After Midterm: Lec Diagnosis I Flashcards
1
Q
When to place crowns on necrotic teeth:
A
never
2
Q
Restorative tx is dependent on:
A
pulpal health
3
Q
Emergency tx is often related to:
A
endo tx
4
Q
TF? Pins to support a large resto will probably kill the pulp one day.
A
T
5
Q
TF? A pin must touch the pulp in order to kill it.
A
F
6
Q
TF? We must have caries in order for the pulp to become necrotic.
A
F
7
Q
Aspects of post-restorative evaluations:
A
pt discomfort or RG finding
8
Q
Key to effective tx:
A
accurate dx
9
Q
Steps in dx:
A
chief complaint, Medical and Dental hx, oral exam, pulp tests, rg interpretation, data alysis, differential dx
10
Q
When to look at rg to diagnose:
A
last
11
Q
How to chose testing method:
A
replicate the pts chief complaint
12
Q
Questions to ask person in pain:
A
type of pain (hot, cold, biting), triggers
13
Q
What to ask if the tooth causing pain has a resto:
A
when done, symptoms before resto, did dentist say it was deep or there was nerve exposure?
14
Q
What to look for extraorally if pt is in pain:
A
swelling
15
Q
What to look for intraorally if pt is in pain:
A
sinus tracts, cracks, probing depth
16
Q
TF? Sinus tract is the same as fistula.
A
F
17
Q
Cracks and sinus tracks can lead to:
A
necrosis
18
Q
Did he explain when to do each type of test based on pts description of the pain?
A
check
19
Q
Can a necrotic tooth have hot/cold pain?
A
no
20
Q
Can a tooth have a lesion if it a vital tooth
A
no
21
Q
% of time we should know issue via pulp testing:
A
99%
22
Q
Questions to ask during data analysis:
A
pulp test result coincide, match RG’s?
23
Q
RGL, but tooth is vital, issue or what to do next:
A
retest, maybe you did the test wrong
24
Q
5 endo tests:
A
EPT, cold, heat, percussion, palpation (of mucosa)
25
3 pulpal endo tests:
EPT, cold, heat
26
2 periradicular tests
percussion, pallpation
27
What do percussion and palpation test?
PDL
28
Steps of EPT:
isolate, dry, conductive medium w tip on mid-B, not resto or gingiva, pt touch handle
29
Why not to dry tooth with air syringe:
if they are having sensitivity they will jump
30
What would happen if you contact gingiva during EPT:
false positive
31
What is the conductive medium we use for EPT?
toothpaste
32
Where to place tip of EPT pulp tester:
MID-B
33
How is the circuit of the EPT test completed?
pt touches handle
34
EPT numbers go from:
0-80
35
80 on EPT indicated:
necrotic pulp
36
TF? 79 means the pulp is probably not necrotic.
F. probably necrotic
37
Anything over this value is considered a false positive:
70
38
What is the importance of the numbers on the EPT?
none
39
What is endo ice:
1, 1, 1,2-tetrafluoroethane
40
Temp of endo ice:
-26.2'C (-15.88F)
41
Why are cotton pellets better for pulp testing than Q-tip?
more sa for cotton pellet
42
Most important step to remember when doing EPT:
dry the tooth!!!!
43
Where to spray endo ice:
in sink, away from ppl
44
no response at mid-buccal + recession, what to do next?
Slide down to the CEJ, may hit gingiva for a sec
45
EPT, false positives:
EPT touching gingiva
46
TF? Endo ice touching gingiva can lead to false positive.
F
47
Prolonged exposure of gingiva to endo ice can lead to:
tissue damage
48
What to record after endo ice testing:
severity and duration of pain
49
Material for heat testing:
gutta-percha stopping (white gutta percha)
50
2 MOA's for heat testing:
movement of dentinal fluid, inc intrapulpal pressure
51
In which direction does dentinal fluid move with heat?
inward
52
How is the procedural set up for heat testing different for heat testing than EPT or cold?
vaseline on tooth
53
Fxn of vaseline on tooth:
to prevent GP from sticking
54
Instrument to wrap GP around:
Glick
55
What does the Glick look like?
plastic on one end, plugger on other
56
Is there a bunsen burner always available in oral surgery clinic or emergency clinic so we don't always have to run down to get our own?
check
57
When to heat Glick for heat testing:
before and after wrapping GP around it
58
What to record after heat testing:
severity and duration
59
How to position mirror handle when pulp testing:
along long axis of tooth
60
Palpate here to here:
healthy tooth to tooth in question
61
Finger to use for palpating
index
62
Gently roll finger along here for palpation:
vestibule
63
Check for this during palpation:
pt discomfort, swelling and/or break in cortical plate
64
Other endo tests:
Anesthetic, Cavity (next semester)
65
If pain during percussion but not pulp issue, what to suspect:
inflammation of PDL
66
inflammation of PDL can be due to:
high occlusion, trauma, torquing forces, clenching, bruxism, pdd
67
Torquing forces can be caused by:
ortho, RPD
68
How to tell if pain to percussion is due to pdd
hor and ver percussion have different responses
69
Is all percussion pain of endo origin?
no
70
What does percussion tell you about the pulp?
nothing
71
Pain during palpation may be due to:
inflammation of mucosa
72
What can lead to inflammation of mucosa:
extension of inflammation/infection through cortical plate
73
How does EPT test indicate vitality of a tooth, what fibers?
via neural response (A-fibers)
74
TF? EPT indicates health of pulp.
F. (just whether alive or dead, right? check)
75
How to activate C fibers with EPT:
leave the instrument on tooth longer
76
Population on which EPT testing will not work:
Adolescents, 5y after tooth eruption for the plexus of Rashkow
77
How many yrs after eruption will the plexus of Rashkow develop and EPT testing to work?
5y
78
TF? Necrotic, healthy, and vital are all dx:
F. vital is not, pulp could be dying and not dead
79
TF? Inflamed pulps are vital.
T, but not healthy
80
of test required to determine necrosis:
2
81
It may be difficult to determine if a tooth is necrotic if the tooth is:
crowned
82
Reasons for false positives for EPT:
poor isolation (#1), touching metal/ gingiva, pus in canal
83
Only true false positive that is not fault of dentist technique:
suppurative fluid in canal
84
Reasons for false negatives for EPT:
extreme calcification, poor contact/lack of contact medium, dead battery
85
Which can test further down, EPT or hot/cold testing?
EPT
86
Is EPT more likely to have false positive or negative?
positive
87
TF? Thermal test only determine whether or not the pulp is alive.
F. help to determine condition of pulp
88
Normal response to thermal testing:
pain
89
How to determine if there is an issue if the normal response to hot/cold testing is pain:
compare to healthy tooth
90
Thermal test response depends on:
dentinal fluid in tubules
91
Dentinal fluid comes from:
odontoblasts
92
Pulp dead, what else are dead?
odontoblasts, no pain, no fluid
93
Types of thermoreceptors the pulp has:
none
94
What can the pulp feel?
pain, not hot or cold
95
Jumpy patients most likely have:
inflamed PDL
96
Always do this if your first test is endo ice:
after pain is gone touch tooth with only a cotton pellet, might be the PDL
97
When might you get false positive w/ thermal tests:
pressure on tooth w inflamed PDL
98
When might you get false negative w/ thermal tests:
calcified pulp, not enough Endo ice, or heat GP enough, waiting too long before placing on tooth, testing multiple teeth wo respraying or reheating
99
More common w thermal testing, false neg or pos?
false neg
100
Review slide 58
ok
101
Can thermal can be done through crown?
yes, esp if metal
102
What to test if a pt is experiencing pain in a given quadrant:
the entire quadrant
103
When might the entire quadrant not respond to pain?
referred pain
104
TF? EPT number reflects whether the pain is lingering or not.
F
105
Lingering pain duration is usually in the:
minutes
