Diagnosing Pulp and Periapical Disease Flashcards
How can acute or chronic pulpitis be distinguished?
More severe pain over a short time is acute
Mild pain that is present over a long time is chronic
How can apical periodontitis be detected?
Results from pain to biting and or chewing, tenderness to percussion, or radiographic changes.
What are the indications of a periapical conditions?
Pain to bite indicates apical periodontitis
Apical abscesses can be detected by localised collection of pus, swelling, and fever
Facial cellulitis can be detected by spreading infection through the face, pus, swelling, and fever
Why is it difficult to compare studies on pulp tests?
Difficult to compare studies on pulp tests due to differing study designs and sample teeth variety..
Most have not tested teeth with pulp disease to compare with healthy teeth.
Not all studies assess the same things.
What kind of studies are best?
Using 2 or 3 tests is better than just 1
Thermal pulp tests can be done on teeth with crowns (do it where crown is narrow)
CO2 is better than Electronic Pulp Testing.
CO2 is similar to cold sprays and cheaper. (cold sprays may give false positive results as it can be felt by the gingiva)
Laser dopplerflow meter is a pulp vitality test
Which tests cannot be done on teeth with crowns?
Electrical tests cannot be done on teeth with crowns
Which pulp tests had the best accuracy of all tests?
EPT
CO2
LDF
What is sensitivity?
Ability to identify a tooth with no pulp or disesaed pulp
What is specificity?
Ability of a test to identify a tooth that has a pulp without disease
Which pulp test has the best sensitivity and specificity?
CO2 is best in both sensitivity and specificity
What is NPV?
Test result indicates disease is not present
Which pulp tests are best for teeth with metalic restorations?
CO2 and Endofrost (Cold spray)
Conclusions
Pulp testing with healthy pulps can be reliable performed with CO2, Electric, Endofrost, and LDF tests
CO2 was the most likely test to identify pulp disease
Teeth with non-metalic restorations were difficult to pulp test accurately
Electric pulp test is accurate when no disease is present.
Ice was a waste of time
COld sprays were less reliable and accurate than CO2 and electric pulp tests
LDF was suitable for unrestored teeth but less reliable, difficult to use in restored teeth, expensive and time wasting.
Conclusions
Pulp testing with healthy pulps can be reliable performed with CO2, Electric, Endofrost, and LDF tests
CO2 was the most likely test to identify pulp disease
Teeth with non-metalic restorations were difficult to pulp test accurately
Electric pulp test is accurate when no disease is present.
Ice was a waste of time
Cold sprays were less reliable and accurate than CO2 and electric pulp tests
LDF was suitable for unrestored teeth but less reliable, difficult to use in restored teeth, expensive and time wasting.
What are recommendations for dental practitioners to use in endo?
Practitioners should have both a CO2 pulp test system and an electric pulp tester.
In order to be able to test teeth in varying situations such as when pulp/canal have disease present, during pulp canal calcification, pre-restoration assessment, and follow-up assessment after trauma.
