Clinical History and Examination

Question 1

What does a severe response to percussion suggest?

Answer 1

periapical inflammation - SHARP pain, patient withdraws.

Question 2

What are some symptoms of paracetamol overdose? What systems may be affected? Where must the patient be referred?

Answer 2

• Abdominal pain, feel sick, vomit.
• Liver or kidney failure.
• Go to A and E

Question 3

When is the working diagnosis established? What does it include?

Answer 3

AFTER HISTORY TAKING, CLINICAL EXAMINATION, SPECIAL TESTS AND SPECIAL INVESTIGATIONS

WORKING DIAGNOSIS BASED ON THE PULPAL AND PERIAPICAL DIAGNOSIS.

Question 4

What are 4 prognostic factors for an RCT according to the european society of endodontology?

Answer 4

• Pre-operative absence of periapical radiolucency.
• Root canal filling with no voids.
• RCF extending within 2mm of radiographic apex.
• Satisfactory coronal seal.

Question 5

What does cone beam ct do?

Answer 5

• Produces 3D scans of the maxillofacial skeleton at a lower dose of radiation.
• Captures a CYLINDRICAL/ SPHERICAL volume of information known as the FIELD OF VIEW.

Question 6

What is direct dentine stimulation? When is it used?

Answer 6

Cutting a testing cavity.
1. explain procedure to patient.
2. perform without anesthesia.
if tooth is vital, patient will feel a sudden sharp pain when dentine is cut.

• useful for CROWNED TEETH.

Question 7

What can be used to locate the origin of a sinus?

Answer 7

• Use a DIAGNOSTIC GUTTA PERCHA and take a radiograph to show the origin of the infection.

Question 8

What is the most accurate indicator of pulp vitality?

Answer 8

VASCULAR SUPPLY and not innervation.

Question 9

3 limitations of radiographs for endodontic diagnosis?

Answer 9

• Pathological changes in the pulp not visible.
• Periapical pathology not visible in the early stages (inflammation must reach cortical plate to be visible).
• 2D image hence multiple views may be required.

Question 10

What is the bite test? What material can be used to perform it?

Answer 10

• Cracked tooth syndrome.
• Provides displacement of fragments and stretching od odontoblastic processes –> patient feels pain on RELEASE of pressure.
• can use a TOOTH SLOOTH.

Question 11

Who developed the WHO probe? What is its use?

Answer 11

• Developed by the British Society of Periodontology.
• It is a SCREENING tool for periodontal assessment - it does NOT provide a diagnosis but indicates what further assessment is required.

Question 12

what is the maximum paracetamol dose for a 70kg person? What can reduce this maximum dose?

Answer 12

4g (8*500mg tablets) in 24 hours for a 70kg person.

-less if alcohol, not eat or liver problems

Question 13

What type of CBCT is best indicated for endodontics? What is its exposure similar to?

Answer 13

Limited volume CBCT. Exposure similar to 2-3 periapicals.

Question 14

What does pulp sensitivity testing stimulate?

Answer 14

Stimulates sensory nerve fibres.

Question 15

What are 6 guidelines on the quality of an RCT according to the european society of endodontology?

Answer 15

1. Rubber dam isolation.
2. Proximity of the restoration to the apical constriction.
3. Sufficient taper of preparation.
4. Adequate irrigation and placement of an inter-appointment medicament.
5. Correct extension of the obturation without extrusion.
6. Adequate coronal seal to prevent reinfection.

Question 16

When should CBCT not be used in endodontics?

Answer 16

• Should NOT be used routinely for diagnosis or screening in the absence of symptoms.

Question 17

When is periapical inflammation visible on radiograph?

Answer 17

Once it has reached the cortical plate.

Question 18

How often should root canal treatment follow up be done according to the European Society of Endodontology’s Quality Guidelines?

Answer 18

• CLINICAL + RADIOGRAPHIC follow up at least 1 year after treatment.
• Further follow up for up to 4 years if healing on a radiographic assessment are slow and the periapical radiolucency is the same size or slowly decreasing

Question 19

What will happen to a sinus following RCT of the offending tooth?

Answer 19

May epithelialise but will still heal following RCT.

Question 20

When is CBCT indicated/ justified in endodontics?

Answer 20

Assessment and treatment of complex cases - perforations, root resorptions, complex anatomy.

Question 21

What classification for mobility is used? What are the values?

Answer 21

Hibberd 1981.
- Class 0: physiological mobility
- Class 1: perceptible mobility - Less than 1mm mobility bucco-lingually.
- Class 2: definite mobility - 1-2mm bucco-lingually.
- Class 3: gross mobility - more than 2mm bucco-lingually and/or vertical mobility.

Question 22

What does percussion determine?

Answer 22

The presence of periapical inflammation.

Question 23

What does palpation determine?

Answer 23

If there is periapical inflammation.

Question 24

What is a tentative diagnosis?

Answer 24

A PRECONCEIVED IDEA OF WHAT THE CONDITION THE PATIENT IS SUFFERING WITH MIGHT BE.
- After taking medical and dental histories and identifying signs and symptoms.

Question 25

What does a mild- moderate response to percussion suggest?

Answer 25

Periodontal inflammation - periodontal disease.

Question 26

Are radiographs required for diagnosis of periapical disease?

Answer 26

yes