Diagnosis in Endodontics

Question 1

diagnosis definition

Answer 1

identification of the nature of an illness or other problem by examination of symptoms

Question 2

what is the 5 step process of diagnosis

Answer 2

1. why is pt seeking advice
2. history and symptoms prompting visit
3. objective clinical test
4. correlation of findings and details to create diagnosis
5. formulation of definitive diagnosis

Question 3

things to consider when formulating diagnosis

Answer 3

pt history, clinical examination, radiographs, special investigations, clinical reasoning

Question 4

PC and HPC in diagnosis

Answer 4

reason for attending serves as a clue to diagnosis
chronology, past/present symptoms, truama

Question 5

pain from A-delta fibres

Answer 5

sharp, pricking sensation. early shooting pain

Question 6

pain from C fibres

Answer 6

dull, aching, burning
late, dull pain

Question 7

endodontic emergency

Answer 7

pain/swelling by inflammation or infection of pulpal and/or periapical tissues

Question 8

can you still have endodontic pain if the nerve has been removed

Answer 8

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

Question 9

what to use when taking a pain history

Answer 9

SOCRATES

Question 10

what is referred pain

Answer 10

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

Question 11

medical conditions which could have oral manifestations or mimic dental pathosis

Answer 11

lymph node involvement = TB, lymphoma
paraesthesia = leukaemia, anaemia
bone pain = sickle cell anaemia
tooth mobility = multiple myeloma
pain = MS, acute maxillary sinusitis, trigeminal neuralgia

Question 12

endodontic examination steps

Answer 12

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

Question 13

sensibility tests

Answer 13

test neuron/nerve function in tooth
contra-lateral teeth should be tested, assumption made that nerve fibres are in pulp

Question 14

electric pulp test

Answer 14

electric current stimulates sensory nerves

Question 15

what are the 7 pulpal diagnoses

Answer 15

1. normal pulp
2. reversible pulpitis
3. symptomatic irreversible pulpitis
4. asymptomatic irreversible pulpitis
5. pulp necrosis
6. previously treated
7. previously initiated therapy

Question 16

normal pulp

Answer 16

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

Question 17

reversible pulpitis

Answer 17

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

Question 18

symptomatic irreversible pulpitis

Answer 18

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

Question 19

asymptomatic irreversible pulpitis

Answer 19

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

Question 20

pulp necrosis

Answer 20

nerve is dead
death of pulp, root canal tx
non responsive to pulp testing, asymptomatic
pain to percussion

Question 21

previously treated

Answer 21

endo treatment
canals obturated
does not typically respond to thermal or electric pulp testing

Question 22

previously initiated therapy

Answer 22

tooth previously treated via pertial therapy like pulpotomy or pulpectomy
tooth may or may not respond to modalities

Question 23

what are the 6 apical diagnoses

Answer 23

1. normal apical tissue
2. symptomatic apical periodontitis
3. asymptomatic apical periodontitis
4. chronic apical abscess
5. acute apical abscess
6. condensing oesteitis

Question 24

normal apical tissues

Answer 24

not sensitive to percussion or palpation testing
radiographically lamina dura surrounding root is intact, PDL space is uniform
comparative testing used

Question 25

symptomatic apical periodontitis

Answer 25

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

Question 26

asymptomatic apical periodontitis

Answer 26

inflammation and destruction of apical periodontium in pulp
apical radiolucency, no clinical symptoms

Question 27

chronic apical abscess

Answer 27

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

Question 28

acute apical abscess

Answer 28

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

Question 29

condensing osteitis

Answer 29

diffuse radiopaque lesion representing localised bony reaction to low-grade inflammatory stimulus usually at apex of tooth
shown as dense, bony region on radiograph

Question 30

treatment options for endodontic diagnoses

Answer 30

• root canal tx [irreversible or necrotic pulp]
• re-root canal tx
• extraction
• monitor/no intervention
• surgical intervention