Diagnosis Flashcards
What should the clinical notes include?
Date
Socrates
Exam
Special investigations
Diagnoses
Treatment options and risks / prognosis
Agreed treatment
Signed /dated
What are the two types of pain?
fibres
A-delta fibres
* Sharp pricking sensation
* Early shooting pain
C fibres
* Dull, aching or burning
* Late dull pain
What is an endodontic emergency?
- Pain and or swelling caused by various stages of inflammation or infection of the pulpal and /or periapical tissues
SOCRATES
- Site
- Onset
- Character
- Radiation
- Association
- Time course
- Exacerbating/Relieving factors
- Severity
What is referred pain?
- Perception of pain in one part of body distant from source of pain
- Difficult to discriminate location of pulpal pain
- Referred pain usually provoked by intense stimulation of C- fibres leading to intense slow, dull pain
What are the characteristics of referred pain?
- Always radiates to ipsilateral side
- Anterior teeth seldom refer pain to other teeth or opposite arch
- Posterior teeth often refer to opposite arch or periauricular area, but seldom to anterior teeth
- Mandibular posterior teeth refer pain to periauricular area more often than maxillary
What medical condition can be the cause of bone pain?
sickle cell anemia
What medical condition can be the cause of tooth mobility?
multiple myeloma
What medical conditions can be the cause of lymph node involvement?
TB
lymphoma
What medical conditions can be the cause of paraesthesia?
leukaemia
anaemia
What medical conditions can be the cause of tooth pain?
Multiple sclerosis
Acute maxillary sinusitis
Trigeminal neuralgia
What does the endodontic examination include?
- Extra oral exam
- Intra oral exam
- Soft tissue exam
- Intra oral swelling
- Sinus tracts
- Palpation
- Percussion
- Mobility
- Periodontal exam
What are sensibility tests?
thermal
electric
What is a vital test?
laser doppler flowmetry
What is used for cold tests?
frozen CO2
endo-frost
endo-ice
What is used for heat tests?
hot gutta percha
What are EPTs testing?
- Electric current used to stimulate sensory nerves
- Primarily A-delta fast conducting fibres
- Unmyelinated C-fibres may or may not respond
Why are EPTs not reliable?
why are they sometimes?
- No indication of reversibility of inflammation
- No correlation between threshold and pulp condition
- EPT of teeth with open apices unreliable
* Negative response reliable indicator
What is a bite test used for?
to find fractures or tooth sleuth
What are the pulpal diagnoses?
- Normal Pulp
- Reversible Pulpitis
- Irreversible Pulpitis
- Pulp Necrosis
- Previously Treated
- Previously Initiated Therapy
What is normal pulp?
- Pulp is symptom-free and normally responsive to pulp testing (normal means response is mild or transisent and lasts no more than 1-2 secs after stimulus is removed)
- Pulp may not be histologically normal
What are qualities of reversible pulpitis?
- Inflammation should resolve following appropriate management of the aetiology
- Discomfort is experienced when a stimulus applied only lasting a few seconds
- Exposed dentin (dentinal sensitivity), caries or deep restorations
- No significant radiographic changes in the periapical region of the suspect tooth and the pain experienced is not spontaneous
What are characteristics of irreversible pulpitis?
- Vital inflamed pulp is incapable of healing and that root canal treatment is indicated
- Characteristics may include sharp pain upon thermal stimulus, lingering pain (often 30 seconds or longer after stimulus removal), spontaneity (unprovoked pain) and referred pain
- Pain may be accentuated by postural changes such as lying down or bending over
- OTC analgesics typically ineffective
- May have no clinical symptoms (asymptomatic)
What is pulp necrosis?
- Diagnostic category indicating death of the dental pulp, necessitating root canal treatment
- Non responsive to pulp testing and is asymptomatic
- Does not by itself cause apical periodontitis
- (pain to percussion or radiographic evidence of osseous breakdown) unless the canal is infected
What is previously treated?
- Clinical diagnostic category indicating that the tooth has been endodontically treated
- Canals are obturated with various filling materials other than intracanal medicaments
- The tooth typically does not respond to thermal or electric pulp testing
What is previously initiated?
- Clinical diagnostic category indicating that the tooth has been previously treated by partial endodontic therapy such as pulpotomy or pulpectomy
- Depending on the level of therapy, the tooth may or may not respond to pulp testing modalities
What are the apical diagnoses?
- Normal Apical Tissues
- Symptomatic Apical Periodontitis
- Asymptomatic Apical Periodontitis
- Chronic Apical Abscess
- Acute Apical Abscess
- Condensing Osteitis
What are normal apical tissues?
- Not sensitive to percussion or palpation testing and radiographically, the lamina dura surrounding the root is intact and the periodontal ligament space is uniform
- Comparative testing for percussion and palpation should always begin with normal teeth as a baseline for the patient
What is symptomatic apical periodontitis?
- Represents inflammation, usually of the apical periodontium
- Painful response to biting and/or percussion or palpation
- May or may not be accompanied by radiographic changes (there may be a periapical radiolucency)
- Severe pain to percussion and/or palpation is highly indicative of a degenerating pulp and root canal treatment is needed.
What is asymptomatic apical periodontitis?
- Inflammation and destruction of the apical periodontium that is of pulpal origin
- Appears as an apical radiolucency and does not present clinical symptoms (no pain on percussion or palpation)
What is a chronic apical abscess?
- Inflammatory reaction to pulpal infection and necrosis
- Characterized by gradual onset, little or no discomfort and an intermittent discharge of pus through an associated sinus tract
- Radiographically, signs of osseous destruction such as a radiolucency
- Sinus tract tracing possible
What is a acute apical abscess?
- Inflammatory reaction to pulpal infection and necrosis
- Characterized by rapid onset, spontaneous pain, extreme tenderness of the tooth to pressure, pus formation and swelling of associated tissues
- May be no radiographic signs of destruction and the patient often experiences malaise, fever and lymphadenopathy
What is condesing osteitis?
Diffuse radiopaque lesion representing a localized bony reaction to a low-grade inflammatory stimulus usually seen at the apex of the tooth
