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Endodontics > Diagnosis > Flashcards

Diagnosis Flashcards

1
Q
  • Symptom free
  • Normal response to sensibility testing
  • No inflammatory changes
A

Normal pulp

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2
Q
  • 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
A

Dentine hypersensitivity

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3
Q
  • Pain short and sharp, not spontaneous
  • Cold, sweet and occasionally hot stimulus
  • No significant radiographic changes
A

Reversible pulpitis

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4
Q
  • Spontaneous pain
  • Exaggerated response to stimulus that lingers after stimulus is removed
  • Sensibility testing responsive
  • Not TTP
  • No periapical changes radiographically
A
  • Irreversible pulpitis
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5
Q
  • Excrutiating pain
  • Momentarily relived by cold
  • Tooth often TTP
  • Reacts violently to heat
  • Radiograph shows thickened PDL
A
  • Advanced symptomatic irreversible pulpitis
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6
Q
  • Usually asymptomatic unless inflammation had progressed to periapical tissues
  • No response to sensibility testing
A

Pulpal necrosis

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7
Q
  • TTP
  • Discomfort on biting and chewing
  • Palpation may or may not be sensitive
  • May be widening of the PDL or a distinct radiolucency
A
  • Symptomatic periapical periodontitis
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8
Q
  • Painful
  • Very TTP
  • Tooth extruded from socket
  • Mobility of tooth
  • Rapid onset
  • May be localised or diffuse swelling
A
  • Acute periapical abscess
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9
Q
  • Not TTP
  • No response to sensibility testing
  • Radiographically there will be a radiolucency around apex of tooth
A

Asymptomatic periapical periodontitis

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10
Q
  • Not TTP
  • No response to sensibility testing
  • Usually asymptomatic
  • Radiographically - radiolucent area on bone
A

Chronic periapical abscess

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11
Q
  • Systemic signs - temp >38 degrees + feeling unwell
  • Drainage through tooth not occurring
    Infection spread into fascial planes
A

Cellulitis

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12
Q

Which nerve supplies the pulp of teeth?

A

Trigeminal

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13
Q

What kind of nerves are associated with sharp pain?

A
  • Myelinated A delta and A beta axons
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14
Q

What kind of nerves are associated with dull throbbing pain?

A

Unmyelinated C fibres

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15
Q

What are the inflammatory mediators of pulp irritation?

A
  • Histamine
  • Bradykinin
  • Arachidonic acid
  • Neuropeptides
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16
Q

What are the treatment options for irreversible pulpitis?

A
  • RCT if tooth restorable

- Extraction

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17
Q

What are the treatment options for advanced symptomatic irreversible pulpitis?

A
  • RCT
  • Pulpotomy for temporary measures and adjust occlusion
  • Extract
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18
Q

What medicament would we use to relive pain until definitive RCT can be carried out?
- What are its active ingredients?

A
  • Odontopaste
  • Antibiotic = clindamycin hydrochloride
  • Anti-inflammatory = triamcinolone
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19
Q

How does inflammatory internal resorption occur?

A
  • Activation of dentinoclasts within inflamed pulp tissue that is in contact with necrotic, infected coronal pulp tissue
20
Q

What does irreversible pulpitis lead to?

A

Liquefaction necrosis

21
Q

What is the cause of a periapical abscess?

A
  • Bacteria have progressed into the periradicular tissues and the patients immune response cannot defend against the invasion
22
Q

What are the treatment options for an acute periapical abscess?

A
  • Drainage
    THEN
  • RCT or extraction
23
Q

Where does a periradicular cyst arise from?

A
  • Epithelial cells rests of malassez
24
Q

What are the histopathological features of a radicular cyst?

A
  • Epithelial lining
  • Cholesterol clefts
  • Fibrous capsule of collagen fibres
  • Inflammatory cells
25
Q

Why do we test control teeth?

A
  • 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
26
Q

What does a severe response to percussion testing indicate?

A
  • Periradicular inflammation
27
Q

What does a mild - mod response to percussion testing indicate?

A
  • Periodontal inflammation

- periodontal disease

28
Q

What does a positive response to pulp sensibility testing indicate?

A
  • Only that there is a presence of some nerve fibres carrying sensory impulses
29
Q

What does an intense, prolonged response to a pulp sensibility test indicate?

A
  • Irreversible pulpitis
30
Q

What does no response to pulp sensibility testing indicate?

A
  • Necrotic pulp

- False negative

31
Q

What may give us a false negative response to sensibility testing?

A
  • Calcified canals
  • Immature apex
  • Recent trauma
32
Q

What can we use to do cold sensibility testing?

A
  • Ethyl chloride
  • Dichlorodifluoromethane
  • Ice sticks
33
Q

What can we use to do heat sensibility testing?

A
  • Hot water
  • GP heated in a flame
  • Rotation of rubber prophy cup
34
Q

Describe the technique for using and electric pulp tester

A
  • 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
35
Q

When might we get false positives from an EPT?

A
  • Electrode makes contact with gingiva or large amalgam restoration
  • Patient is anxious
  • Liquefaction necrosis
  • Tooth is not dry or well isolated
36
Q

When might we get false negatives from an EPT?

A
  • 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
37
Q

What does a laser doppler do?

A

Is an objective test of the presence of moving red blood cells within a tissue

38
Q

What are the indications for laser doppler flowmetry?

A
  • Pulp testing in children
  • Traumatised teeth
  • Monitoring revascularisation of replanted teeth
  • Differential diagnosis of periapical radiolucencies
39
Q

When would we do a bite test and what would we use to do it?

A
  • To diagnose a cracked tooth

Tooth slooth

40
Q

What are the limitations of using radiographs to diagnose?

A
  • Pathological changes in the pulp are not visible

- Periradicular pathology is not visible in the early stages

41
Q

What is meant by direct pulp capping?

A
  • A medicament is placed directly over the exposed pup in an attempt to maintain pulp vitality and avoid more extensive treatment
42
Q

What are the indications for direct pulp capping?

A
  • Exposure due to caries - the pulp is likely to be inflamed
  • Traumatically exposed pulps - pulp is likely to be normal
43
Q

What are the criteria for a successful direct pulp cap?

A
  • No history of pain
  • No swelling
  • Normal sensibility tests
  • Not TTP
  • No radiological evidence of periradicular pathology
  • Young patient
44
Q

What are the contraindications of direct pulp capping?

A
  • History of previous toothache
  • Deciduous teeth
  • Elderly patients
  • Large carious exposures
    Pulp hyperaemiac at site of exposure
    Pulp necrotic at site o exposure
45
Q

What is the most commonly used material for pulp capping?

A
  • Calcium hydroxide

Dycal

46
Q

What other materials can be used for direct pulp capping?

A
  • MTA
  • Bio-aggregate
  • Biodentine
47
Q

What is the technique of direct pulp capping?

A
  1. LA
  2. Rubber dam
  3. Remove carious dentine
  4. Arrest haemorrhage - rinse with sodium hypochlorite
  5. Dress with pulp capping agent
  6. Seal with RMGI and place permanent restoration

Endodontics (2 decks)

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