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Conservation > Diagnosis > Flashcards

Diagnosis Flashcards

1
Q

What is pulpitis?

A

Inflammation of the pulp when exposed to an insult

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2
Q

Describe 4 common causes of pulpitis

A

Bacteria - Caries / Periodontal disease
Mechanical - Iatrogenic / Trauma / Orthodontic forces
Chemical - Restorative materials
Thermal

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3
Q

Describe the progressive continuum of pulpal disease

A

Normal Pulp
Reversible Pulpitis
Irreversible Pulpitis (symptomatic or asymptomatic)
Pulp Necrosis

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4
Q

Describe reversible pulpitis

A
  • Short acting with stimulus (thermal / sweet stimuli)
  • Pain does not linger when stimulus removed
  • No spontaneous pain
  • Not TTP
  • No radiographic changes
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5
Q

Describe symptomatic irreversible pulpitis

A
  • 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)
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6
Q

Describe pulp necrosis

A
  • No response to vitality tests
  • May lead to periapical disease
  • Radiograph may show evidence of PDL and PA pathology
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7
Q

Name 4 types of PA disease

A
  1. Symptomatic apical periodontitis
  2. Asymptomatic apical periodontitis
  3. Acute apical abscess
  4. Chronic apical abscess
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8
Q

Describe symptomatic apical periodontitis

A
  • Inflammatory components present
  • Pain on biting, palpation or TTP
  • May see increase in PDL radiographically
  • Periapical radiolucency
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9
Q

Describe asymptomatic apical periodontitis

A
  • No pain on TTP

- Periapical radiolucency

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10
Q

Describe acute apical abscess

A
  • 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
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11
Q

Describe chronic apical abscess

A
  • Gradual onset
  • Little to no discomfort
  • Signs of destruction present
  • Well defined periapical radiolucency
  • Discharge of pus through sinus tract
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12
Q

Name 2 components of making an accurate diagnosis

A
  1. History

2. Clinical examination (including special investigations)

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13
Q

Describe why PMH is important to take during a history with regard to RCT

A

No medical condition contraindicated RCT but some may influence treatment decisions e.g cardiac or immunosuppression

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14
Q

Describe asymptomatic irreversible pulpitis

A
  • 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)
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15
Q

Describe dentine hypersensitivity

A
  • Not an inflammatory process
  • Hot, cold and sweet stimuli
  • Normal pulp tests
  • Not TTP
  • Stimulate response on exposed dentine
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16
Q

Describe cracked tooth syndrome

A
  • 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)
16
Q

Describe cracked tooth syndrome

A
  • 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)
17
Q

Describe 5 components of extra-oral examination

A
  1. Swelling
  2. Symmetry
  3. Tender areas
  4. Lymphadenopathy
  5. Sinuses
18
Q

Describe 6 components of an intra-oral examination

A
  1. Hard and soft tissues
  2. Caries and restorations
  3. Swelling
  4. Periodontal status and mobility
  5. Sinus tracts
  6. Oral hygeine
19
Q

What is a general rule when using SIs?

A

At least 2 independent positive SIs (1 of which should be radiograph) indicating the need to RCT before commencing treatment

20
Q

Name 6 types of SIs

A
  1. Palpation
  2. Percussion (TTP)
  3. Mobility
  4. Radiographs
  5. Pulp testing
  6. LA
21
Q

Describe palpation as a SI

A
  • Palpate soft tissues overlying suspected teeth to detect tender areas
  • Size and site of swelling noted
  • Examined for fluctuance and crepitus
22
Q

Describe percussion as a SI

A
  • Gently tap crown of tooth laterally and vertically
  • Tapping with finger generally more accurate and less painful
  • Detects inflammation of periodontal ligament
23
Q

Describe mobility as a SI

A
  • 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
24
Q

Describe radiography as a SI

A
  • 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
25
Q

Describe 6 things to note on radiographs during pulpal assessment

A
  1. Tooth restorability
  2. Extent of restorations or caries
  3. Amount of secondary dentine
  4. Size of pulp chamber
  5. Evidence of resorption / periapical radiolucencies
  6. Calcifications
26
Q

Describe pulp testing as a SI

A
  • Tests if intact nerve supply is present

- Electric (EPT) and thermal (E.C.) most common methods

27
Q

Describe EPT as a vitality test

A
  • Gradations of current applied to stimulate response
  • Must have conducting medium
  • Avoid with pacemaker
  • Test contralateral tooth
  • not accurate in multi-rooted tooth
28
Q

Describe LA as a SI

A
  • Used when pain is not localised
  • Can localise pain to quadrants
  • Use other SIs to find tooth
29
Q

Name 2 common signs of pulp necrosis

A
  1. Colour (darker and more translucent)

2. Presence of sinus (discharge close to affected tooth)

Conservation (27 decks)

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