Clinical Classification and Presentation of pulp and periapical disease Flashcards
Cause of pulpitis
Trauma - tooth surface loss
Primary and secondary caries - inflammatory responses
Restorative - crowns and fillings
Reversible pulpitis
Discomfort to cold and sweet stimuli
Symptomatic irreversible pulpitis
Acute
Lingering pain which can’t be localised as it has not extended to the PA region yet
Pulp cannot heal - endodontic treatment required
Asymptomatic irreversible pulpitis
Chronic
No pain - requires pulp testing
Endodontic treatment required
Pulp necrosis
RCT indicated
No response to pulp testing
May also be due to calcification of tooth
Bacteria cause periapical periodontitis
Post-necrosis
Pulp chamber space invaded by bacteria and colonised
Infection spreads periapically and tissue fluid, inflammatory cells and inflammatory exudate are released
Progresses to periodontitis
Periapical diagnoses
normal, SPAPD, APAPD, APAA, CPAA
Normal diagnosis
Normal response and normal tissue
Spapd
Symptomatic periapical periodontitis
Infection has spread periapically
Pain can be localised
Minute radiographic changes
APAPD
Asymptomatic periapical periodontitis
Periapical radiolucency
APAA
Acute periapical abscess Pus and swelling in periapical region Rapid onset Malaise, fever and lymphadenopathy Requires endo/extraction
CPAA
Chronic periapical abscess
Pus is discharged therefore no build up of pressure
Condensing osteitis
Inflammation of bone leads to localised bony response
Diffused radiopacity at tooth apex
Diagnostic tools
Examination for redness/swelling Pulp testing Percussion Mobility - loss of pdl attachment/bony support Palpation Radiographs Operative
