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BDS4 Endodontics > Diagnosis in Endodontics > Flashcards

Diagnosis in Endodontics Flashcards

1
Q

What is main aim of dentistry?

A

prevention

relieve suffering

cure disease

all based on knowledge of clinical pathology

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2
Q

What is the process of a diagnosis?

A

CO

HPC - symptoms that prompt visit

Objective clinical tests

Differential diagnosis

Definitive diagnosis

Tx options

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3
Q

How do we take a pt history?

A

CO HPC PMH PDH FH SH

CO - is in pts own words as to why the are here - this gives us clues and then we carry out diagnostic tests

HPC - events that have led to complaint (SOCRATES - site, consent, character, radiation, associated symptoms, time, exacerbating factors, severity)

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4
Q

What do we do following patient history?

A

Clinical and Endodontics exam

then we can do SIs - radiographs, sensibility testing

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5
Q

What do we assess in E/O?

A

TMJ

lymph nodes

MOM

Swelling

asymmetry

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6
Q

What do we check during Endodontics exams?

A

Buccal soft tissue

Palatal or lingual mucosa

colour

palpation

restorations

TTP

sinus

EPT

ethyl chloride

radiographs

Dx

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7
Q

What can pain be?

A

Odontogenic or non odontogenic

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8
Q

What can pain be transferred via?

A

trigeminal nerve

opthalmic

maxillary

mandibular

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9
Q

What do branches of CNV primarily transmit pain in response to?

A

thermal mechanical or chemical stimuli

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10
Q

What types of pain do A delta fibres transmit?

A

sharp, shooting pain

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11
Q

What do C fibres transmit?

A

dull aching pain, late pain

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12
Q

What is pain?

A

Unpleasant sensory experience causes by intense or damaging stimuli

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13
Q

What is agony?

A

Acute physical or mental pain and is suffering or struggle that precede death

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14
Q

What are some good qs to ask pt about the pain?

A

Where is the pain?

What does it feel like to u? - sharp? dull? throbbing? aching? constant?

how bad is it - scale of 1-10 with 10 being worst pain you have felt

how long does the pain last?

do analgesics help?

does anything take pain away?

does it keep you awake at night?

have u had this before?

any trauma?

any previous dental work?

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15
Q

What is being awake at night a sign of?

A

Irreversible pulpits - nothing appears to be managing the pain

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16
Q

What is referred pain?

A

perception of pain in one part of the body distant from the source of pain and is due to how we form in the womb

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17
Q

What is referred pain provoked by?

A

C fibres - leads to intense dull slow pain

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18
Q

Where does referred pain radiate to?

A

Ipsilateral side

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19
Q

Do anterior teeth refer pain?

A

No its very rare

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20
Q

Do posterior teeth refer pain?

A

yes often to opposite arch but not anterior teeth

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21
Q

What is an Endodontics emergency?

A

This is when there is pain or swelling which is caused by various stages of inflammation or infection of the plural and or periodical tissues

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22
Q

What is involved in the Endodontics exam?

A

EO exam

IO exam - swellings, lumps, bumps, abscesses, abnormalities

soft tissue exam

hard tissue exam - restorations, caries

IO swellings

Sinus tracts

palpation

percussion

mobility

perio exam

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23
Q

What is Ludwig’s angina?

A

Ludwig’s angina is a rare skin infection that occurs on the floor of the mouth, underneath the tongue. This bacterial infection often occurs after a tooth abscess, which is a collection of pus in the center of a tooth. It can also follow other mouth infections or injuries.

rapidly and frequently fatal progressive gangrenous cellulitis and ooedema of the soft tissues of the neck and floor of the mouth

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24
Q

What are the types of sensibility testing?

A

Thermal

Electric

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25
Q

What is thermal pulp testing?

A

This is when we use hot or cold stimuli on the tooth

ethyl chloride - placed on cotton ball and directly onto toot to see pts reaction - do they feel cold sensation?

can also use heated GP but less common as can damage pulp and surrounding mucosa

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26
Q

if we use hot GP to test the pulp what should we do?

A

Use vaseline - to prevent excessive heat causing irreversible pulpitis

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27
Q

What is electric pulp testing?

A

This is when we apply a current to the tooth to generate an action potential in A delta fibres

it is done by applying a conducting medium to the tooth (toothpaste) and we then put the probe of the ep tester onto the medium and give pt the conducting probe to complete the circuit and tell pt to let go when they feel tingling sensation

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28
Q

What may not respond in electric pulp testing?

A

Unmyelinated C fibres

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29
Q

What does pulp testing give no indication of?

A

reversibility or inflammation - it is hard to tell between reversible and irreversible

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30
Q

In EPT readings is there a correlation between reading and pulp condition?

A

No - just need a positive reading

31
Q

What are some issues with pulp testing?

A

They can be misinterpreted by the patient - subjective testing so to try prevent this we test several teeth to see if pt is onboard with the testing

we assume that a nerve fibre means that there is an intact blood supply however this is not the case always

32
Q

What do EPT and Ethyl chloride test for?

A

Sensibility not vitality

33
Q

What can we use to test for tooth fractures?

A

Tooth sleuth

34
Q

How does a tooth sleuth work?

A

wedged tip that rests between the cusps of posterior teeth.

Pt is asked to “bite” on the Tooth Slooth, the plastic wedge pushes the cusps away from each other. When the patient is asked to “release”, or “open”, the plastic wedge releases the force, and the cusps are allowed to rest again.

In a healthy tooth, = no discomfort at all.

Some patients experience pain on “biting”, = inflammation of the tissues supporting the tooth. This can be caused by many disorders that would need other tests to be properly diagnosed.

Other patients may experience a sharp pain on “release”. This pain on “release” is due to a crack that goes into the dentin of a vital tooth. = you have a cracked tooth!

PLACE TOOTH SLEUTH ON EACH CUSP POINTED SIDE DOWN AND HAVE PT BITE THEN RELEASE = CAN IDENTIFY FRACTURED TOOTH

35
Q

How can we assess for tooth fractures?

A

tooth sleuth

staining

transillumination

36
Q

What x-rays must we take for endo?

A

2 pre-operative x-rays from different angles

37
Q

What does radiographic report include?

A

Type of x-ray
Grading - diagnostically acceptable or diagnostically unacceptable

Apical pathology
Bone loss
Crown
Anything else

38
Q

What are the types of endo diagnoses?

A

Normal pulp

reversible pulpitis

symptomatic irreversible pulpitis

asymptomatic irreversible pulpitis

Pulpal necrosis

previously rct

previously initiated therapy

39
Q

What is a normal pulp?

A

Pulp that is symptoms free and normally responsive to pulp testing

(pos testing to EPT and ethyl chloride - mild or transient response lasting no more then 1/2 seconds after removing stimuli)

40
Q

What is reversible pulpitis?

A

This is where the pulp is inflamed however it should resolve after we manage the cause

41
Q

What is clinical signs of reversible pulpitis?

A

Discomfort when application fo stimulus in pulp testing

No significant radiographic changes in the PA region and pain is not spontaneous

not being kept awake at night

42
Q

When is reversible pulpitis likely?

A

When pt has exposed dentine, caries or deep restorations

43
Q

How do we manage reversible pulpitis?

A

non invasive procedure - such as removing caries and filling and then follow up to check on the pulp

44
Q

What is symptomatic irreversible pulpitis?

A

This is when the pulp is vital and inflamed and incapable of healing - pt will need a root canal

45
Q

What are signs of symptomatic irreversible pulpitis?

A

Sharp pain on thermal stimulus, pain lingers for 30 seconds or longer after, spontaneous pain, referred pain, can’t sleep

46
Q

What are thermal testing results for SIP?

A

sharp pain that lingers for 30 seconds or longer after stimulus removal

47
Q

What is pain like for SIP?

A

spontaneous pain

keeps pt up at night

analgesics ineffective

referred pain

48
Q

What is the pain like for RP?

A

can be managed by analgesics

discomfort when stimulus applied but only lasts a few seconds

49
Q

What are the causes of SIP?

A

deep caries, extensive restos, fractures that expose pulp

50
Q

Why is it difficult to diagnose SIP?

A

Inflammation hasn’t yet reached periodical tissues yet - tooth is still vital so no pain or discomfort on percussion

51
Q

What is asymptomatic irreversible pulpitis?

A

Vital inflamed pulp incapable of healing with no clinical symptoms

52
Q

What does AIP usually respond to?

A

thermal testing normally but pt may have deep caries or trauma that would result in pulpal exposure following removal

53
Q

What Is pulpal necrosis?

A

This is when the pulp has died - there is pulpal necrosis and no response to pulp sensibility testing - the pulp is liquefied

54
Q

What happens when we percuss tooth that has pulpal necrosis?

A

Pain on percussion

55
Q

What is previously root canal treated teeth?

A

This is a tooth that has been endodontically treated - the tooth won’t respond to thermal or EPT

56
Q

What is a tooth that have previously initiated root canal treatment?

A

This is tooth that has had partial Endodontics treatment carried out - for example may have had pulpotomy or pulpectomy but still needs finished

57
Q

What are the apical diagnosis?

A

Normal apical tissues

Symptomatic apical periodontitis

Asymptomatic Apcical periodontitis

Chronic apical abscess

Acute apical abscess

Condensing osteitis

58
Q

What are normal apical tissues?

A

This is when apical tissues are not sensitive to percussion or palpation and radiographically the lamina dura intact and PDL space is uniform

59
Q

What is the lamina dura?

A

Lamina dura is compact bone that lies adjacent to the periodontal ligament, in the tooth socket. The lamina dura surrounds the tooth socket and provides the attachment surface with which the Sharpey’s fibers of the periodontal ligament perforate.

60
Q

What is the PDL?

A

is a group of specialized connective tissue fibers that essentially attach a tooth to the alveolar bone within which it sits. It inserts into root cementum one side and onto alveolar bone on the other.

61
Q

When doing percussion and palpation tests what should we always do?

A

carry out comparative testing with normal teeth to act as a baseline

62
Q

What is symptomatic apical periodontitis?

A

This is when there is inflammation of the apical periodontium - pt may have pain when biting and can be TTP

63
Q

What radiographic changes may be seen in SAP?

A

can have a normal width of PDlL or periapical radiolucency

64
Q

What can severe pain on percussion or palpation indicate?

A

Tooth needs RCT as the pulp is degenerating

65
Q

What is asymptomatic apical periodontitis?

A

This is when there is inflammation and destruction of apical periodontium however pt has no clinical symptoms BUT APICAL RADIOLUCENCY - no pain or TTP

66
Q

What does asymptomatic apical periodontitis appear as?

A

Appears as periapcial radiolucency but often no clinical symptoms (no pain or TTP)

67
Q

What is a chronic apical abscess?

A

This is an inflammatory reaction to pulpal infection or necrosis and has a gradual onset with little to no discomfort and intermittent discharge of pus through a sinus tract

68
Q

What is the onset of chronic apical abscesses like?

A

Gradual - pt will experience little to no discomfort and there is intermittent discharge of pus through sinus tract

69
Q

What is an acute apical abscess?

A

This is an inflammatory reaction to pulpal infection nd necrosis that has rapid onset with spontaneous pain, extreme tenderness, pus formation and swelling

70
Q

What are symptoms of acute apical abscess?

A

Rapid onset

spontaneous pain

extreme tenderness

pus

swelling

no radiographic signs but pt often unwell

71
Q

What is condensing osteitis?

A

This is a diffuser radiopaque lesion representing a bony reaction to low grade inflammatory stimulus - usually seen at apex of teeth

72
Q

What are 5 tx options in endo?

A
  1. Do nothing/monitor
  2. RCT
  3. Re-RCT
  4. XLa
  5. surgical intervention
73
Q

If pt has irreversible puliptis or necrosis what must we do?

A

RCT or Xla

BDS4 Endodontics (7 decks)

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