Diagnosis Flashcards
- Symptom free
- Normal response to sensibility testing
- No inflammatory changes
Normal pulp
- Pain occurs with thermal, chemical + tactile stimuli
- Exaggerated response to stimuli
- Severe and sharp but does not linger on removal of stimulus
- No specific factors such as caries/fractures/recent restorations
Dentine hypersensitivity
- Pain short and sharp, not spontaneous
- Cold, sweet and occasionally hot stimulus
- No significant radiographic changes
Reversible pulpitis
- Spontaneous pain
- Exaggerated response to stimulus that lingers after stimulus is removed
- Sensibility testing responsive
- Not TTP
- No periapical changes radiographically
- Irreversible pulpitis
- Excrutiating pain
- Momentarily relived by cold
- Tooth often TTP
- Reacts violently to heat
- Radiograph shows thickened PDL
- Advanced symptomatic irreversible pulpitis
- Usually asymptomatic unless inflammation had progressed to periapical tissues
- No response to sensibility testing
Pulpal necrosis
- TTP
- Discomfort on biting and chewing
- Palpation may or may not be sensitive
- May be widening of the PDL or a distinct radiolucency
- Symptomatic periapical periodontitis
- Painful
- Very TTP
- Tooth extruded from socket
- Mobility of tooth
- Rapid onset
- May be localised or diffuse swelling
- Acute periapical abscess
- Not TTP
- No response to sensibility testing
- Radiographically there will be a radiolucency around apex of tooth
Asymptomatic periapical periodontitis
- Not TTP
- No response to sensibility testing
- Usually asymptomatic
- Radiographically - radiolucent area on bone
Chronic periapical abscess
- Systemic signs - temp >38 degrees + feeling unwell
- Drainage through tooth not occurring
Infection spread into fascial planes
Cellulitis
Which nerve supplies the pulp of teeth?
Trigeminal
What kind of nerves are associated with sharp pain?
- Myelinated A delta and A beta axons
What kind of nerves are associated with dull throbbing pain?
Unmyelinated C fibres
What are the inflammatory mediators of pulp irritation?
- Histamine
- Bradykinin
- Arachidonic acid
- Neuropeptides
What are the treatment options for irreversible pulpitis?
- RCT if tooth restorable
- Extraction
What are the treatment options for advanced symptomatic irreversible pulpitis?
- RCT
- Pulpotomy for temporary measures and adjust occlusion
- Extract
What medicament would we use to relive pain until definitive RCT can be carried out?
- What are its active ingredients?
- Odontopaste
- Antibiotic = clindamycin hydrochloride
- Anti-inflammatory = triamcinolone
How does inflammatory internal resorption occur?
- Activation of dentinoclasts within inflamed pulp tissue that is in contact with necrotic, infected coronal pulp tissue
What does irreversible pulpitis lead to?
Liquefaction necrosis
What is the cause of a periapical abscess?
- Bacteria have progressed into the periradicular tissues and the patients immune response cannot defend against the invasion
What are the treatment options for an acute periapical abscess?
- Drainage
THEN - RCT or extraction
Where does a periradicular cyst arise from?
- Epithelial cells rests of malassez
What are the histopathological features of a radicular cyst?
- Epithelial lining
- Cholesterol clefts
- Fibrous capsule of collagen fibres
- Inflammatory cells
Why do we test control teeth?
- So the patient knows what to expect
- So the dentist can observe the patients response
- So we can determine if the stimulus if capable of evoking a reponse
What does a severe response to percussion testing indicate?
- Periradicular inflammation
What does a mild - mod response to percussion testing indicate?
- Periodontal inflammation
- periodontal disease
What does a positive response to pulp sensibility testing indicate?
- Only that there is a presence of some nerve fibres carrying sensory impulses
What does an intense, prolonged response to a pulp sensibility test indicate?
- Irreversible pulpitis
What does no response to pulp sensibility testing indicate?
- Necrotic pulp
- False negative
What may give us a false negative response to sensibility testing?
- Calcified canals
- Immature apex
- Recent trauma
What can we use to do cold sensibility testing?
- Ethyl chloride
- Dichlorodifluoromethane
- Ice sticks
What can we use to do heat sensibility testing?
- Hot water
- GP heated in a flame
- Rotation of rubber prophy cup
Describe the technique for using and electric pulp tester
- Clean, dry and isolate tooth
- Place toothpaste on electrode
- Place on labial/palatal surface avoiding metal restorations
- Increase level of current until a sensation is felt by the patient
When might we get false positives from an EPT?
- Electrode makes contact with gingiva or large amalgam restoration
- Patient is anxious
- Liquefaction necrosis
- Tooth is not dry or well isolated
When might we get false negatives from an EPT?
- Patient is premedicated
- Inadequate contact with enamel
- Trauma
- Canal is calcified
- Apex is immature
(these teeth contain fewer Adelta fibres than mature teeth) - Partial necrosis
What does a laser doppler do?
Is an objective test of the presence of moving red blood cells within a tissue
What are the indications for laser doppler flowmetry?
- Pulp testing in children
- Traumatised teeth
- Monitoring revascularisation of replanted teeth
- Differential diagnosis of periapical radiolucencies
When would we do a bite test and what would we use to do it?
- To diagnose a cracked tooth
Tooth slooth
What are the limitations of using radiographs to diagnose?
- Pathological changes in the pulp are not visible
- Periradicular pathology is not visible in the early stages
What is meant by direct pulp capping?
- A medicament is placed directly over the exposed pup in an attempt to maintain pulp vitality and avoid more extensive treatment
What are the indications for direct pulp capping?
- Exposure due to caries - the pulp is likely to be inflamed
- Traumatically exposed pulps - pulp is likely to be normal
What are the criteria for a successful direct pulp cap?
- No history of pain
- No swelling
- Normal sensibility tests
- Not TTP
- No radiological evidence of periradicular pathology
- Young patient
What are the contraindications of direct pulp capping?
- History of previous toothache
- Deciduous teeth
- Elderly patients
- Large carious exposures
Pulp hyperaemiac at site of exposure
Pulp necrotic at site o exposure
What is the most commonly used material for pulp capping?
- Calcium hydroxide
Dycal
What other materials can be used for direct pulp capping?
- MTA
- Bio-aggregate
- Biodentine
What is the technique of direct pulp capping?
- LA
- Rubber dam
- Remove carious dentine
- Arrest haemorrhage - rinse with sodium hypochlorite
- Dress with pulp capping agent
- Seal with RMGI and place permanent restoration
