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3rd yr- CP3- > Diagnosis and Management of dental pain > Flashcards

Diagnosis and Management of dental pain Flashcards

(70 cards)

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1
Q

What steps do we need to take before reaching a diagnosis?

A
  1. History
  2. Examination
  3. Differential diagnosis
  4. Investigations
    Then you reach your working diagnosis
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2
Q

What is our differential diagnosis?

A

A list of possible diseases we think the patient ay have

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3
Q

How can ew narrow dow our list of differential diagnosis’s?

A

By carrying out specific investigations that ether rule in or out the potential causes that we come across

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4
Q

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

A
  1. Detine hypersensitivity
  2. Reversible Pulpitis
  3. Irreversible Pulpitis
  4. Cracked tooth syndrome
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5
Q

Give some examples of conditions that are associated with a dead tooth

A

1, Symptomatic apical periodontitis

  1. Acute apical abscess
  2. Chronic apical abscess
  3. Asymptomatic apical periodontitis
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6
Q

Describe the aetiology of dentine hypersensitivity

A

Hydrodynamic theory of tooth sensitivity

Alpha nerve fibres stimulated

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7
Q

What do patients usually complain of if they have dentine hypersensitivity (icl HPC)

A
  1. Short sharp pain
  2. Worse with hot, cold and sweet things
  3. Hard to locate
    HPC: Only present when stimulus is present
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8
Q

Upon examination wha might you see in a patient wit dentine hypersensitivity?

A 
Look for:
Exposed dentine 
Lost restorations 
Gingival recession
Fractured teeth
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9
Q

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

  1. Sensitivity test
  2. TTP
A
  1. Positive response

2. Not TTP

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10
Q

How can you manage dentine hypersensitivity?

A

Seal dentinal tubules to prevent fluid flow

Place fluoride varnish

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11
Q

Describe the aetiology of reversible pulpitis

A

Milk transient inflammation in the pulp

Alpha nerve fibres stimulated

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12
Q

What do patients usually complain of if they have reversible pulpitis (Include HPC)

A
  1. Short sharp pan (5-10secs)
    2.Worse with cold, hot and sweet things
  2. Hard to locate
    HPC: Only present when stimulus is present
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13
Q

Upon 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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14
Q

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

  1. Sensitivity test
  2. TTP
A
  1. Positive response

2. Not TTP

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15
Q

What radiograph should you take if you suspect a patient has reversible pulpitis?

A

Bitewing to look for caries

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16
Q

How do we manage reversible pulpitis

A
  1. Removal of irritant
  2. Protection of the pulp
  3. Temporary dressings
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17
Q

Describe the aetiology of irreversible pulpitis?

A

More severe plural inflammation from high it cannot recover

C fibres in the pulp are stimulated

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18
Q

What do patients usually complain of 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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19
Q

Describe the typical History of presenting complain for a patient with irreversible pulpitis

A
  1. Lasts a long time afters stimulus is removed (mins to hrs)
  2. May be spontaneous
  3. May keep the patient awake at night
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20
Q

Upon examination what might you see in a patient with irreversible pulpitis?

A

Look for:
Caries
Deep restorations

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21
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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22
Q

What radiograph should you take if you suspect a patient has irreversible pulpitis?

A

Bitewings to look for caries

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23
Q

How do we manage irreversible pulpitis

A
  1. Temporary reduction of inflammation with pulp- steroid dressing
  2. RCT
  3. Extraction
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24
Q

Describe the aetiology of cracked tooth syndrome ?

A

Cack extending into dentine open when patient bites with tooth and closes after causing pain as fluid id forced into dentinal tubules

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25
What do patients usually complain of if they have cracked tooth syndrome
1. Pain on biting or after realising bite 2. Usually sensitive to cold 3. Difficult to say who tooth hurts
26
Describe the typical History of presenting complain for a patient with cracked tooth syndrome
Can go on for years regressively gets worse Causes avoiding eating on that side
27
Upon examination what might you see in a patient with cracked tooth syndrome?
Look for: 1. occlusal interferences 2. Large restoartions 3. Visible cracks
28
List what the likely outcomes are for a patient with cracked tooth syndrome to: 1. Sensitivity test 2. TTP
1. Positive response | 2. May be TTP
29
Will cracks be visible on a radiograph if a patient has cracked tooth syndrome
no
30
How can we identify which cusp is flexing in a patient with cracked tooth syndrome?
By using a tooth sleuth
31
How can we manage cracked tooth syndrome?
Remove ant restorations and replace then with cusp protective restorations
32
Describe the aetiology of a high restoration?
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
33
What do patients usually complain of if they have a high restoration
1. Painful to put teeth together | 2. Patients may avoid eating on the side with the high restorations
34
Upon examination what might you see in a patient with a high restoration ?
If they have a new amalgam filling they may have shay spots | Use articulating paper
35
List what the likely outcomes are for a patient with a high restoration to: 1. Sensitivity test 2. TTP
1. Positive response | 2. May be TTP
36
How can we manage a high restoration
Remove high spot usually instantaneous relief to pain on biting
37
Describe the aetiology of food packing
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
38
What do patients usually complain of if they have food packing
Pain when biting | For gets stuck between teeth
39
Upon examination what might you see in a patient suffering from food packing?
Look for: 1. Collected food inter proximally 2. Poor contact points 3. Perio probe wil reveal bleeding
40
What might a radiograph show if a patient is suffering from food packing?
May show bone loss inter proximally and open contacts
41
How can we manage food packing?
1. Clean out all the food 2. Try to correct poor contacts 3. Instruct the patient to clean inter proximally regular
42
Describe the aetiology of acute lateral periodontal abscess?
Pus formation n personal poket | Pus may be prevented from escaping by calculus
43
What do patients usually complain of if they have an acute lateral periodontal abscess
Pain and swelling that may have stared following periods treatment
44
Upon examination what might you see in a patient who has an acute lateral periodontal abscess?
Fluctuant swelling Tooth may be mobile Pocket wit pus may be present
45
What might a radiograph show if a patient has an acute lateral periodontal abscess
Radiograph may show loss of alveolar crest
46
How can we manage an acute lateral periodontal abscess
1. Drainage of pus under LA 2. Clean any pockets 3. MAY need antibiotics
47
Describe the aetiology of symptomatic acute apical periodontitis?
Acute inflammation in the periodontal ligament at the apex. This is due to bacterial toxins coming from infected dead root canal
48
What do patients usually complain of if they have symptomatic acute apical periodontitis
1. Extremel painful to put teeth together 2. Very well localised .3 Usually a short history
49
Upon examination what might you see in a patient who has symptomatic acute apical periodontitis?
Tooth may have caries or be heavily restored
50
List what the likely outcomes are for a patient with symptomatic acute apical periodontitis: 1. Sensitivity test 2. TTP
1. Negative response (unless tooth is multi rooted) | 2. Very TTP
51
How can we manage symptomatic acute apical periodontitis
1. Extraction 2. RCT 3 Pain killers/ occlusal adjustment if RCT can't be carried out immediately
52
Describe the aetiology of acute apical abscess?
Pus formation in the peri radicular tissues | Pus racks through cortical one plate and causes accumulation in the soft tissues
53
What do patients usually complain of if they have an acute apical abscess
Intense throbbng pain and swelling Patiently feel generally unwell Short onset
54
Upon examination what might you see in a patient who has an acute apical abscess?
1. Fluctuant swelling intra-orally or extra-orally | 2. Possible lymphadenopathy
55
List what the likely outcomes are for a patient who has an acute apical abscess : 1. Sensitivity test 2. TTP
1. Non responsive | 2. Very TTP and touch
56
What might a radiograph show in a patient with an acute apical abscess/
May show area of exacerbation of existing pathology
57
How do we manage an acute apical abscess
Drainage of pus through root canal or soft tissues
58
Describe the aetiology of chronic apical abscess?
Pus formation in peri radicular tissues | May have formed a sinus tract
59
What do patients usually complain of if they have a chronic apical abscess
Tooth may be symptom free | Possible vague mid symptoms or the occasional tooth ache
60
What might the history of prsenting complaint be of a patient with a chronic apical abscess
Possible previous failed Endodontics treatment | Untreated periapical periodontitis
61
Upon examination what might you see in a patient who has a chronic apical abscess?
Small localised swelling or sinus tract | May be able to express pus
62
List what the likely outcomes are for a patient who has a chronic apical abscess : 1. Sensitivity test
1. Negative response
63
What might a radiograph show if a patient has a chronic apical abscess
Will show PA area
64
How do we manage chronic apical abscesses
RCT or apical surgery
65
Describe the aetiology of asymptomatic apical periodontitis?
Bacterial occupying the dead pulp space causes a defensive reaction in surrounding tissues Can lead to the formation of a granuloma
66
What do patients usually complain of if they have asymptomatic apical periodontitis
Usually symptoms free but there may be past history of pain in the area
67
Upon examination what might you see in a patient who has asymptomatic apical periodontitis?
Heavily restored / caries tooth
68
List what the likely outcomes are for a patient who has asymptomatic apical periodontitis : 1. TTP
1. Mild TTP
69
What might a radiograph show in a patient who has asymptomatic apical periodontitis?
Will show PA areaMay show deep caries, restoration or the reason for pulp dead
70
How can we mage asymptomatic apical periodontitis?
Leave and monitor if asymptomatic | Carry out RCT

3rd yr- CP3- (3 decks)

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