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

Diagnosis and Management of dental pain Flashcards

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
Q

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

A
  1. Pain on biting or after realising bite
  2. Usually sensitive to cold
  3. Difficult to say who tooth hurts
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26
Q

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

A

Can go on for years
regressively gets worse
Causes avoiding eating on that side

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27
Q

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

A

Look for:

  1. occlusal interferences
  2. Large restoartions
  3. Visible cracks
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28
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

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29
Q

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

A

no

30
Q

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

A

By using a tooth sleuth

31
Q

How can we manage cracked tooth syndrome?

A

Remove ant restorations and replace then with cusp protective restorations

32
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

33
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 restorations

34
Q

Upon examination what might you see in a patient with a high restoration ?

A

If they have a new amalgam filling they may have shay spots

Use articulating paper

35
Q

List what the likely outcomes are for a patient with a high restoration to:

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

2. May be TTP

36
Q

How can we manage a high restoration

A

Remove high spot usually instantaneous relief to pain on biting

37
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

38
Q

What do patients usually complain of if they have food packing

A

Pain when biting

For gets stuck between teeth

39
Q

Upon examination what might you see in a patient suffering from food packing?

A

Look for:

  1. Collected food inter proximally
  2. Poor contact points
  3. Perio probe wil reveal bleeding
40
Q

What might a radiograph show if a patient is suffering from food packing?

A

May show bone loss inter proximally and open contacts

41
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
42
Q

Describe the aetiology of acute lateral periodontal abscess?

A

Pus formation n personal poket

Pus may be prevented from escaping by calculus

43
Q

What do patients usually complain of if they have an acute lateral periodontal abscess

A

Pain and swelling that may have stared following periods treatment

44
Q

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

A

Fluctuant swelling
Tooth may be mobile
Pocket wit pus may be present

45
Q

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

A

Radiograph may show loss of alveolar crest

46
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
47
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

48
Q

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

A
  1. Extremel painful to put teeth together
  2. Very well localised
    .3 Usually a short history
49
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

50
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

51
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
52
Q

Describe the aetiology of acute apical abscess?

A

Pus formation in the peri radicular tissues

Pus racks through cortical one plate and causes accumulation in the soft tissues

53
Q

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

A

Intense throbbng pain and swelling
Patiently feel generally unwell
Short onset

54
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

55
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

56
Q

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

A

May show area of exacerbation of existing pathology

57
Q

How do we manage an acute apical abscess

A

Drainage of pus through root canal or soft tissues

58
Q

Describe the aetiology of chronic apical abscess?

A

Pus formation in peri radicular tissues

May have formed a sinus tract

59
Q

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

A

Tooth may be symptom free

Possible vague mid symptoms or the occasional tooth ache

60
Q

What might the history of prsenting complaint be of a patient with a chronic apical abscess

A

Possible previous failed Endodontics treatment

Untreated periapical periodontitis

61
Q

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

A

Small localised swelling or sinus tract

May be able to express pus

62
Q

List what the likely outcomes are for a patient who has a chronic apical abscess :
1. Sensitivity test

A
  1. Negative response
63
Q

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

A

Will show PA area

64
Q

How do we manage chronic apical abscesses

A

RCT or apical surgery

65
Q

Describe the aetiology of asymptomatic apical periodontitis?

A

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

66
Q

What do patients usually complain of if they have asymptomatic apical periodontitis

A

Usually symptoms free but there may be past history of pain in the area

67
Q

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

A

Heavily restored / caries tooth

68
Q

List what the likely outcomes are for a patient who has asymptomatic apical periodontitis :
1. TTP

A
  1. Mild TTP
69
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

70
Q

How can we mage asymptomatic apical periodontitis?

A

Leave and monitor if asymptomatic

Carry out RCT

3rd yr- CP3- (3 decks)

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