Diagnosis Flashcards
What is pulpitis?
Inflammation of the pulp when exposed to an insult
Describe 4 common causes of pulpitis
Bacteria - Caries / Periodontal disease
Mechanical - Iatrogenic / Trauma / Orthodontic forces
Chemical - Restorative materials
Thermal
Describe the progressive continuum of pulpal disease
Normal Pulp
Reversible Pulpitis
Irreversible Pulpitis (symptomatic or asymptomatic)
Pulp Necrosis
Describe reversible pulpitis
- Short acting with stimulus (thermal / sweet stimuli)
- Pain does not linger when stimulus removed
- No spontaneous pain
- Not TTP
- No radiographic changes
Describe symptomatic irreversible pulpitis
- Pulp is so inflamed even on removal of stimulus no healing occurs
- Symptomatic usually acute
- Thermal (heat) or pressure stimuli cause heightened resposne
- Moderate to severe pain
- OTC analgesics ineffective
- Difficult to diagnose as no involvement of periapical tissue (NOT TTP)
Describe pulp necrosis
- No response to vitality tests
- May lead to periapical disease
- Radiograph may show evidence of PDL and PA pathology
Name 4 types of PA disease
- Symptomatic apical periodontitis
- Asymptomatic apical periodontitis
- Acute apical abscess
- Chronic apical abscess
Describe symptomatic apical periodontitis
- Inflammatory components present
- Pain on biting, palpation or TTP
- May see increase in PDL radiographically
- Periapical radiolucency
Describe asymptomatic apical periodontitis
- No pain on TTP
- Periapical radiolucency
Describe acute apical abscess
- Very painful with rapid onset
- TTP
- May see pus formation and swelling
- May be systemically unwell or suffer lymphadenopathy
- May or may not be radiographic changes
Describe chronic apical abscess
- Gradual onset
- Little to no discomfort
- Signs of destruction present
- Well defined periapical radiolucency
- Discharge of pus through sinus tract
Name 2 components of making an accurate diagnosis
- History
2. Clinical examination (including special investigations)
Describe why PMH is important to take during a history with regard to RCT
No medical condition contraindicated RCT but some may influence treatment decisions e.g cardiac or immunosuppression
Describe asymptomatic irreversible pulpitis
- Pulp is so inflamed even on removal of stimulus no healing occurs
- Asymptomatic usually chronic
- No clinical symptoms
- May be present for long time but eventually succumbs to necrosis
- Radiographic changes (hyperplastic pulpitis, resorption and calcification)
Describe dentine hypersensitivity
- Not an inflammatory process
- Hot, cold and sweet stimuli
- Normal pulp tests
- Not TTP
- Stimulate response on exposed dentine
Describe cracked tooth syndrome
- Crack in enamel extending to EDJ but may extend into dentine or pulp
- Allows flexing of tooth structure and so pain on biting
- Not TTP but lateral pressure may elicit response
- Occasional thermal response
- Usually associated with large restoration and removal reveals crack
- Difficult to diagnose (transillumination)
Describe cracked tooth syndrome
- Crack in enamel extending to EDJ but may extend into dentine or pulp
- Allows flexing of tooth structure and so pain on biting
- Not TTP but lateral pressure may elicit response
- Occasional thermal response
- Usually associated with large restoration and removal reveals crack
- Difficult to diagnose (transillumination)
Describe 5 components of extra-oral examination
- Swelling
- Symmetry
- Tender areas
- Lymphadenopathy
- Sinuses
Describe 6 components of an intra-oral examination
- Hard and soft tissues
- Caries and restorations
- Swelling
- Periodontal status and mobility
- Sinus tracts
- Oral hygeine
What is a general rule when using SIs?
At least 2 independent positive SIs (1 of which should be radiograph) indicating the need to RCT before commencing treatment
Name 6 types of SIs
- Palpation
- Percussion (TTP)
- Mobility
- Radiographs
- Pulp testing
- LA
Describe palpation as a SI
- Palpate soft tissues overlying suspected teeth to detect tender areas
- Size and site of swelling noted
- Examined for fluctuance and crepitus
Describe percussion as a SI
- Gently tap crown of tooth laterally and vertically
- Tapping with finger generally more accurate and less painful
- Detects inflammation of periodontal ligament
Describe mobility as a SI
- Finger placed on either side of crown
- Push with one finger and use to other to assess movement
- Can indicate periodontal disease, root fracture, occlusal problem, parafunction or inflammation of periodontium
Describe radiography as a SI
- Most reliable
- IOPA usually radiograph of choice
- No evidence of pulpal vitality
- GP in sinus tract will show up on radiograph to show tooth affected
Describe 6 things to note on radiographs during pulpal assessment
- Tooth restorability
- Extent of restorations or caries
- Amount of secondary dentine
- Size of pulp chamber
- Evidence of resorption / periapical radiolucencies
- Calcifications
Describe pulp testing as a SI
- Tests if intact nerve supply is present
- Electric (EPT) and thermal (E.C.) most common methods
Describe EPT as a vitality test
- Gradations of current applied to stimulate response
- Must have conducting medium
- Avoid with pacemaker
- Test contralateral tooth
- not accurate in multi-rooted tooth
Describe LA as a SI
- Used when pain is not localised
- Can localise pain to quadrants
- Use other SIs to find tooth
Name 2 common signs of pulp necrosis
- Colour (darker and more translucent)
2. Presence of sinus (discharge close to affected tooth)
