Diagnosing dental conditions Flashcards
What is the points in history for reversible pulpitis
- Short, sharp pain
- Poorly localised
- Mainly to cold stimuli, also sweet/heat
- Doesn’t linger
- Controlled with analgesics
What would you see clinically with reversible pulpitis
- Recent restoration or failing restoration
- Abrasion, erosion, attrition, recession, caries into dentine
- Not TTP
- Positive/hypersensitive for short duration to sensibility testing
What are the radiographic findings of reversible pulpitis
- Caries into dentine
- Lamina dura seen
- No periapical change
What is management of reversible pulpitis
- Removal of caries
- If pulp not exposed
- ZOE temporary dressing
What is the points in history for irreversible pulpitis
- Rapid onset or spontaneous pain
- Poorly localised pain
- Constant or lingering: dull/throbbing, sharp/stabbing
- Referred pain to opposite arch/ adjacent teeth
- Disturbed sleep
- Pain persists after stimulus removed
- Exacerbated by hot
- May be alleviated by cold
- Analgesics ineffective
What would you see clinically with irreversible pulpitis
- Extensive caries/ restoration into dentine or pulp
- Recent/failing restoration
- Not TTP
- Sensibility: negative or painful delayed
What are the radiographic findings of irreversible pulpitis
- Caries or large restoration near/into pulp
- Widening of periodontal ligament
- No periapical change
What is the points in history for acute apical periodontitis
- Spontaneous onset
- Constant/lingering pain especially on biting, tenderness, dull ache, throbbing
- Well localised pain
- Rarely sensitive to thermal change
- Analgesics ineffective
What would you see clinically with acute apical periodontitis
- Swelling palpable but localised to the tooth (TTPalp)
- Tooth may be carious, discoloured, extensive restoration
- May have had previous RCT
- Lymphadenopathy
- TTP
- Sensibility: negative
What are the radiographic findings of acute apical periodontitis
- Widening of PDL
- Apical lesion
What is the points in history for acute apical abscess
- Rapid onset of pain
- Varying intensity of throbbing pain
- Well localised
- Pain on biting
- Analgesic ineffective
- Disturbed sleep, restlessness
What would you see clinically with acute apical abscess
- Swelling palpable and fluctuant
- Raided sulcus region of suspect tooth, swelling (TTPalp)
- Tooth may be mobile
- Pyrexia, malaise
- Lymphadenopathy
- May be flushing of cheek
- TTP
- Sensibility: negative
What are the radiographic findings of acute apical abscess
- Widening of PDL
- Apical lesion
What is management of acute apical abscess
- Assess floor of mouth: if raised A&E
- Restorability: restorable then drain via extirpation
- Antibiotics is systemic
- Large fluctuant soft swelling, incise and drain
What is the history for chronic apical periodontitis
- Pain in the past but now no longer sensitive to hot or cold
What are the clinical findings of chronic apical periodontitis
- Caries or extensive restoration
- Not TTP, may be dull percussion sound
- Radiographically: periapical lesion
What is the management of chronic apical periodontitis
- Unrestorable extract
- Restorable: establish drainage of abscess
- Previously root treated then antibiotics may be indicated
What are the points in the history for a patient with pericoronitis
- Young people (18-25)
- Associated with eruption of lower wisdom tooth
- Pain is well localised
- May have a facial swelling
- Limited mouth opening
- Discomfort when swallowing
- Unpleasant taste or odour form mouth
- Fever, fatigue, nausea
What are the clinical findings of pericoronitis?
- Inflammation of operculum
- Pus and discharge from area
- Signs of trauma to operculum from opposing teeth
- Lymphadenopathy
What is the management of pericoronitis
- Assess floor of mouth: raised then A&E
- Irrigation with saline under the operculum
- OHI
- Antibiotics if systemic or immunocompromised
- Extraction if multiple occurrence (NICE)
What are the points in the history in TMJ and muscles of mastication pain
- Trismus
- Tenderness in region of TMJ on affected side
- tenderness of any of the muscles of mastication
- deviation of the mandible on opening
- clicking or crepitus from TMJ
- earache / tinnitus
- unable to move jaw or jaw locked in position (dislocation)
- upper wisdom tooth pain
what is the management of TMJ and muscles of mastication pain
- jaw dislocation refer to A&E
- advised optimal analgesics/ anti-inflammatory drugs
- advise local heat/ ice packs
- soft diet and avoid chewing gum
- referral for night guard
what are the points of history for acute maxillary sinusitis
- tooth ache from upper posterior teeth
- pain when bending down
- headache and facial pain
- fever, fatigue
- purulent discharge
- decreased sense of smell
- nasal congestion and obstruction
what are the clinical findings of acute maxillary sinusitis
- upper teeth TTP
- pain worsens when tilting head forward
- tenderness in the cheek area
what is the initial management of acute maxillary sinusitis
- exclude other dental causes
- self limiting after 2.5 weeks
- steam inhalation
- if signs of bacterial infection consider antibiotics
what are the points in history for alveolar osteitis
- pain 24-48 hours after extraction
- unpleasant odour/taste from affected area
- occasional swelling
- may be signs of infection, socket is empty
what are the pre-disposing factors of dry socket
- not following post-op
- smoking
- surgical trauma (20%)
- vasoconstrictor in LA
- oral contraceptives
- mandibular
- history of bisphosphonates or radiotherapy
what is the management of dry socket
- recommend optimal analgesia
- irrigate socket with saline and remove debris
- dress with alvogyl
- if signs of spreading/systemic infection then consider antibiotics
what is the points in history of post-extraction haemorrhage
- bleeding following extraction
- immediate: failure of initial haemostasis
- within few hours (reactionary)
- within week (indicative of possible infection)
what are the clinical signs of post extraction haemorrhage
- bleeding from extraction socket
- may be signs of infection: erythema, oedema, purulent exudate
what is the management of post extraction haemorrhage
- review medial history and any recent surgery
- assess patients general condition and measure pulse and blood pressure
- reassure patient and ask them to gently rinse mouth with warm water
- identify source of bleeding
- administer LA (ideally with adrenaline) and apply pressure to wound with gauze (20mins)
- if haemostasis isn’t achieve: oxidised cellulose (surgicell) and suture
- confirm haemostasis: still bleeding then max fax
what are the points in the history for acute periodontal/ lateral abscess
- localised swelling
- throbbing pain, dull ache and tenderness
- few days onset, may be recurrent
- pain when provoked
- worsened by biting and pressure
- well localised
what are the findings on clinical examination acute periodontal/ lateral abscess
- intra oral swelling at gingival margin
- increased mobility
- periodontal pocketing
- lymphadenopathy
- bleeding and pus released on probing of socket
- may be pyrexic
- slightly TTP but more in the lateral direction
- sensibility: positive or negative (perio endo lesion)
what is the management of acute periodontal/ lateral abscess
- assess floor of the mouth
- root surface debridement +/- LA with irrigation of the pocket
- extraction of the tooth (poor prognosis)
- Antibiotics if systemic symptoms or patient immunocompromised
What are the points in the history for necrotising ulcerative gingivitis
- Young adult
- Smoker
- Poor OHI
- Stressed
- Pain, bleeding, swelling from gingiva
- Halitosis
What are the clinical finding of necrotising ulcerative gingivitis
- necrosis and ulceration of gingival tissues with ‘punched
- out’ appearance of interdental papillae.
- loss of attachment
- oral hygiene poor
- increased bleeding on probing
- tender gingivae
- lymphadenopathy
what is the management of ANUG
- oral hygiene and smoking cessation
- scaling teeth +/- LA
- antibiotics
- prescription of hydrogen peroxide +/- 0.2% chlorhexidine mouthwash.
What is the points in history for dentine hypersensitivity
- pain with hot cold and sweet,
- short sharp pain,
- pain relieved by removal of stimulus
- may have had recent scaling/ tooth whitening
- ongoing periodontal treatment
what are the clinical findings for dentine hypersensitivity
- root surface exposure due to gingival recession and thin/eroded cementum
- failing restoration margins, exposed dentine
- may be caries
- sensitive to cold air stream (cover exposed roots of adjacent teeth with cotton wool)
what is management of dentine hypersensitivity
- advise to use desensitising toothpaste
- avoid extreme temperature & acidic food
- apply topical fluoride varnish, dentine bonding agents, or cover exposed dentine with suitable restorative material
what are the points in history for food packing
- pain after eating fibrous food
- recent large filling
what are the clinical findings for food packing
- Lost or broken contact point
- gingival inflammation
- overhang
- Food debris often caught in open contact point
- no resistance to floss passing through contact point
- may be tender to lateral percussion
what is the management of food packing
- scaling
- OHI with tepe
- Consider replacement of restoration to improve contact point
What are the points in the history for cracked tooth syndrome
- sound tooth gives sharp pain on biting and with hot and cold fluids
- pain on release of pressure
- Long history of symptoms
What are the clinical findings of cracked tooth syndrome
- crack or fracture line may be evident/stained enamel crack
- evidence of parafunction
- existing restoration often present
- pain on release of pressure as checked with tooth sleuth
- TTP sometimes
- Sensibility: positive with exaggerated response
What is the management for cracked tooth syndrome
- if symptoms of reversible pulpitis- cement orthodontic band to prevent cusps being wedged apart- tooth will then require cuspal coverage restoration
- if there are signs of irreversible pulpitis, prognosis uncertain- will need to extirpate tooth and assess extent of fracture- if vertical crack into root surface- likely to require extraction.
