?
- Short, sharp pain triggered by cold, hot or sweet
- Often poorly localised
- No spontaneous pain
- No sleep disturbance
Clinically what would you see in a patient with reversible pulpitis?
- Caries
- Exposed dentine/cementum
- Large/deep restoration
- Crown
Special test results for reversible pulpitis?
- No TTP
- Gives a positive or exaggerated response to ethyl chloride and/or EPT
What are the treatment options for reversible pulpitis?
Caries removal and temporary restoration
Seal exposed dentine/cementum
What would a patient complain of with irreversible pulpitis?
- 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
Clinically what would you see in a patient with irreversible pulpitis?
Deep caries
Large restoration or crown
Special test results for irreversible pulpitis
May have an exaggerated response to EPT
May have no response to ethyl chloride
Usually not TTP
Radiograph result for irreversible pulpitis
Radiolucency extending close or into the pulp
Deep restoration or crown
Often no apparent apical changes
Treatment options for irreversible pulpitis
RCT - access and dress (ADC)
Extraction
What would a patient complain of with acute apical periodontitis?
Pain on biting
Symptoms similar to irreversible pulpitis but pain is well localised
Clinically what would you see with acute apical periodontitis?
Deep caries
Large restoration or crown
Special test results for acute apical periodontitis?
TTP
Radiograph results for acute apical periodontitis?
Radiolucency extending close or into the pulp (caries)
Deep restoration or crown
May show widening of the PDL space or show no apparent changes
Treatment options for acute apical periodontitis?
RCT - access and dress
Extraction
Symptoms for acute periapical abscess?
Often pain on biting
Swelling adjacent to the tooth
Spontaneous pain that is well localised
May have reduced mouth opening
Clinically what would you see with acute periapical abscess?
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
Special test results for acute periapical abscess
Often find TTP
Negative response to ethyl chloride and EPT
Radiographic findings of acute periapical abscess
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
Treatment options for acute periapical abscess
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
What symptoms may chronic periapical abscess present with?
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
Clinically what would you see with a chronic periapical abscess?
Deep caries
Large restoration or crown
Retained root
Sinus may be present
Special test results for chronic periapical abscess?
Could be TTP
Negative response to ethyl chloride and EPT
