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BDS3 Endodontics > Diagnosis in endodontics > Flashcards

Diagnosis in endodontics Flashcards

1
Q

What is the definition of diagnosis?

A
  • The identification of the nature of an illness or other problem by examination of the symptoms
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2
Q

What is the process of forming a diagnosis? (5)

A
  1. Why is patient seeking advice
  2. History and symptoms prompting visit
  3. Objective clinical tests
  4. Correlation of objective findings and subjective details to create differential diagnosis
  5. Formulation of definitive diagnosis
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3
Q

What are the elements involved in making a diagnosis? (10)

A
  • Questioning
  • Listening
  • Testing
  • Interpreting
  • Answering ‘why?’
  • Not just gathering data
  • Data interpretation
  • Data processing
  • Questionable versus significant
  • Active dialogue
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4
Q

What is the investigative process for endodontics (for making a diagnosis)? (5)

A
  • Patient history
  • Clinical (endodontic examination)
  • Radiographs
  • Special Investigations
  • Clinical reasoning
  • Diagnosis then treatment
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5
Q

Why is the history of the patient’s presenting complaint important?

A
  • It serves as a clue to diagnosis

- Document using patient’s own words

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6
Q

What should be involved in the history of the presenting complaint? (4)

A
  • Chronology of events leading to P.C.
  • Past and present symptoms
  • Procedures or trauma
  • Clinician led conversation to produce clear and concise narrative
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7
Q

What might be included in a patients clinical notes? (11)

A
  • Complaining of
  • History of presenting complaint (SOCRATES)
  • Past medical history
  • Past dental history
  • Social history
  • Exam: intra and extra oral exam
  • Special investigations
  • Diagnosis
  • Treatment options and risks/prognosis
  • Agreed treatment
  • Signed/dated
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8
Q

What kind of pain do you get from A-delta fibres?

A
  • Sharp pricking sensation

- Early shooting pain

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9
Q

What kind of pain do you get from C fibres?

A
  • Dull, aching or burning

- Late dull pain

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10
Q

What is the definition of endodontic emergency?

A
  • Pain and or swelling cause by various staged of inflammation or infection of the pulp and/or periapical tissues
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11
Q

When taking a pain history you would cover SOCRATES. What does this stand for?

A
  • Site
  • Onset
  • Character
  • Radiates
  • Associated symptoms
  • Time
  • Exacerbating/relieving factors
  • Severity
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12
Q

What is the definition of pain?

A
  • IT is an unpleasant feeling often cause by intense or damaging stimuli, such as stubbing a toe, burning a finger, putting alcohol on a cut, and bumping a funny bone
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13
Q

What is the definition of agony?

A
  • Acute physical or mental pain or anguish

- The suffering or struggle preceding death

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14
Q

What are questions you could ask that would help you get a pain history from the patient? (11)

A
  • Where is the pain? (maxilla/mandible, front or back of mouth)
  • What does it feel like? (short sharp/dull ache)
  • How bad is it?
  • How long is it there for? (constant/few minutes)
  • Does anything take pain away? (pain killers/cold)
  • What makes it worse? (heat, chewing)
  • Does it keep you awake at night?
  • Does the pain come on randomly/spontaneously?
  • Have you had this before?
  • Have you had any dental work recently?
  • Have you suffered any trauma?
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15
Q

What is referred pain?

A
  • Perception of pain in one part of the body distant from source of pain
  • Difficult to discriminate location of pulpal pain
  • Referred pain usually provoked by intense stimulation of C-fibres leading to intense slow, dull pain
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16
Q

Where does referred pain always radiate to in teeth?

A
  • The ipsilateral side
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17
Q

Which teeth seldom refer pain to other teeth or opposite arch?

A
  • Anterior teeth
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18
Q

Where do posterior teeth often refer to?

A
  • To the opposite arch or periradicular area, but seldom to anterior teeth
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19
Q

Where do mandibular posterior teeth refer pain to more often than maxillary?

A
  • The periradicular area
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20
Q

What should you include in a medical history? (2)

A
  • Medical conditions and medications that impact on management
  • Medical conditions that may have oral manifestations or mimic dental pathosis
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21
Q

What are medical conditions that mimic dental pathosis?

A

May be non odontogenic conditions that from the symptoms are initially thought to be odontogenic problems

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22
Q

What can TB and lymphoma cause dentally?

A
  • Lymph node involvement
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23
Q

What can Leukaemia and anaemia cause dentally?

A
  • Paraesthesia
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24
Q

What can sickle cell anaemia cause dentally?

A
  • Bone pain
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25
Q

What can multiple myelomas cause dentally?

A
  • Tooth mobility
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26
Q

What can MS, acute maxillary sinusitis and trigeminal neuralgia cause dentally?

A
  • Pain
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27
Q

What is clinical reasoning?

A
  • Higher order thinking in which the health provider, guided by best evidence or theory, observes and relates concepts and phenomena to develop an understanding of their significance
  • The use of patient’s history, physical signs, symptoms, laboratory data and radiological images to arrive at a diagnosis and formulate a plan of treatment
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28
Q

What can clinical reasoning/decision making be affected by? (7)

A
  • Attitude, preconceptions, bias, previous experience or perspective
  • Mood
  • Timeframe
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29
Q

What should be included in an endodontic examination? (9)

A
  • Extraoral exam
  • Intraoral exam
  • Soft tissue exam
  • Intraoral swelling
  • Sinus tract
  • Palpation
  • Percussion
  • Mobility
  • Periodontal exam
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30
Q

What are examples of pulp sensibility/vitality tests? (4)

A
  • Thermal
  • Electric
  • Laser Doppler Flowmetry
  • Pulse oximetry
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31
Q

Should contralateral teeth be tested with a sensibility test?

A
  • Yes
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32
Q

Why is there sometimes problems with sensibility testing of multi-rooted teeth?

A
  • Can have a situation where the tooth will respond po sitively to an ethyl chloride test but actuallt there is a problem with a nevre in that tooth
  • One root canal could be necrotic and another could be normal
33
Q

What can be used for cold sensibility tests?

A
  • Frozen carbon dioxide
  • Ice (less reliable)
  • Ethyl chloride
  • Refrigerant spray
  • Dry and isolate
34
Q

What do cold sensibility tests test?

A
  • Hydrodynamic forces
35
Q

Are cold sensibility tests reliable?

A
  • Fairly reliable
36
Q

What can be the problem with heat tests?

A
  • Too much heat may cause irreversible pulpitis
37
Q

How can you do heat tests? (2)

A
  • Hot GP - use vaseline

- ‘Hot’ water and dental dam

38
Q

How do electric pulp tests work?

A
  • Electric current used to stimulate sensory nerves
  • Primarily A-delta fast conducting fibres
  • Unmyelinated C-fibres may or may not respond
39
Q

How do you carry out an electric pulp test?

A
  • Dry teeth and isolate
  • Probe place on incisal edge or cusp tip (pulp horn proximity)
  • Conducting medium used (toothpaste)
  • Circuit completed
  • Current slowly increases until response
  • If patient can feel tingling or any discomfort from the tooth they let go
40
Q

Is the electric pulp test an indication of reversibility of inflammation?

A
  • No
41
Q

Does the electric pulp test show a correlation between threshold and pump condition?

A

No (the number on the pulp tester does not give you an indication of how alive the tooth is)

42
Q

Is a negative response on an electric pulp test a reliable indicator?

A
  • Yes
43
Q

Is an electric pulp test on a tooth with open apices reliable?

A
  • No
44
Q

What are other special tests that can be used other than heat/cold and sensibility tests? (4)

A
  • Bite test (frac finder or tooth sleuth)
  • Test cavity (drill into tooth with no LA)
  • Staining and trans-illumination
  • Selective anaesthesia
45
Q

When diagnosing a tooth what 3 things should you think about in relation to that tooth?

A
  • Top of the tooth (crown)
  • Middle of the tooth (pulp)
  • Bottom of tooth (apex, bone, and soft tissue)
46
Q

What are the 7 most likely pulpal diagnosis’s? (7)

A
  • Normal pulp
  • Reversible pulp
  • Symptomatic irreversible pulpitis
  • Asymptomatic irreversible pulpitis
  • Pulp necrosis
  • Previously treated
  • Previously initiated therapy
47
Q

What is a normal pulp?

A
  • Pulp is symptom free and normally responsive to pulp testing
  • Pulp may not be histologically normal
  • ‘clinically’ normal pulp results in a mild or transient response to thermal cold testing, lasting no more then 1-2 seconds after the stimulus is removed
  • Compare the tooth in question with adjacent and contralateral teeth. Test other teeth first so that the patient is familiar with the experience of a normal response to cold
48
Q

Explain reversible pulpitis?

A
  • Inflammation should resolve following appropriate management of the aetiology
  • Discomfort is experienced when a stimulus applied only lasting a few seconds
  • Exposed dentine (dentinal sensitivity), caries or deep restorations
  • No significant radiographic changes in the periapical region of the suspect tooth and the pain experienced is not spontaneous
  • Follow-up required to determine whether the ‘reversible pulpitis’ has returned to a normal status
  • Although dentinal sensitivity per se is not an inflammatory process, all of the symptoms of this entity mimic those of a reversible pulpitis
49
Q

What is symptomatic irreversible pulpitis?

A
  • Vital inflammed pulp is incapable of healing and that root canal treatment is indicated or needs to be extracted
50
Q

What are common characteristics of symptomatic irreversible pulpitis?

A
  • May include sharp pain upon thermal stimulus, lingering pain (often 30 seconds or longer after stimulus removal), spontaneity (unprovoked pain) and referred pain
51
Q

What may pain form symptomatic irreversible pulpitis be accentuated by?

A
  • Postural changes such as lying down or bending over
52
Q

Are OTC an lgesics effective for symptomatic irreversible pulpitis?

A

No

53
Q

What are common aetiologies of symptomatic irreversible pulpitis? (3)

A
  • Deep caries
  • Extensive restorations
  • Fractures exposing the pulpal tissues
54
Q

Why might teeth with symptomatic irreversible pulpitis be difficult to diagnose?

A
  • Because the inflammation has not yet reached the periapical tissues, thus resulting in no pain or discomfort to percussion
55
Q

What are the primary tools for assessing pulpal status in symptomatic irreversible pulpitis? (2)

A
  • Dental history and thermal testing
56
Q

What is asymptomatic irreversible pulpitis?

A
  • Vital inflammed pulp is incapable of healing and RCT or extraction is indicated
  • No clinical symptoms and usually respond to thermal testing but may have had trauma or deep caries that would likely result in exposure following removal
57
Q

What is pulp necrosis?

A
  • Diagnostic category indicating death of the dental pulp, necessitating RCT
58
Q

Is pulp necrosis responsive to pulp testing?

A
  • No
59
Q

Is pulp necrosis symptomatic or asymptomatic?

A
  • Asymptomatic
60
Q

Does pulp necrosis cause apical periodontitis?

A

Not by itself

61
Q

With pulp necrosis is there pain to percussion or radiographic evidence of osseous breakdown?

A
  • No, unless the canal is infected
62
Q

What is ‘previously treated’ teeth?

A
  • Clinical diagnostic category indicating that the tooth has been endodontically treated
  • Canals are obturated with various filling materials other than intracanal medicaments
63
Q

Do ‘previously treated’ teeth usually respond to thermal or electric pulp testing?

A
  • No
64
Q

What is the category ‘previously initiated’?

A

Clinical diagnostic category indicating that the tooth has been previously treated by partial endodontic therapy such as pulpotomy or pulpecti my

65
Q

Do ‘previously initiated’ endo teeth usually respond to pulp testing modalities?

A
  • Depending on the level of therapy, the tooth may or may not respond to pulp testing modalities
66
Q

What are the possible apical diagnoses? (6)

A
  • Normal apical tissues
  • Symptomatic apical periodontitis
  • Asymptomatic apical periodontitis
  • Chronic apical abscess
  • Acute apical abscess
  • Condensing osteitis
67
Q

Explain normal apical tissues?

A
  • Not sensitive to percussion or palpatiomn testing and radiographically, the lamina dura surrounding the root is in tact and the periodontal ligament space is uniform
  • Comparative testing for percussion and palpation should always begin with normal teeth as a baseline for the patient
68
Q

What is symptomatic apical periodontitis?

A
  • Represents inflammation, usually of the apical periodontium
69
Q

Would you get any response to biting and/or percussion or palpation with a tooth with symptomatic apical periodontitis?

A
  • Would get a painful response
70
Q

Will symptomatic apical periodontitis be accompanied by radiographic changes?

A
  • May or may not be (depending upon the stage of the disease, there may be normal width of the periodontal ligament or there may be a periapical radiolucency)
71
Q

What is highly indicative of a degenerating pulp and RCT is needed?

A
  • Severe pain to percussion and/or palpation
72
Q

What is asymptomatic apical periodontitis?

A
  • Inflammation and destruction of the apical periodontium that is of pulpal origin
  • Appears as an apical radiolucency and doe snot present clinical symptoms (no pain on percussion or palpation)
73
Q

What is a chronic apical abscess?

A
  • Inflammatory reaction to pulpal infection and necrosis
  • Characterised by gradual onset, little or no discomfort and an intermittent discharge of pus through an associated sinus tract
74
Q

What is the radiological sign of a chronic apical abscess?

A

Signs of osseos destruction such as a radiolucency

75
Q

What is an acute apical abscess?

A
  • Inflammatory reaction to pulpal infection and necrosis
  • Characterised by rapid onset, spontaneous pain, extreme tenderness of the tooth to pressure, pus formation and swelling of associated tissues
76
Q

Are there radiographic signs of an acute apical abscess?

A
  • May be no radiographic signs of destruction and the patient often experiences malaise. fever and lymphadenopathy
77
Q

What is Condensing osteitis?

A
  • Diffuse radiopaque lesion representing a localised bony reaction to a low-grade inflammatory stimulus usually seen at the apex of the tooth
78
Q

What are the possible endo treatments? (5)

A
  • Root canal treatment
  • Re root canal treatment
  • Extract the tooth
  • Monitor/don’t intervene
  • Surgical intervention

BDS3 Endodontics (8 decks)

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