Diagnosis Flashcards
How does dentine sensitivity occur
Rapid flow of fluid through tubules which can be accelerated through dehydration (air heat drying)
When is pulp affected by perio
When accessory canal is exposed to oral cavity
Areas devoid of cementum
When should you consider retreating a root filled tooth
Compromised seal more than 3 months
Lesion not reducing in size
Symptoms
Types of root resorption
Pressure
Chemical
Replacement (ankylosis)
Invasive
Infective (root internal / ex)
Indications of replacement root resorption
Loss of pdl
Moth eaten appearance
Metallic sound
Intraoccluded
Indications of invasive root resorption
Pink coronal discolouration
Rl with radiopaque line
Irregular mottled / moth eaten
Cervical
Ortho (full mouth pas if so)
Rad appearance of internal and external resorption
I - uniform enlargement of the root canal
E - bowl like radio licences
Why can you get pain when instrumenting non vital teeth
C fibres can remain excitable after compromised blood flow They respond to simulation in degenerating pulp
They function in hypoxia
How does thermal testing work
Excited the alpha fibres
Activates hydrodynamic forces in dentinal tubules
C fibres only stimulated if injured 42.8 degrees
What pain is attributed to C fibres
Dull
Throbbing
Poorly localised
Burning
Associations with acute apical
Periodontitis
No / minimal rad changes
TTP (inflam of periradicular tissues)
Irreversible / necrotic pulp
Inflam in the pdl space
Differential =occl trauma
Associations with chronic apical periodontitis
Asymptomatic but can have acute exacerbation / phonenix abscess
PAP
Iimitations of EPT
stimulates A delta fibres
Unreliable with young pulp
What can indicate a root fracture
Isolated pocket mobility sinus at gingival margin j shaped rl
What is a reverse pocket
Sinus coming through a perio pocket
How do you diagnose how inflamed the pulp is
Pain history
Cold testing
Good Pa
Colour and intensity of pulp bleeding (infected yellow / dark purple or ++ bleeding)
How to carry out an angled rad
Mesial point distal
Distal point mesial
What would you do if the palatal and mb2 over overlaying each other on the PA
Take an angled rad
Distal pointing mesial
Moves mb2 mesial
If the DB root was overlaying the P root on an upper 6 pa what would you do
Mesially angulated rad to move the db root distal
What should you assess on the I/O exam
Perio
Bpe/6ppc
Bone loss
Mobility
Furcation involvement
What is the direction of fluid movement on temp testing ?
Hot- inward movement of fluid
Cold - outward movement of fluid
What does lingering to cold suggest?
Irreversible pulpits - deeper C fibres ?
What can ttp be related to
Sinus
Parafunction
Pain from another tooth
When do you need to see more than 3mm of apical tissue with a PA
When lesion extends past this
