Diagnosis and Management of Pain Flashcards
what comprises in the pulp?
blood vessels
nerves
lymph vessels
what are the 2 main nerves in the tooth responsible for pain?
alpha delta - short, sharp pain
c - slow, dull throb
what important cells are in the lymph vessels?
odontoblasts
stem cells
purpose of odontoblasts
produce dentine throughout life
how do vesse ls enter the tooth?
through the apex of the tooth and apical foramen
what is the fluid in the dentinal tubules called?
dentinal tubular fluid
what is early decay detected as?
white spot lesion
what is a white spot lesion?
demineralisation on the dentine, no cavitation
What are the 2 features of Reversible Pulpitis, regarding the pulp?
- increased outward flow of dentinal tubular fluid
- odontoblasts are stimulated to form secondary dentine
in response to attack, why does dentinal tubular fluid have outward flow?
- flush out toxins
- increase the lay down of peritubular dentine
- contains agents - immunoglobulins, calcium and phosphate
what are the last nerve cells to die in the pulp, hence the throbbing?
c fibres
what can a dark tooth often mean?
- a dead tooth
- the remnants of the pulp tissue and haemoglobin has broken down into bilirubin and biliverdin
= staining
what is pulpal necrosis?
bacteria invades into pulpal area
what is acute periapical periodontitis?
inflammation in the perio ligament
- around the apex
- caused by bacteria leak from root canal
when does the periapical area stop swelling after bacterial inflammation?
- when it becomes an abscess
- tooth defence matches bacterial potency = chronic infection
for extra-oral examination, what key things are there to look for?
facial symmetry
swelling
enlarged lymph nodes
assess muscles of mastication for tenderness
intra-orally, what key things can you look for with a patient presenting pain?
caries
cracks
swellings
lost fillings
mobility
tenderness
deep periodontal pockets
opposing arch
how do you perform a percussion test?
finger pressure on tooth or tap on tooth with mirror handle
What are the 2 Sensitivity Tests?
Ethyl Chloride
Electric Pulp Test
how is a false positive and a false negative perceived on an ethyl chloride test?
false positive
- patient aware of cold in the mouth but not on the tooth
false negative
- too much insulation from materials or patient with high pain threshold
how is a false positive and a false negative perceived on an EPT?
false positive
- anxieties of electric shock will stop it
- current conduct to other teeth
false negative
- too much insulation
how can you look for a crack in the tooth?
transillumination, with the curing light
5 ways to further investigate.
percussion test
sensitivity test
pressure on biting
trans-illumination
radiograph
what is a tooth sleuth?
a tool used to check cracked teeth
