Diagnosis Flashcards
7 diagnosis of pulpal
- Normal pulp
- Reversible pulpitis
- Assymptomatic Irreversible pulpitis
- sympotomatic irreversible pulpitis
- pulp necrosis
- Previously treated
- Previously initiated therapy
Normal pulp
Characteristics
What makes you know
What part of diagnosis?
Responds normal to cold
symptom free and normal responses to pulp testing
Reversible Pulpitis
Characteristics
What makes you know
What part of diagnosis?
Based upon subjective and objective findings indicating that the inflammation should resolve and the pulp return to normal
hypersensative, but NO LINGERING
Symptomatic Irreversible Pulpitis
Characteristics
What makes you know
What part of diagnosis?
LINGERING
will respond + to cold testing
subjective/ objective findings indicating that the vital inflamed pulp is incapable of healing.
LINGERING THERMAL PAIN
SPONTANEOUS PAIN
REFERRED PAIN
Asymptomatic Irreversible Pulpitis
Characteristics
What makes you know
What part of diagnosis?
normal response to cold
no clinical symptoms but inflammation produced by caries, caries excavation, trauma
there is inflammation present
Pulp Necrosis
Characteristics
What makes you know
What part of diagnosis?
No response to cold or EPT testing is negative
pulp is nonresponsive to pulp testing
cold -, heat -, EPT -
Previously treated
Characteristics
What makes you know
What part of diagnosis?
Part of PULPAL diagnosis
There is FILLING MATERIAL present within the canal
canals are obturated with various filling materials other than intracranal medicaments
Previously initiated therapy
Characteristics
What makes you know
What part of diagnosis?
Part of the PULPAL diagnosis
Root canal tx has been initiated - but only with partial endodontic therapy
like pulpectomy (total removal of the nerve– crown and root) or pulpotomy (pulpal tissue removed from coronal part of tooth)
7 apical diagnosis
- Normal apical tissue
- Symptomatic apical periodontitis
- Asymptomatic apical periodontitis
- Acute apical abscess
- chronic apical abscess
- Condensing osteitis
Normal apical tissue
Characteristics
What makes you know
What part of diagnosis?
Part of the APICAL diagnosis
percussion -, swelling -, sinus tract -
teeth with normal periradicular tissues that are not sensative to percussion or palpation testing
lamina dura is intact and the periodontal ligament space is uniform
Symptomatic Apical Periodontitis
Characteristics
What makes you know
What part of diagnosis?
APICAL DIAGNOSIS
PERCUSSION +,
+/- APICAL RADIOLUSCENCY – there may or may not be a radioluscency present at the apex – like there can be or there cannot be
inflammation is present - there is also a painful response to biting or percussion or palapation
it might or might not be associated with a radiolucent area
IF PERCUSSION + IT HAS TO BE THIS
Asymptomatic Apical periodontitis
Characteristics
What makes you know
What part of diagnosis?
part of APICAL diangosis
PERCUSSION WILL BE NEGATIVE
THERE WILL BE AN APICAL LESION
inflammation and destruction of apical periodontium THAT IS OF PULPAL ORIGIN and appears as a radiolucent area, and does not produce clinical symptoms
ex) – shadow present but no lesion
Acute apical abscess
Characteristics
What makes you know
What part of diagnosis?
part of APICAL diagnosis
SWELLING INDICATES THIS
percussion can be +!!!
an inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation, and swelling of associated tissues
Chronic apical abscess
Characteristics
What makes you know
What part of diagnosis?
part of APICAL diagnosis
SINUS TRACT IS PRESENT
an inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little or no dis(comfort, and the intermittent discharge of pus through an associated sinus tract
Condensing osteoitis Characteristics What makes you know What part of diagnosis? what is special about this one?*
part of APICAL diagnosis and this is SPECIAL because it is not written alone - but in conjunction with one of the other 5 apical diagnosis
there is a diffuse radio-opaque lesion representing a localized bony reaction to a low grade inflammatory stimulus, usually seen at the apex of the tooth
Primary etiology of endo lesion?
BACTERIA (like perio)
+ fungi + virus
explain Kakehashi et al 1965
21 germ free rats
drilled into pulp and left open
all were due to bacteria
Dr. Herbert Schilder importance
Capacity to heal is 100% - x
so X is the ability of the clinician
- so if you remove all source than will
percussion - describe
use a control tooth first
LIGHT tapping
must be reproducible and repeatable
*looking for a different feeling not necessarily pain
looking for a YES or NO
Palpation - describe what you’re looking for
soft tissue swelling
boney expansion
T/F mobility is a predictor of prognosis?
NO - false
describe cold test
importance?
MOST RELIABLE TEST we have (when using the Endo Ice)
- primary pulp test to determine vitality of pulp
- ice stick
CO2/Refrigerant Spray (Endo Ice)
- Rubber Dam Technique
Tell patient to keep up hand for as long as they feel the cold then put down hand when do not feel it anymore
This is a COMPARATIVE TEST
types of nerve fibers and describe each funciton
A-alpha –> proprioception (muscle sense) ( not in pulp but in the PDL)
A- beta –> touch
A- delta –> PAIN and TEMP
C –> Pain, temperature, and itch
A-delta and C fibers importance
most abundant in the pulp
A-delta on periphary more (pain and temp)
- myelinated
-even if responding to temperature it will interpret it as PAIN ONLY
C - pain, temp, and itch
- unmyelinated
Referred pain in anterior is from?
From anterior teeth
Anterior teeth DO NOT refer pain from upper to lower and visa versa
is pain referred across midline?
NO
referred pain in the posterior is from? can refer pain where?
From the posterior teeth and posterior teeth CAN refer pain from upper to lower and visa versa
testing tips if cannot isolate tooth causing pain? or ruling out reffered pain?
Anesthesia test
Cavity test - start drilling and if feel pain?
thermal tests are valuable in differentiating between what?
reversible and irreversible pulpitis
EPT test
Electric Pulp Testing
A positive repsonse only denotes some variable nerve fibers present and are capable of responding
RESPONSE IS EITHER PRESENT OR ABSENT
numbers are NOT significant
+/- testing
if feeling - then it is vital
Accuracy for pulp tests
Cold - 86% most accurate
Electric - 81% (second best)
Heat 71% - least accurate
*use a combination of tests
transillumination for craze line vs. crack
Determine if presence of a crack or not by applying a bright fibrooptic light probe to the surface
- if craze line - light will go all the way through
can you see a root fracture on radiograph
often you cannot
use of staining?
Determine length and severity of cracks in the tooth
use of a tooth sleuth or a cotton pellet?
Determining chance of a crack being present
when bite down where is the pain and how long does it last for?
is it present at moment you bite?
when you let go?
or both?
if pain WHEN BITING what does this signify?
peri-apical or periodontal inflammation present
if pain on moment release?
fracture related (likekly not inflammation related)
can a radipgraph be used to determine the health of the pulp?
NO CANNOT determine by radiograph alone even if it is nectrotic
- need periapical and bitewings
