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5th yr- Finals- CP3 revision > Diagnosis and management of dental pain > Flashcards

Diagnosis and management of dental pain Flashcards

1
Q

What is a differential diagnosis

A

A list of possible diseases we think a patient may have

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2
Q

Give examples of dental conditions that are assorted with a vital pulp

A
  1. Dentine hypersensitivity
  2. Reversible pulpitits
  3. Irreversible pulpitis
  4. Cracked tooth syndrome
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3
Q

Give examples of conditions that are associated with a dead tooth

A
  1. Symptomatic apical periodontitis
  2. Acute apical abscess
  3. Chronic apical abscess
  4. Asymptotic apical periodontitis
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4
Q

Describe the aetiology of dentine hypersensitivity

A

Hydrodynamic theory of tooth sensitivity
associated with alpha nerve fibre stimulation

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5
Q

What do patients usually complain of if they have dentine hypersensitivity

A
  1. Short sharp pain
  2. Worse with hot, cold and sweet things
  3. Hard to locate
  4. Only present when stimulus present
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6
Q

Upon examination what might you see in a patient with dentine hypersensitivity

A

Look for:
1. Exposed dentine
2. Lost restorations
3. Gingival recession
4. Fractured teeth

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7
Q

List what the likely outcomes are for a patient with dentine hypersensitivity to:

  1. Sensitivity test
  2. TTP
A
  1. Sensitivity testing: positive
  2. Not TTP
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8
Q

How can you manage dentine hypersensitivity

A

Seal dentinal tubules to prevent fluid flow
Place flouride varnish

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9
Q

Describe the aetiology of reversible pulpits

A

Mild transient inflammation in the pulp
Associated with simulation of alpha nerve fibres

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10
Q

What do patients usually complain of if they have reversible pulpitis

A
  1. Short sharp pain (5-10 secs)
  2. Pain worse with hot, cold and sweet things
  3. Hard to locate
  4. Pain only present when stimulus present
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11
Q

On examination what might you see in a patient with reversible pulpitis

A

Look for:
1. Caries
2. Cracks
3. High restorations
4. Deep restorations

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12
Q

List what the likely outcomes are for a patient with reversible pulpitis to:

  1. Sensitivity test
  2. TTP
A
  1. Sensitivity testing: positive
    2 .Not TTP
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13
Q

How do we manage reversible pulpitis

A
  1. Removal or irritant
  2. Protection of the pulp
  3. Temporary dressings
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14
Q

Describe the aetiology of irreversible pulpitis

A

More severe pulpal inflammation from which it cannot recover
C fibres in the pulp are stimulated

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15
Q

What do patients usually complain if they have irreversible pulpitis

A
  1. More throbbing severe pain
  2. Worse with hot but can be cold/ sweet stimulus
  3. Hard to locate
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16
Q

Describe the typical history of presenting complaint for a patent with irreversible pulpitis

A
  1. Last a long time after stimulus is removed (mins to hrs)
  2. May be spontaneous
  3. Mat keep the patient awake at night
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17
Q

Upon examination what might you see in a patient with irreversible pulpits

A

Look for
Caries
Deep restorations

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18
Q

List what the likely outcomes are for a patient with irreversible pulpitis to:

  1. Sensitivity test
  2. TTP
A
  1. Positive response
  2. Not TTP
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19
Q

How do we manage irreversible pulpit its

A
  1. Temporary reduction of inflammation with pulp steroid dressing
  2. RCT
  3. Extraction
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20
Q

Describe the aetiology of cracked tooth syndrome

A

Crack extends into dentine when patient bites with tooth and closes after causing pain as fluid is forced into the dentinal tubules

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21
Q

What do patients usually complain of if they have cracked tooth syndrome

A
  1. Pain on biting or after releasing bite
  2. Usually sensitive to cold
  3. Difficult to say which tooth hurts
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22
Q

Describe the typical history of presenting complain for a patient with cracked tooth syndrome

A
  1. Can go on for years
  2. Regressively gets worse
  3. Causes avoidance of eating food on that side
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23
Q

Upon examination what might you see in a patient with cracked tooth syndrome

A

Look for:
1. Occlusal interference
2. Large restorations
3. Visible cracks

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24
Q

List what the likely outcomes are for a patient with cracked tooth syndrome to:

  1. Sensitivity test
  2. TTP
A
  1. Positive response
  2. May be TTP
25
Q

Will cracks be visible on a radiograph if a patient has cracked tooth syndrome

A

no

26
Q

How can we identify which cusp is flexing in a a patient with cracked tooth syndrome

A

By using tooth sleuth

27
Q

How can we manage cracked tooth syndrome

A

Remove any restorations and replace with cusp protective restorations

28
Q

Describe the aetiology of a high restoration?

A

High biting high restorations results in increased pressure on the tooth effectively bring the PDL and can cause the release of pain mediators on the PDL

29
Q

What do patients usually complain of if they have a high restoration

A
  1. Painful to put teeth together
  2. Patients may avoid eating on the side with the high restoration
30
Q

Describe the aetiology of food packing

A

Usually associated with a poor contact point
Food collects in inter proximal area and is packed down further for on top
Causes inflammation of gingiva

31
Q

How can we manage food packing?

A
  1. Clean out all the food
  2. Try to correct poor contacts
  3. Instruct the patient to clean inter proximally regular
32
Q

Describe the aetiology of acute lateral periodontal abscess?

A
  1. Pus formation in periodontal pocket
  2. Pus may be prevented from escaping by calculus
33
Q

What do patient usually complain of if they ache an acute lateral periodontal abscess

A

Pain and swelling that may have started following periodontal treatment

34
Q

Upon examination what might you see in a patient who has an acute lateral periodontal abscess

A

Fluctuant swelling
tooth may be mobile

35
Q

What might a radiograph show if a patient has an acute lateral periodontal abscess

A

Radiographs may show loss of alveolar crest

36
Q

How can we manage an acute lateral periodontal abscess

A
  1. Drainage of pus under LA
  2. Clean any pockets
  3. May need antibiotics
37
Q

Describe the aetiology of symptomatic acute apical periodontitis?

A

Acute inflammation in the periodontal ligament at the apex
This is due to bacterial toxins coming from infected dead root canal

38
Q

What do patient s usually complain of if they have symptomatic acute apical periodontitis

A
  1. Extremely painful to put teeth together
  2. Very well localised
  3. Usually a short history
39
Q

Upon examination what might you see in a patient who has symptomatic acute apical periodontitis

A

Tooth may have caries or be heavily restored

40
Q

List what the likely outcomes are for a patient with symptomatic acute apical periodontitis:

  1. Sensitivity test
  2. TTP
A
  1. Negative response (unless tooth is multi rooted)
  2. Very TTP
41
Q

How can we manage symptomatic acute apical periodontitis

A
  1. Extraction
  2. RCT
  3. Pain killers/ occlusal adjustment if RCT can’t be carried out immediately
42
Q

Describe the aetiology of acute apical abscess

A

Pus formation in the peri radicular tosses
Pus racks through cortical paste and causes accumulation in the soft tissues

43
Q

What do patients usually complain of If they have an acute apical abscess

A
  1. Intense throbbing pain and swelling
  2. Patient feels generally unwell
  3. Short onset
44
Q

Upon examination what might you see in a patient who has an acute apical abscess

A
  1. Fluctuant swelling intra orally or extra orally
  2. Possible lymphadenopathy
45
Q

List what the likely outcomes are for a patient who has an acute apical abscess :

  1. Sensitivity test
  2. TTP
A
  1. Non responsive
  2. Very TTP and touch
46
Q

What might a radiograph show in a patient with an acute apical abscess/

A

May show area of exacerbation of existing pathology

47
Q

How do we manage an acute apical abscess

A

Drainage of pus through root canal or soft tissues

48
Q

Describe the aetiology of chronic apical abscess

A

Pus forms peri radicular tissues
May have formed a sinus tract

49
Q

What do patients usually complain of if they have chronic apical abscess

A

Tooth may be symptom free
Possible vague mild symptoms or the occlusal tooth ache

50
Q

When might the history of presenting complain be of patient with chronic apical abscess

A

Possible previous failed Endodontic treatment
Untreated periapical periodontitis

51
Q

Upon examination what might you see in a patient who has a chronic apical abscess?

A
  1. Small localised swelling or sinus tract
  2. Mat be able to express pus
52
Q

What might a radiograph show if a patient has a chronic apical abscess

A

Will show PA area

53
Q

How do we manage chronic apical abscesses

A

RCT or apical surgery

54
Q

Describe the aetiology of asymptomatic apical periodontitis

A

Bacteria occupying the dead pulp space causes a defensive reaction in surrounding tissues
Can lead to the formation of a granuloma

55
Q

What do patient usually complain of If they have asymptomatic apical periodontitis

A

Usually symptom free but there may be pas history of pain in the area

56
Q

Upon examination what might you see in a patient who has asymptomatic apical periodontitis?

A

Heavily restored
carious Tooth

57
Q

What might a radiograph show in a patient who has asymptomatic apical periodontitis?

A

Will show PA areaMay show deep caries, restoration or the reason for pulp dead

58
Q

How can we mage asymptomatic apical periodontitis?

A

Leave and monitor if asymptomatic
Carry out RCT

5th yr- Finals- CP3 revision (1 decks)

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