Diagnosis in Endodontics Flashcards
diagnosis definition
identification of the nature of an illness or other problem by examination of symptoms
what is the 5 step process of diagnosis
- why is pt seeking advice
- history and symptoms prompting visit
- objective clinical test
- correlation of findings and details to create diagnosis
- formulation of definitive diagnosis
things to consider when formulating diagnosis
pt history, clinical examination, radiographs, special investigations, clinical reasoning
PC and HPC in diagnosis
reason for attending serves as a clue to diagnosis
chronology, past/present symptoms, truama
pain from A-delta fibres
sharp, pricking sensation. early shooting pain
pain from C fibres
dull, aching, burning
late, dull pain
endodontic emergency
pain/swelling by inflammation or infection of pulpal and/or periapical tissues
can you still have endodontic pain if the nerve has been removed
YES
the tooth still sits in the PDL and alveolar bone which can still suffer from inflammation
symptoms can occur post-treatment
can be inflammation or infection of bone
what to use when taking a pain history
SOCRATES
what is referred pain
perception of pain is difficult to determine location of pulpal pain
usually provoked by intense stimulation of C fibres, leading to intense, slow, dull pain
radiation to ipsilater side, anterior teeth rarely refer pain
posterior teeth refer to opposite arch
mandibular posterior refer to periauricular area
medical conditions which could have oral manifestations or mimic dental pathosis
lymph node involvement = TB, lymphoma
paraesthesia = leukaemia, anaemia
bone pain = sickle cell anaemia
tooth mobility = multiple myeloma
pain = MS, acute maxillary sinusitis, trigeminal neuralgia
endodontic examination steps
E/O - airway compromised, eye swelling, sinus breaking through skin
I/O
soft tissue - swelling, lumps
hard tissue - carious
root fracture
sinus tracts
palpation
percussion
mobility
periodontal exam
sensibility tests
test neuron/nerve function in tooth
contra-lateral teeth should be tested, assumption made that nerve fibres are in pulp
electric pulp test
electric current stimulates sensory nerves
what are the 7 pulpal diagnoses
- normal pulp
- reversible pulpitis
- symptomatic irreversible pulpitis
- asymptomatic irreversible pulpitis
- pulp necrosis
- previously treated
- previously initiated therapy
normal pulp
symptom free and responds normally to pulp testing
clinically - mild response to cold testing, no more than 1-2 seconds after stimulus removed
compare with contralater tooth
reversible pulpitis
inflammation can resolve after management
discomfort when sitmulus applied, lasting a few seconds
exposed dentine caries or deep restoration
no significant radiograph changes in periapical region, pain is not spontaenous
symptomatic irreversible pulpitis
vital inflamed pulp is incapable of healing, root canal tx is needed
sharp pain on thermal stimulus, lingering pain 30secs, spontaneity/unprovoked pain, referred pain
pain accentuated via lying down, bending over
analgesics ineffective
deep caries, extensive restoration, fractures exposing pulpal tissues
hard to diagnose as inflammation not yet reached periapical tissues so no pain to percussion
thermal testing
asymptomatic irreversible pulpitis
vital inflamed pulp incapble of healing, root tx needed
no clinical symptoms, responds to thermal testing
deep cavity into pulp, excavation of caries can lead to exposure
root treatment or extraction
pulp necrosis
nerve is dead
death of pulp, root canal tx
non responsive to pulp testing, asymptomatic
pain to percussion
previously treated
endo treatment
canals obturated
does not typically respond to thermal or electric pulp testing
previously initiated therapy
tooth previously treated via pertial therapy like pulpotomy or pulpectomy
tooth may or may not respond to modalities
what are the 6 apical diagnoses
- normal apical tissue
- symptomatic apical periodontitis
- asymptomatic apical periodontitis
- chronic apical abscess
- acute apical abscess
- condensing oesteitis
normal apical tissues
not sensitive to percussion or palpation testing
radiographically lamina dura surrounding root is intact, PDL space is uniform
comparative testing used
symptomatic apical periodontitis
inflammation, usually of apical periodontium
painful response to biting, percussion, palpation
can be accompanied by radiographic changes [depending on stage of disease, may be normal PDL width or periapical radiolucency]
severe pain to percussion/palpation, degenerative pulp and root canal tx needed
asymptomatic apical periodontitis
inflammation and destruction of apical periodontium in pulp
apical radiolucency, no clinical symptoms
chronic apical abscess
inflammatior reaction to pulpal infection and necrosis
gradual onsent, little/no discomfort, intermittent discharge of pus through associated sinus tract
radiographically - signs of osseous destruction and radiolucency
sinus tract tracing possible
acute apical abscess
inflammatory reaction to pulpal infection and necrosis
rapid onset, spontaneous pain, extreme tenderness of tooth to pressure, pus formation and swellung of associated tissues
radiographically, may be no signs of destructions
pt experiences malaise, fever, lymphadenopathy
condensing osteitis
diffuse radiopaque lesion representing localised bony reaction to low-grade inflammatory stimulus usually at apex of tooth
shown as dense, bony region on radiograph
treatment options for endodontic diagnoses
- root canal tx [irreversible or necrotic pulp]
- re-root canal tx
- extraction
- monitor/no intervention
- surgical intervention
