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BDS5 > Diagnosing dental conditions > Flashcards

Diagnosing dental conditions Flashcards

1
Q

What is the points in history for reversible pulpitis

A
  • Short, sharp pain
  • Poorly localised
  • Mainly to cold stimuli, also sweet/heat
  • Doesn’t linger
  • Controlled with analgesics
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2
Q

What would you see clinically with reversible pulpitis

A
  • Recent restoration or failing restoration
  • Abrasion, erosion, attrition, recession, caries into dentine
  • Not TTP
  • Positive/hypersensitive for short duration to sensibility testing
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3
Q

What are the radiographic findings of reversible pulpitis

A
  • Caries into dentine
  • Lamina dura seen
  • No periapical change
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4
Q

What is management of reversible pulpitis

A
  • Removal of caries
  • If pulp not exposed
  • ZOE temporary dressing
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5
Q

What is the points in history for irreversible pulpitis

A
  • 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
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6
Q

What would you see clinically with irreversible pulpitis

A
  • Extensive caries/ restoration into dentine or pulp
  • Recent/failing restoration
  • Not TTP
  • Sensibility: negative or painful delayed
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7
Q

What are the radiographic findings of irreversible pulpitis

A
  • Caries or large restoration near/into pulp
  • Widening of periodontal ligament
  • No periapical change
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8
Q

What is the points in history for acute apical periodontitis

A
  • Spontaneous onset
  • Constant/lingering pain especially on biting, tenderness, dull ache, throbbing
  • Well localised pain
  • Rarely sensitive to thermal change
  • Analgesics ineffective
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9
Q

What would you see clinically with acute apical periodontitis

A
  • Swelling palpable but localised to the tooth (TTPalp)
  • Tooth may be carious, discoloured, extensive restoration
  • May have had previous RCT
  • Lymphadenopathy
  • TTP
  • Sensibility: negative
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10
Q

What are the radiographic findings of acute apical periodontitis

A
  • Widening of PDL
  • Apical lesion
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11
Q

What is the points in history for acute apical abscess

A
  • Rapid onset of pain
  • Varying intensity of throbbing pain
  • Well localised
  • Pain on biting
  • Analgesic ineffective
  • Disturbed sleep, restlessness
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12
Q

What would you see clinically with acute apical abscess

A
  • 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
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13
Q

What are the radiographic findings of acute apical abscess

A
  • Widening of PDL
  • Apical lesion
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14
Q

What is management of acute apical abscess

A
  • Assess floor of mouth: if raised A&E
  • Restorability: restorable then drain via extirpation
  • Antibiotics is systemic
  • Large fluctuant soft swelling, incise and drain
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15
Q

What is the history for chronic apical periodontitis

A
  • Pain in the past but now no longer sensitive to hot or cold
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16
Q

What are the clinical findings of chronic apical periodontitis

A
  • Caries or extensive restoration
  • Not TTP, may be dull percussion sound
  • Radiographically: periapical lesion
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17
Q

What is the management of chronic apical periodontitis

A
  • Unrestorable extract
  • Restorable: establish drainage of abscess
  • Previously root treated then antibiotics may be indicated
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18
Q

What are the points in the history for a patient with pericoronitis

A
  • 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
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19
Q

What are the clinical findings of pericoronitis?

A
  • Inflammation of operculum
  • Pus and discharge from area
  • Signs of trauma to operculum from opposing teeth
  • Lymphadenopathy
20
Q

What is the management of pericoronitis

A
  • 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)
21
Q

What are the points in the history in TMJ and muscles of mastication pain

A
  • 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
22
Q

what is the management of TMJ and muscles of mastication pain

A
  • 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
23
Q

what are the points of history for acute maxillary sinusitis

A
  • 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
24
Q

what are the clinical findings of acute maxillary sinusitis

A
  • upper teeth TTP
  • pain worsens when tilting head forward
  • tenderness in the cheek area
25
Q

what is the initial management of acute maxillary sinusitis

A
  • exclude other dental causes
  • self limiting after 2.5 weeks
  • steam inhalation
  • if signs of bacterial infection consider antibiotics
26
Q

what are the points in history for alveolar osteitis

A
  • pain 24-48 hours after extraction
  • unpleasant odour/taste from affected area
  • occasional swelling
  • may be signs of infection, socket is empty
27
Q

what are the pre-disposing factors of dry socket

A
  • not following post-op
  • smoking
  • surgical trauma (20%)
  • vasoconstrictor in LA
  • oral contraceptives
  • mandibular
  • history of bisphosphonates or radiotherapy
28
Q

what is the management of dry socket

A
  • recommend optimal analgesia
  • irrigate socket with saline and remove debris
  • dress with alvogyl
  • if signs of spreading/systemic infection then consider antibiotics
29
Q

what is the points in history of post-extraction haemorrhage

A
  • bleeding following extraction
  • immediate: failure of initial haemostasis
  • within few hours (reactionary)
  • within week (indicative of possible infection)
30
Q

what are the clinical signs of post extraction haemorrhage

A
  • bleeding from extraction socket
  • may be signs of infection: erythema, oedema, purulent exudate
31
Q

what is the management of post extraction haemorrhage

A
  • 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
32
Q

what are the points in the history for acute periodontal/ lateral abscess

A
  • localised swelling
  • throbbing pain, dull ache and tenderness
  • few days onset, may be recurrent
  • pain when provoked
  • worsened by biting and pressure
  • well localised
33
Q

what are the findings on clinical examination acute periodontal/ lateral abscess

A
  • 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)
34
Q

what is the management of acute periodontal/ lateral abscess

A
  • 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
35
Q

What are the points in the history for necrotising ulcerative gingivitis

A
  • Young adult
  • Smoker
  • Poor OHI
  • Stressed
  • Pain, bleeding, swelling from gingiva
  • Halitosis
36
Q

What are the clinical finding of necrotising ulcerative gingivitis

A
  • 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
37
Q

what is the management of ANUG

A
  • oral hygiene and smoking cessation
  • scaling teeth +/- LA
  • antibiotics
  • prescription of hydrogen peroxide +/- 0.2% chlorhexidine mouthwash.
38
Q

What is the points in history for dentine hypersensitivity

A
  • 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
39
Q

what are the clinical findings for dentine hypersensitivity

A
  • 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)
40
Q

what is management of dentine hypersensitivity

A
  • 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
41
Q

what are the points in history for food packing

A
  • pain after eating fibrous food
  • recent large filling
42
Q

what are the clinical findings for food packing

A
  • 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
43
Q

what is the management of food packing

A
  • scaling
  • OHI with tepe
  • Consider replacement of restoration to improve contact point
44
Q

What are the points in the history for cracked tooth syndrome

A
  • sound tooth gives sharp pain on biting and with hot and cold fluids
  • pain on release of pressure
  • Long history of symptoms
45
Q

What are the clinical findings of cracked tooth syndrome

A
  • 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
46
Q

What is the management for cracked tooth syndrome

A
  • 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.

BDS5 (10 decks)

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