clinical classification and presentation of pulp/periapical disease

Question 1

special investigations

Answer 1

pulp tests
periapical test
radiography test
photography 
impressions

Question 2

clinical classifications (causes) of pulpits

Answer 2

1) Caires
- primary and secondary caries
2) trauma
- eg fracture may expose tubules
3) tooth surface loss
4) restorative intervention
- restorations
- crowns ect
- involves removal of tooth tissue with high speed bur, will open up dentinal tubules which may irritate the pulp, may also get thermal damage

these will cause a transient pulpal inflammation, but without bacteria will not leda to pulp necrosis

Question 3

pulp diagnoses

Answer 3

normal
reversible pulpitis
symptomatic irreversible pulpitis
asymtompatic irreversible pulpits

Question 4

normal pulp

Answer 4

• symptom free

- normal response to pulp testing eg cold testing in mild or transient response of no more than 1-2 seconds

Question 5

reversible pulpitis

Answer 5

• reversibly inflamed pulp tissue
• if stimulus of inflammation removed should be reversible
• discomfort to stimuli such as cold or sweet lasting a few seconds after removal of stimulus

Question 6

symptomatic irreversible pulpits

Answer 6

• irreversibly inflamed pulp tissue with associated symptoms
• subjective diagnosis that the pulp is incapable of healing and endodontic treatment is required or extraction (subjective due to symptoms)
  Pain characteristics
• lingering pain after removal of stimulus
• spontaneous pain
• keeps patient awake at night
• pain may be referred
• pain may be difficult to localised as the inflammation has not reached the periapical tissues (Tend to go back to the same trunk)
• pain will generally never cross the midline

Question 7

asymptomatic irreversible pulpits

Answer 7

• irreversibly inflamed pulp tissue without associated symptoms
• subjective diagnosis that the pulp is incapable of healing and endodontic treatment is required

Question 8

pulp necrosis

Answer 8

dental pulp necrotic, endo needed
tooth non repsontive to pulp testing and is asymptomatic
necrosis itself does not cause periapicla periodontitis, bacteria is needed, pulp no longer able to defend itselfe

Question 9

events following pulp necrosis

Answer 9

Invasion of the pulp chamber space by microbes

• development of an ecosystem and formation of biofilm (ecosystem of bacteria) within the root canal system, coating the walls
• leads to infection
• as you get an increased infection of bacteria the toxins are going to lead through the apical foramen, can lead to periapical pathology
• the bacteria tend to stay in the compartment in the root canal, only the toxins are generally leaked through into the tissues
• this is because bacteria in the pulp chamber/canal have a food source and are also kept away from the hosts defence system
• can sometimes get bacteria progressing through the foramen in the apical tissue, extraarticular infection, but tends to be rare

Question 10

what is in response to toxins from bacteria in pulp necrosis

Answer 10

• tissue fluids
• inflammatory exudate
• immune cells
  consequences
• bony tissue around the apical area will become resorbed, can notice that on a radiograph

Question 11

what is apical periodontitis also known as

Answer 11

periodical periodontitis

periraicualr periodontitis

Question 12

periapicla diagnosis

Answer 12

normal apical tissues
symptomatic/acute periapical periodonttis
asymptomatic/chronic periodonttis
acute periapical abcess
chronic periodical abcess

Question 13

symptomatic/acute periodical periodontitis

Answer 13

• inflammation has spread to the periapical tissues resulting in tenderness to pressure
• patient is able to localise the source of pain to a specific tooth (due to the apical tissues having mechanoreceptors)
• radiograph changes may or may not be visible (may have had insufficient time for resorption of bone)

Question 14

asymptomatic/chronic periapical periodontitis

Answer 14

• inflammation has spread to the periapical tissues however the inflammation is low grade and presents no symptoms
• radiographic changes appear as periapical radiolucency
• tooth may not respond to sensibility tests

Question 15

acute periapical abscess

Answer 15

• inflammation of the periapical tissues with pus formation and swelling
• rapid onset, spontaneous pain with extreme tenderness of tooth to pressure
• patient may experience malaise, fever and lymphadenopathy
• radiograph changes may not be visible

Question 16

chronic periodical abscess

Answer 16

• inflammation of the periapical tissues with intermittent discharge of pus through an associated sinus tract looks like a little red lump, if pressed around would be able to see some discharge
• usually associated with little or no discomfort i.e. patient may or may not be aware
• radiographic changes usually appear as periapical radiolucency

Question 17

condensing osteitis

Answer 17

• diffuse radiopaque lesion representing a localised bony reaction to a low grade inflammatory stimulus usually seen at the apex of the tooth
• increased mineralisation around the apices of the teeth
• tooth may still be vital but chronically inflamed, may also be non vital and no respond to sensibility testing