Diagnosis Flashcards
What are the steps for an endo diagnosis?
- Chief complaint
- MHx
- DHx
- Diagnostic Evaluations (questioning patient on COLDSPA)
- Objective Examination: Extraoral + intraoral examinations to check for swelling, discoloration, inflammation, large restorations, etc.
Clinical Tests:
- Periradicular (percussion + palpation)
- Cold Test
- Heat test
- Electric pulp test
- Test cavity (cut to dentine with PFM crown, sharp response indicates vital pulp)
- Perio examination (probing): differential diagnosis
- Radiographic examination
Special tests (if absolutely necessary/diagnosis unclear)
- Caries removal: remove caries and see if into pulp, if so irreversible pulpitis needing RCT
- Selective anaesthesia
- Transillumination: differential diagnosis with cracks
- Frac finder: same as transillumination
Analyse data+ formulate diagnosis, prognosis and treatment plan + assessment of case difficulty
What does COLDSPA stand for?
- Characteristic (Sharp or dull)
- Onset (did it start a week ago, day ago, month ago)
- Location
- Duration (how long does the pain last each time)
- Severity
- Precipitating factors (what triggers pain, is it spontaneous)
- Associated factors (is there anything that relieves the pain)
What are the possible responses to cold and heat test and what do they indicate?
- Short sharp pain: Reversible pulpitis
- Intense, prolonged pain: irreversible pulpitis
- Non-responsive: necrotic pulp
- False negative may occur with constricted canals
- Remember to use adjacent teeth as an index
What are the possible responses to an electric pulp test and what are they likely to mean?
- Early reaction: reversible pulpitis
- Late reaction with lingering discomfort: irreversible pulpitis
- No response: necrotic
What are some limitations to radiographic examinatioN?
- Pathologic vital pulp may not always show signs
- Necrotic pulps may not produce radiographic changes at early stages (later stage apical periodontitis)
- To be visible inflammatory process must spread through cortical bone
What characteristics do periradicular lesions of pulpal origin normally have?
- Breakdown of lamina dura
- Lesion visible even with various cone shifts
- Have a “hanging-drop shape”
Does obliteration of pulpal canals indicate a need for treatment?
Not necessarily.
What can internal resorption of extensive diffuse calcification in pulp chamber indicate?
-Diffuse, long term, low grade irritation
What factors should be considered for prognosis?
- Strategic value of tooth
- Periodontal factors
- Patient factors
- Restorability options
What are some possible pulp and root canal conditions?
Normal pulp
Reversible pulpitis (acute or chronic)
Irreversible pulpitis (acute or chronic)
Necrobiosis (part of pulp necrotic and infected, rest is irreversibly inflamed)
Pulp necrosis (may or may not be infected)
Pulpless (pulp chamber not present), infected root canal system
Degenerative chagnes
- Atrophy
- Canal calcification
- Hyperplasia
- Internal resorption (surface, inflammatory, replacement)
Previous treatment
What are some possible periapical conditions?
Normal
Apical periodontitis (acute, chronic)
Periapical cyst
Periapical abscess (acute, chronic)
Facial cellulitis
Extra radicular infection
Foreign body reaction
Periapical scar
External root resorption
What must be included in a diagonsis?
Pulp condition
Periapical condition
Cause of condition
If patient can localise pain is this more likely a pulpal or periapical problem?
Periapical
