Diagnosis Flashcards
Jones
Most effective cold test?
2 cotton pellet results in a significantly lower intrapulpal temperature compared to #4 or cotton tip applicator
Spilka 1996
Canine space infection?
Loss of definition of the nasolabial fold on one side of the nose may be the earliest sign of a canine space infection
Spilka 1996
Buccal space infection?
For mandib 2nd and 3rd molars to cause buccal space infection, max root apices must lie superior to attachment of buccinator to maxilla, and mand root apices must be inferior to buccinator muscle attachment to mandible.
Laskin 1964
Swelling?
Swellings of non-odontogenic origin must always be considered in the differential dx, especially if an obvious dental etiology is not found.
Remeikis 1999
Sinus tract?
Many patients with extraoral sinus tracts are treated by a dermatologist with systemic/topical antibiotics prior to seeing a dentist.
Difference between sublingual swelling and submandibular swelling?
Sublingual if infection exits superior to mylohyoid attachment (elevated tongue, bilateral). Submandibular if infection exits inferior to attachment.
Harrison and Larson 1976
sinus tracts?
Only one in ten sinus tracts are lined with epithelium. (The rest-granulation tissue).
Baumgartner 1984
sinus tracts?
2/3 of sinus tracts do not have epithelium that extends beyond the surface mucosa rete ridges.
Seltzer and Bender 1963
significance of clinical signs and symptoms?
Not a good correlation between the objective clinical signs and symptoms and the pulp histology.
Peters, Baumgartner, Lorton 1994
EPT and cold testing?
If a mature, untraumatized tooth does not respond to both electric pulp test and cold test, then the pulp should be considered necrotic.
Jones, Rivera, Walton 2002
CO2 v. refrigerant
Refrigerant spray and CO2 are equivalentn in determining pulpal responsiveness, but refrigerant spray elicited a faster response.
who said Loss of definition of the nasolabial fold on one side of the nose may be the earliest sign of a canine space infection
Spilka 1996
Canine space infection?
who said For mandib 2nd and 3rd molars to cause buccal space infection, max root apices must lie superior to attachment of buccinator to maxilla, and mand root apices must be inferior to buccinator muscle attachment to mandible.
Spilka 1996
Buccal space infection?
who said Swellings of non-odontogenic origin must always be considered in the differential dx, especially if an obvious dental etiology is not found.
Laskin 1964
Swelling?
who said Many patients with extraoral sinus tracts are treated by a dermatologist with systemic/topical antibiotics prior to seeing a dentist.
Remeikis 1999
Sinus tract?
who said Only one in ten sinus tracts are lined with epithelium. (The rest-granulation tissue).
Harrison and Larson 1976
sinus tracts?
who said 2/3 of sinus tracts do not have epithelium that extends beyond the surface mucosa rete ridges.
Baumgartner 1984
sinus tracts?
who said If a mature, untraumatized tooth does not respond to both electric pulp test and cold test, then the pulp should be considered necrotic.
Peters, Baumgartner, Lorton 1994
EPT and cold testing?
who said Not a good correlation between the objective clinical signs and symptoms and the pulp histology.
Seltzer and Bender 1963
significance of clinical signs and symptoms?
who said: Refrigerant spray produces pulp testing results that are reproducible, reliable, and equivalent to CO2 (and also slightly faster)?
Jones, Rivera, Walton 2002
CO2 v. refrigerant
What is Endo Ice made of and what is its temperature? According to whom?
Tetrafluoroethane. -26.2 degrees Celcius
Jones Rivera Walton 2002
who said: A significantly lower intrapulpal temperature is acheived with a #2 cottone pellet?
Jones 1999
who said (2): CO2 and refrigerant spray are superior to other cold testing methods and equivalent or superior to the electric pulp tester for assessing pulp vitality?
Fuss 1986 and Ausburger 1981
Fuss 1986, Ausburger 1981
Cold?
CO2 and refrigerant spray are superior to other cold testing methods and equivalent or superior to the electric pulp tester for assessing pulp vitality
In Petersson’s study: What was the sensitivity of the three tests?
Cold: 83% Heat: 86% EPT: 72%
Definition of a test’s sensitivity
The ability of a test identify teeth that are diseased
Definition of a test’s specificity
The ability of a test to identify teeth that are no diseased
In Petersson’s study: What was the specificity of the three tests?
Cold: 93% EPT: 93% Heat: 41%
who said: The response of the pulp to EPT does not reflect the histologic health or disease status of the pulp
Seltzer, Bender, Ziontz 1963
Seltzer, Bender, Ziontz 1963
EPT
The response of the pulp to EPT does not reflect the histologic health or disease status of the pulp
In Petersson’s study: What was the accuracy of the three tests?
Cold: 86%, EPT: 81%, Heat: 71%
who said: The EPT can be bridged to natural tooth structure?
Pantera, Anderson, Pantera 1992
Pantera, Anderson, Pantera 1992
EPT
The EPT can be bridged to natural tooth structure.
who said: The tip of the EPT probe that will be placed in contact with the tooth must be coated with a water or petroleum based medium
Michaelson, Seidberg, Guttuso 1975
Michaelson, Seidberg, Guttuso 1975
EPT
The tip of the EPT probe that will be placed in contact with the tooth must be coated with a water or petroleum based medium
Who said: The EPT probe should be placed in the incisal third of the facial or buccal area of the tooth to be tested?
Bender, Landau, Fonsecca, Trowbridge 1989
Bender, Landau, Fonsecca, Trowbridge 1989
EPT
The EPT probe should be placed in the incisal third of the facial or buccal area of the tooth to be tested?
Peters, Baumgartner, Lorton 1994
cold is more reliable for who?
Cold tests are more reliable than ept in younger patients with less developed apices
Who said: Cold tests are more reliable than ept in younger patients with less developed apices
Peters, Baumgartner, Lorton 1994
Gopikrishna 2007-developed what?
A pulse ox sensor that can be directly applied to a tooth, and is more accurate in assessing vitality then electric and thermal.
Who developed a pulse ox sensor, showed it was very accurate, and also that it is great for evaluating teeth subjected to trauma?
Gopikrishna 2007
Goldman et al. 1974
diagnosis
There was agreement for the presence of pathosis only 50% of time among two endodontists, three residents, and a radiology professor. Seven mos. later, the evaluators agreed with themselves 75-83% of the time.
Who said: There was agreement for the presence of pathosis only 50% of time among two endodontists, three residents, and a radiology professor. Seven mos. later, the evaluators agreed with themselves 75-83% of the time.
Goldman et al. 1974
Kaffe 1988
diagnosis
The most consistent radiographic finding when a tooth is non-vital is a break in the lamina dura
Who said: The most consistent radiographic finding when a tooth is non-vital is a break in the lamina dura
Kaffe 1988
Seltzer and Bender 1961
radiographic diagnosis
The radiographic evidence of pathosis will only be observed once bone loss extends to junction of cortical and cancellous bone
who said: The radiographic evidence of pathosis will only be observed once bone loss extends to junction of cortical and cancellous bone
Seltzer and Bender 1961
which teeth did Seltzer and Bender 1961 say are most likely to exhibit pathosis sooner, and why?
Anterior/premolars, because they are located close to the cortical/cancellous bone junction.
who said: Anterior/premolars are more likely to exhibit pathosis sooner on xrays because they are located close to the cortical/cancellous bone junction.
Seltzer and Bender 1961
Miles 1993
Resolution of conventional xray film?
16 line pairs per millimeter
Resolution that human eye can see
10 line pairs per millimeter
who said In file length determination, digital is better than conventional, though it may not be clinically significant
Eikenerg and Vandre 2000
Eikenerg and Vandre 2000
digital v conventional radiography
File length determination is more accurate using digital versus conventional radiography, though it may not be clinically significant
who said: Digital imaging required 50% less radiation than film to obtain the same diagnostic information (amount of alveolar bone loss)
Paurazas, Geist 2000
Paurazas, Geist 2000
digital v. conventional radiography
Digital radiography requires 50% less radiation than film to obtain the same diagnostic information (amount of alveolar bone loss)
Khocht and Chang 2003
digital v. conventional radiography
Digital radiographs showed a higher number of sites with alveolar bone loss than conventional film.
Who said Digital radiographs showed a higher number of sites with alveolar bone loss than conventional film?
Khocht and Chang 2003
Who first reported on the use of CBCT in dentistry? What year?
Mozzo, Proccacci 1998
who found a 100% accuracy with CBCT scans predicting 78 periapical lesions (confirmed with biopsy), but only a 78% accuracy when using conventional radiographic imaging?
Velvart et al. 2001
Velvart et al. 2001
periapical lesions
CBCT scans had a 100% accuracy of predicting 78 periapical lesions (confirmed with biopsy). Conventional radiographic imaging had only 78% accuracy.
Nakata et al. 2007
peripaical lesions
periapical bone loss associated with a palatal root was detected by CBCT when it was not visible in conventional periapical radiographs
who found: periapical bone loss associated with a palatal root was detected by CBCT when it was not visible in conventional periapical radiographs
Nakata et al. 2007
who said: the most common cause of vertical root fractures may be iatrogenic dental treatment (excessive force during lateral condensation, or forcing/tapping of dowels into place.)
Gerstein 1980
Gerstein 1980
VRF
The most common cause of vertical root fractures may be iatrogenic dental tx (excessive force during lateral condensation or forcing/tapping of dowels into place)
who said: the most common dental procedure contributing to vertical root fractures is endodontic tx?
Bender 1983
Bender 1983
VRF
The most common dental procedure contributing to vertical root fractures is endodontic tx.
who found there is no difference in dentin properties after endodontic tx (teeth are not more susceptible to fracture?)
Huang, Schilder, Nathanson 1991
Huang, Schilder, Nathanson 1991
after endo tx
After endo treatment, there is no difference in dentin properties (teeth are not more susceptible to fracture).
who found Mandibular second molars have a higher incidence of vertical root fractures, followed by maxillary first molars and maxillary premolars
Cameron 1964
Cameron 1964
VRF
Mandibular second molars have a higher incidence of vertical root fractures, followed by maxillary first molars and maxillary premolars
who said the presence of multiple sinus tracts adjacent to a tooth is indicative of vertical root fracture?
Farber and Green 1973
Farber and Green 1973
VRF
he presence of multiple sinus tracts adjacent to a tooth is indicative of vertical root fracture
who showed that when a tooth is transilluminated, the area beyond the fracture will not have light transmitted to it, and will be gray in comparison?
Pitts and Natkin 1983
Pitts and Natkin 1983
diagnostic test?
showed that when a tooth is transilluminated, the area beyond the fracture will not have light transmitted to it, and will be gray in comparison (if a crack is transilluminated, light will not pass through it).
who said A fracture becomes visible only when the x-ray beam is directed within 4 degrees of the fracture plane
Rud and Omnell 1970
Rud and Omnell 1970
diagnosing cracks
A fracture becomes visible only when the x-ray beam is directed within 4 degrees of the fracture plane
who said: CBCT is superior to dental radiography in the detection of vertical root fractures
Youssefzadeh 1999
Youssefzadeh 1999
VRF
CBCT is superior to dental radiography in the detection of vertical root fractures
Who described the J-shaped lesion often associated with vrf?
Tamse 1999
Tamse 1999
VRF
Described the J-shaped lesion often associated with vertical root fractures
who said for a tooth with a fracture, a full-coverage restoration with cuspal reinforcement should be placed?
Schwartz 1992
Schwartz 1992
restorations
for a tooth with a fracture, a full-coverage restoration with cuspal reinforcement should be placed
who found that using EPTs, patients could localize which tooth was being stimulated only 37.2% of the time, and could narrow the location to three teeth only 79.3% of the time?
Friend and Glenwright 1968
Friend and Glenwright 1968
referred pain
found that using EPTs, patients could localize which tooth was being stimulated only 37% of the time, and could narrow the location to three teeth only 79% of the time
who said anterior teeth seldom refer pain to other teeth, whereas posterior teeth may refer pain to the opposite arch or periauricular area, but rarely the anterior teeth.
Seltzer 1978
Seltzer 1978
referred pain
anterior teeth seldom refer pain to other teeth, whereas posterior teeth may refer pain to the opposite arch or periauricular area, but rarely the anterior teeth.
who said When second molars were stimulated with an ept, patients could discriminate accurately which arch the sensation was coming from only 85% of the time. First molars: 95% Anterior teeth: 100%
VanHassel and Harrington 1969
VanHassel and Harrington 1969
referred pain
When second molars were stimulated with an ept, patients could discriminate accurately which arch the sensation was coming from only 85% of the time. First molars: 95% Anterior teeth: 100%
who said Exposed dentin in the cervical area accounts for most cases of reversible pulpitis diagnosed as dentin sensitivity?
Rees and Addy 2002
Rees and Addy 2002
diagnosis
Exposed dentin in the cervical area accounts for most cases of reversible pulpitis diagnosed as dentin sensitivity?
Jones, Rivera, Walton 2002
diagnosis
Refrigerant spray produces pulp testing results that are reproducible, reliable, and equivalent to CO2 (also slightly faster)
Max blood pressure allowed at VCU
180/110
Hadley 2008
digital sensors are significantly better than d speed film at detection of lesions in bone
Who said digital sensors are significantly better than d speed film at detection of lesions in bone
Hadley 2008
Who said diagnostic accuracy increases with multiple radiographs (3)?
Brynolf 1970
Who said there is not enough lit comparing NSRCT and implant placement, but a systemic review indicates that the decision to
treat a tooth endodontically or replace it with an implant must be based on factors other than the
treatment outcomes of the procedures themselves. NSD in survival between restored NSRCT teeth and single tooth implants
Iqbal/Kim 2007
Iqbal/Kim 2007
Implant v. NSRCT
Who said there is not enough lit comparing NSRCT and implant placement, but a systemic review indicates that the decision to
treat a tooth endodontically or replace it with an implant must be based on factors other than the
treatment outcomes of the procedures themselves. NSD in survival between restored NSRCT teeth and single tooth implants
Who came up with a CBCTPAI to identify apical periodontitis using a cone beam?
Estrela 2008
Estrela 2008
what did he come up with?
Came up with a CBCTPAI to identify apical periodontitis using a cone beam
Who found that apical Periodontitis was identified in 39.5% and 60.9% of cases by radiography and CBCT, respectively
Estrela 2008
Estrela 2008
CBCT v. radiography
found that apical Periodontitis was identified in 39.5% and 60.9% of cases by radiography and CBCT, respectively
To get best radiographs, how to do shift shot?
Maxillary- mesial
Mandibular-distal
who said it’s best to manage cases of calcific metamorphosis through observation and periodic examination?
gutmann 2001
who said: 3.8% to 24% of traumatized teeth develop varying degrees of calcific metamorphosis. Studies indicate that of these, approximately 1% to 16% will develop pulpal necrosis
gutmann 2001
gutmann 2001
traumatized teeth to calcific metamophosis?
3.8% to 24% of traumatized teeth develop varying degrees of CM. Studies indicate that of these, approximately 1% to 16% will develop pulpal necrosis
Miller 2004
cold testing
Intact teeth and those restored with full coverage restorations respond similarly during thermal testing.
(R.S. is able to produce the same temp reduction for PFM/all ceramic as non-restored teeth).
who said: Intact teeth and those restored with full coverage restorations respond similarly during thermal testing.
Miller 2004
What does ALARA stand for?
As low as reasonably achievable
Who do we quote for approximate ionizing radiation dosages for CBCT?
Ludlow 2006
Microsieverts received in one day of background radiation?
7-8
Microsieverts received from one digital PA?
6
Microsieverts for a CBCT anterior focused field?
4.7 (less than one PA)
Microsieverts for a CBCT maxillary posterior focused field?
9.8 (less than two PAs)
Microsieverts for a CBCT mandibular posterior focused field?
38.3 (less than seven PA’s)
Who showed that 34% of radiolucencies detected with CBCT were missed with periodical radiography in maxillary premolars and molars
Low 2008
Who said: CBCT may provide a more accurate diagnosis than biopsy and histology for periapical lesions
Simon 2006
What is streaking on a CBCT?
An artifact caused by radiopaque materials such as bone and metal (and gutta percha!)
Simon 2006
cbct
CBCT may provide a more accurate diagnosis than biopsy and histology for periapical lesions
Blattner 2010
CBCT
The CBCT accurately identified the presence or absence of the MB2 canal in 78.95% of samples. Statistical analysis showed that there was no significant difference in the ability of CBCT scanning to detect the MB2 canal when compared with the gold standard of clinical sectioning.
Who said: The CBCT accurately identified the presence or absence of the MB2 canal in 78.95% of samples. Statistical analysis showed that there was no significant difference in the ability of CBCT scanning to detect the MB2 canal when compared with the gold standard of clinical sectioning.
Blattner 2010
Who described the stressed pulp syndrome?
Abou-Rass 1982
Abou-Rass 1982 Came up with what?
The stressed pulp syndrome–describes pulps that have received repeated previous injury and survived with diminished responses and lessened repair potentials
Who showed that laser doppler flowmetry correctly identified necrotic teeth compared to contralateral vital teeth (necrotic teeth had a lower output)
Tronstad 1994
Who showed that the laser doppler flowmetry probe with the smallest separation of fibers was the most sensitive in distinguishing necrotic pulps from vital ones
Tronstad 1994
Tronstad 1994
what diagnostic test did show worked?
Laser doppler flowmetry
Who showed that patients with odontogenic pain can identify the tooth 73% of the time. Those with periradicular pain can identify the tooth 89% of the time?
McCarthy and McClanahan 2010
What did McCarthy and McClanahan show about patient’s ability to correctly identify the tooth that was hurting?
They could do it 73% of the time in patients with odontogenic pain, and 89% of the time in patients with periradicular pain.
Who disproved the pulp strangulation theory?
Van Hassel
Who looked through clinical records and found that 40% of non vital teeth had experienced a silent pulpitis (no hx of spontaneous pain or prolonged pain to thermal stimulus)?
Michaelson & Holland 2002
Michaelson and Holland
silent pulpitis
40% of patients experience silent (painless) pulpitis
Who said that reversible pulpitis is then most difficult diagnosis to make?
Louis Berman 1984
Wahab 1987
pulp testing
Slowly increasing EPT current gave more accurate and reproducible results than did rapidly increasing current, and a rate of 2 mu a/sec was found to be appropriate for clinical pulp-testing
Who showed that increasing EPT current slowly gives more accurate results (2 is best)
Wahab 1987
What is the focal infection theory? Who came up with it and when?
1920s, Dr. Weston A. Price. Bacteria trapped in dentinal tubules during root canal treatment could “leak” and cause almost any type of generative systemic disease
What did Dr. Weston Price come up with in the 1920’s?
The focal infection theory (disproved later).
Who came up with the erroneous hollow tube theory? When? How did they do it?
Rickert & Dixon 1931. Took sterile needles and implanted them in the dorsum of rats. They caused irritation and inflammation, and it was believed this was from the hollow tube–lent credibility to endodontics.
Who were Rickert & Dixen 1931?
Came up with the hollow tube theory (sterile needles implanted in rats caused inflammation)
Who refuted the hollow tube theory?
Torneck in 1966
How did Torneck refute the hollow tube theory?
polyethylene tubes alone did not cause inflammation, but when they were filled with infected muscle, they did. (It’s not the hollow space causing inflammation, it’s what’s in the space.)
Two early studies that support the conclusion that bacteria harbored in the root canal system are the causative factors in endodontic disease
Kakehashi & Stanley 1965, Ergstrom 1964
Who showed that you can accurately diagnose a periapical lesion 74% of the time with one PA, but 90% of the time with three PA’s?
Brynolf 1970
Brynolf 1970
showed that you can accurately diagnose a periapical lesion 74% of the time with one PA, but 90% of the time with three PA’s
Two studies to quote for the reduction in radiation between digital and conventional film?
Soh (digital is 22% of conventional radiation dose)
White/Pharoah (75% reduction from conventional to digital)
Who first evaluated temperature changes in teeth using hot tap water, a burlew wheel, heated ball burnisher or GP (trying to elicit patient’s c.c.)
Cooley
Who showed that thermal (heat) testing does not harm the tooth (if used for a clinically relevant duration).
Rickoff, Trowbridge, Fuss 1988
Rickoff, Trowbridge, Fuss 1988
Heat testing using gutta percha increased pulp temperature by less than 2°C with less than five seconds of application—a temperature change that is unlikely to have caused pulp damage.
Who showed that cold test and EPT used in conjunction resulted in a more accurate method for diagnostic testing?
Weisleder, Trope, Teixeira 2009
Weisleder, Trope, Teixeira 2009
showed that cold test and EPT used in conjunction resulted in a more accurate method for diagnostic testing
Who said that cold tests are more reliable in children (developing teeth) than EPT?
Fulling & Andreasen 1976
Fulling and Andreasen 1976
Cold tests are more reliable in children (developing teeth) than EPT
Who said that laser doppler flowmetry is more accurate than EPT in determining teeth with necrotic pulps?
Ingolfsson and Tronstad 1994
Ingolfsson and Tronstad 1994
laser doppler flowmetry is more accurate than EPT in determining teeth with necrotic pulps
Huang, Schilder, Nathanson 1991
showed that dentin does not have less moisture after endo (disproved Helfer).
What did both Cameron (1981) and Rosen (1982) say about testing for cracked teeth?
That they elicit pain only when the percussion or bite test is applied in a certain direction to one cusp or section of tooth.
Who said that a cracked tooth or fractured cusp will elicit pain only when percussion or bite test is applied in a certain direction to one cusp or section of a tooth?
Cameron (1981) and Rosen (1982)
Who developed a pulse ox sensor that can be directly applied to a tooth for assessing human pulp vitality, and found that it is more accurate than electric and thermal pulp tests?
Gopikrishna
Who said that CBCTs are superior to radiographs in detecting vertical root fractures?
Youssefzadeh 1999
Youssefzadeh 1999 CBCTs?
CT is superior to dental radiography in the detection of dental vertical root fractures.
Remeikis 1999?
Many patients with a sinus tract that drains extraorally see a dermatologist first.
Many patients with a sinus tract that drains extraorally see a dermatologist first.
Remeikis 1999
How to calculate positive predictive value?
TP/TP +FP
How to calculate negative predictive value?
TN/ TN + FN
How to calculate accuracy?
(TP + TN)/ (TP +FP + TN + FN)
How to calculate sensitivity?
TP/ (TP + FN)
How to calculate specificity?
TN/ (TN + FP)
In Petersson’s 1999 study, what was the positive predictive value for the three tests?
cold: 89, ept: 88, heat: 48
In Petersson’s 1999 study, what was the negative predictive value of the three tests?
cold: 90, ept: 84, heat: 83
Cohen, Cha, Spangberg 1993
Cold testing is a more reliable way of predicting pulpal anesthesia than lip numbness
Who showed by testing irreversible pulpitis teeth after lido and mepiv injections that cold testing is a more reliable way of predicting pulpal anesthesia than lip numbness
Cohen, Cha, Spangberg 1993
Who showed that subjects with a negative response to cold testing are 80% less likely to experience pain during NSRCT compared to subjects with just lip numbness
Hsiao-Wu 2007
Who showed that a lesion can be present with irreversible pulpitis?
Stashenko, Yamasaki sp?
Who said that EPT’s are safe to use with pacemakers?
Baumgartner, Wilson 2006
Two studies on baroldontalgia and tooth aches
Ferjentsik 1982 and Cunningham 1985
Who described the endo-antral syndrome (and what is it?)
Selden 1999. Infection from maxillary posteriors into the sinus.
Two studies who said said there is no relationship between value and pulp pathology for EPT?
Mumford 1967, Matthews 1974
Tw studies that EPT’s are less reliable than cold in traumatized teeth?
Bhaskar 1973, Pileggi 1996
Who showed that bitewings are best for examining alveolar bone?
Ramadan and Mitchell 1962
Who compared cbct with radiographs in the dx of periapical pathology, and showed that in 70% of cases CBCT provided additional relevant info?
Lofthag-Hansen 2007
Who suggested a PA index based on CBCT imaging?
Estrela 2008, Esposito 2011
Lofthag-Hansen 2007
CBCT v. PA’s
Compared CBCT with radiographs in the dx of periapical pathology, and showed than in 70% of cases, CBCT provided additional relevant info.
