Diagnosis in Endo Flashcards
dental pain
a delta fibres = sharp pricking sensation & early shooting pain
c fibres = dull, aching, burning pain & late dull pain
referred pain
perception of pain in one b=part of body distant from source of pain
usually provoked by intense stimulation of C fibres leading to intense slow, dull pain
always radiates to ipsilateral side
referred pain in teeth
anterior teeth seldom refer pain to other teeth or opposite arch
posterior teeth often refer to opposite arch or periauricular area but seldom to anterior teeth
mandibular posterior teeth refer pain to periauricular area more often than maxillary
EPT
electric pulp test
no indication of reversibility of inflammation & no correlation between threshold & pulp condition but a negative response is a reliable indicator
EPT of teeth with open apices is unreliable
normal pulp
symptom free
normally responsive to pulp testing
mild / transient response to thermal cold testing lasting no more than 1-2 seconds after stimulus removed
compare with adjacent & contralateral teeth & test other teeth first so pt is familiar with experience of a normal response to cold
reversible pulpitis
inflammation should resolve following appropriate management of aetiology
discomfort experienced when stimulus applied only lasting a few seconds
exposed dentine, caries, deep restorations
no significant radiographic changes in periapical region of the suspect tooth & pain is not spontaneous
symptomatic irreversible pulpitis
vital inflamed pulp incapable of healing, RCT indicated
sharp pain upon thermal stimulus, lingering pain (>30 secs after stimulus removed), spontaneity & referred pain
pain can be accentuated by postural changes i.e. lying down or bending over
OTC analgesics typically ineffective
common aetiologies inc deep caries, extensive restorations or # exposing pulpal tissues
can be difficult to diagnose as inflammation has not yet reached the periapical tissues so no pain on percussion
asymptomatic irreversible pulpitis
vital inflamed pulp incapable of healing
RCT indicated
no clinical symptoms
pulp necrosis
death of pulp
non responsive to pulp testing
asymptomatic
does not by itself cause apical periodontitis
pain to percussion / radiographic evidence of osseous breakdown unless canal is infected
normal apical tissues
not sensitive to percussion or palpation testing & radiographically the lamina dura surrounding the root is intact & pdl space is uniform
comparative testing for percussion & palpation should always begin with normal teeth as a baseline for the pt
symptomatic apical periodontitis
inflammation, usually of the apical periodontium
painful response to biting and/or percussion or palpation
may or may not be accompanied by radiographic changes i.e. depending on stage of disease
severe TTP is highly indicative of a degenerating pulp and RCT is needed
asymptomatic apical periodontitis
inflammation & destruction of apical periodontium that is of pulpal origin
appears as apical radiolucency & does not present clinical symptoms i.e. no pain / TTP
chronic apical abscess
inflammatory reaction to pulpal infection & necrosis
characterised by gradual onset, little or no discomfort & intermittent discharge of pus through an associated sinus tract
radiographically signs of osseous destruction such as a radiolucency
sinus tract tracing possible
acute apical abscess
inflammatory reaction to pulpal infection & necrosis
characterised by rapid onset, spontaneous pain, extreme tenderness of tooth to pressure, pus formation & swelling of associated tissues
may be no radiographic signs of destruction & pt often experiences malaise, fever & lymphadenopathy
condensing osteitis
diffuse radiopaque lesion representing a localised bony reaction to a low grade inflammatory stimulus usually seen at the apex of the tooth
