Apical Diagnosis

Question 1

“There is very _____ correlation between clinical symptoms and histo/pathological reality”

Answer 1

Little

Question 2

Can apical periodontitis be diagnosed solely on a radiograph?

Answer 2

No

Question 3

What are the 5 elements of Clinical Examination and Testing?

Answer 3

1. Medical & Dental History
2. CC + Signs & Symptoms
3. Clinical examination
4. Clinical testing
5. Radiological indications

Question 4

______ which are generally of limited use in DX of purely pulpal disease may become of some value in Apical DX as you will see.

Answer 4

Radiographs

Question 5

T/F: Many unrelated non-odontogenic entities can mimic “Lesions of Endodontic Origin” (LEO)s radiographically but in fact be something entirely different*

Answer 5

True

Question 6

What tooth fractures the most in the mouth?

Answer 6

2nd mand molar

Question 7

Once pulp is necrotic, The disease process _____ extends peri-apically.

Answer 7

rapidly

Question 8

Once pulp is necrotic and the disease spreads periapically, how does it respond to percussion?

Answer 8

Percussion +

Question 9

Can periapical involvement occur without radiographic evidence?

Answer 9

Yes

Question 10

How much medullary bone can be destroyed without seeing a PARL?

Answer 10

100%

Question 11

How much of the cortical bone must be absent to see a PARL?

Answer 11

40%

Question 12

Are there mechanoreceptors in pulp or PDL?

Answer 12

PDL not pulp

Question 13

T/F: All peri-radicular inflammation is sensitive to percussion

Answer 13

True

Question 14

What percentage of patients with endo involved teeth can point to the exact tooth that is hurting?

Answer 14

37%

Question 15

– Teeth not sensitive to percussion or palpation. Lamina dura is intact and the PDL is uniform and unbroken.

Answer 15

WNL: (Normal)

Question 16

– Inflammation of the periodontium producing a painful response to biting/percussion/maybe palpation.

Answer 16

SAP: (Symptomatic Apical Periodontitis)

Question 17

– Inflammation and destruction of the periodontium that is of pulpal origin appearing as a radiolucent area with no clinical symptoms.

Answer 17

AAP (Asymptomatic Apical Periodontitis)

Question 18

– Inflammatory reaction to pulpal infection with rapid onset, spontaneous pain, tooth tender to pressure, pus formation and SWELLING & FEVER

Answer 18

AAA (Acute Apical Abscess)

Question 19

– Inflammatory reaction to pulpal infection with gradual onset, little or no discomfort and DRAINING SINUS TRACT.

Answer 19

CAA: (Chronic Apical Abscess)

Question 20

– Diffuse radiopaque lesion representing a localized boney reaction to a low-gradeinflammatory stimulus.

Answer 20

CO: (Condensing Osteitis)

Question 21

______ is pathognomonic for CAA

Answer 21

Draining sinus tract

Question 22

Always trace out a Draining Sinus Tract (DST) with _____ and ______

Answer 22

Gutta Percha cone & Radiograph

Question 23

This is our most valuable exam procedure in APICAL diagnosis.

Answer 23

Percussion:

Question 24

•Gently feel the tissues looking for tenderness, swelling, unusual texture, color or composition.

Answer 24

Palpation