Diagnosis and Management of Pain

Question 1

what comprises in the pulp?

Answer 1

blood vessels
nerves
lymph vessels

Question 2

what are the 2 main nerves in the tooth responsible for pain?

Answer 2

alpha delta - short, sharp pain
c - slow, dull throb

Question 3

what important cells are in the lymph vessels?

Answer 3

odontoblasts
stem cells

Question 4

purpose of odontoblasts

Answer 4

produce dentine throughout life

Question 5

how do vesse ls enter the tooth?

Answer 5

through the apex of the tooth and apical foramen

Question 6

what is the fluid in the dentinal tubules called?

Answer 6

dentinal tubular fluid

Question 7

what is early decay detected as?

Answer 7

white spot lesion

Question 8

what is a white spot lesion?

Answer 8

demineralisation on the dentine, no cavitation

Question 9

What are the 2 features of Reversible Pulpitis, regarding the pulp?

Answer 9

• increased outward flow of dentinal tubular fluid
• odontoblasts are stimulated to form secondary dentine

Question 10

in response to attack, why does dentinal tubular fluid have outward flow?

Answer 10

• flush out toxins
• increase the lay down of peritubular dentine
• contains agents - immunoglobulins, calcium and phosphate

Question 11

what are the last nerve cells to die in the pulp, hence the throbbing?

Answer 11

c fibres

Question 12

what can a dark tooth often mean?

Answer 12

• a dead tooth
• the remnants of the pulp tissue and haemoglobin has broken down into bilirubin and biliverdin
  = staining

Question 13

what is pulpal necrosis?

Answer 13

bacteria invades into pulpal area

Question 14

what is acute periapical periodontitis?

Answer 14

inflammation in the perio ligament
- around the apex
- caused by bacteria leak from root canal

Question 15

when does the periapical area stop swelling after bacterial inflammation?

Answer 15

• when it becomes an abscess
• tooth defence matches bacterial potency = chronic infection

Question 16

for extra-oral examination, what key things are there to look for?

Answer 16

facial symmetry
swelling
enlarged lymph nodes
assess muscles of mastication for tenderness

Question 17

intra-orally, what key things can you look for with a patient presenting pain?

Answer 17

caries
cracks
swellings
lost fillings
mobility
tenderness
deep periodontal pockets
opposing arch

Question 18

how do you perform a percussion test?

Answer 18

finger pressure on tooth or tap on tooth with mirror handle

Question 19

What are the 2 Sensitivity Tests?

Answer 19

Ethyl Chloride
Electric Pulp Test

Question 20

how is a false positive and a false negative perceived on an ethyl chloride test?

Answer 20

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

Question 21

how is a false positive and a false negative perceived on an EPT?

Answer 21

false positive
- anxieties of electric shock will stop it
- current conduct to other teeth

false negative
- too much insulation

Question 22

how can you look for a crack in the tooth?

Answer 22

transillumination, with the curing light

Question 23

5 ways to further investigate.

Answer 23

percussion test
sensitivity test
pressure on biting
trans-illumination
radiograph

Question 24

what is a tooth sleuth?

Answer 24

a tool used to check cracked teeth

Question 25

how do you use a tooth sleuth?

Answer 25

hold over cusp
patient bites for a few seconds
should not be painful upon releasing bite
- repeat per cusp

Question 26

why may food packing arise?

Answer 26

poor contact points

Question 27

what can be the effects of food packing?

Answer 27

• inflamed gingiva
• pain when eating
• food stuck between teeth
• periodontal probe will bleedhat

Question 28

why does chronic apical periodontitis arise?

Answer 28

bacteria occupies dead pulp space
= defensive reaction in surrounding tissue