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BDS3 - Endodontics > Diagnosis In Endodontics > Flashcards

Diagnosis In Endodontics Flashcards

1
Q

What do you need to put in your notes about the history of a present complaint?

A 
Chronology of events leading to PC
Past and present symptoms
Procedures or Trauma
Clinician led conversation t0 produce clear and concise narrative
(all in patients own words).
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2
Q

What type of pain do A-delta fibres cause?

A

Sharp pricking sensation, early shooting pain.

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3
Q

What type of pain do C fibres cause?

A

Dull, aching or burning pain. Late dull pain.

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4
Q

What is classed as an endodontic emergency?

A

Pain and or swelling caused by various stages of inflammation or infection of the pulpal and or periapical tissues.

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5
Q

What does SOCRATES stand for when doing a pain history?

A 
Site
Onset
Character
Radiation
Association
Time course
Exacerbating/Relieving factors
Severity.
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6
Q

What is the definition of pain?

A

An unpleasant feeling often caused by an intense or damaging stimuli, such as stubbing a toe, burning a finger, pulling alcohol on a cut and bumping the funny bone.

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7
Q

What is the definition of agony?

A

The suffering of pain preceding death.

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8
Q

What is referred pain?

A

Perception of pain in one part of the body distant from the source of pain. Referred pain usually provoked by intense stimulation of C-fibres leading to intense, slow, dull pain.

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9
Q

Where does referred pain always radiate to?

A

The ipsilateral side.

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10
Q

Where do anterior teeth refer pain to?

A

Other teeth or opposite arch.

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11
Q

Where do posterior teeth often refer pain to?

A

The opposite arch or periauriccular area (seldom to anterior teeth).

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12
Q

Where is the dental origins of TB and lymphoma?

A

Lymph node involvement.

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13
Q

Where is the dental origins of leukaemia and anaemia?

A

Paraesthesia.

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14
Q

What is the dental origin of sickle cell anemia?

A

Bone pain.

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15
Q

What is the dental origins of multiple myeloma?

A

Tooth mobility.

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16
Q

What is the dental origin of MS, trigeminal neuralgia and acute maxillary sinusitis?

A

Pain.

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17
Q

What is clinical reasoning?

A

Higher order thinking in which the health care provider, guided by the best evidence or theory, observes and relates concepts and phenomena to develop an understanding of their significance.

18
Q

What are the different steps to an endodontic examination?

A 
Extra oral exam
Intra oral exam
Soft tissue exam
Intraoral swelling
Sinus tracts
Palpation
Percussion
Mobility
Periodontal exam.
19
Q

What are 4 examples of pulp tests?

A

Thermal
electric
Laser doppler flowmetry
Pulse oximetry.

20
Q

Why is sensibility testing problematic with multi-rooted teeth?

A

Can have a situation in mulitrooted tooth- respond positivity but there is damage- some are damaged and some are normal.

21
Q

How do cold sensibility tests work?

A 
Through hydrodynamic forces
Cold/Hot tests
Frozen CO2 (-78 degrees)
Ice is less reliable!
Ethyl chloride
Refrigerant spray
Dry and isolate
Close to pulp horn
DO they get a response
These are fairly reliable.
22
Q

How do heat tests work and what can too much heat cause?

A

Might cause irreversible pulpitis
Hot GP- use vaseline
Hot water and dental dam etc.

23
Q

How does an electric pulp test work?

A

An electric current is used to stimulate sensory fibres. Primarily A-delta fast conducting fibres. Unmyelinated C fibres may or may not respond
IT HAS NO INDICATION OF REVERSIBILITY OF INFLAMMATION AND NO CORRRELATION BETWEEN THRESHOLD AND PULP CONDITION!
-EPT OF OPEN APICES IS UNRELIABLE
-NEGATIVE RESPONSE IS A RELIABLE INDICATOR
-always remember to test the contralateral tooth.

24
Q

What are some other special tests you can do?

A

Bite test (tooth sleuth)
Test cavity
Staining (good for fractures) and transillumination
Selective anaesthesia.

25
Q

*remember we need two pre-op radiographs from different angulations for endo with a proper dental/medical history and clinical exam before making a decision on diagnosis.

A

*

26
Q

What is one example of a way that you can tract a sinus tract?

A

By placing GP into the sinus and taking a radiograph.

27
Q

What do you include in a radiographic report?

A 
What type of radiograph it is
What teeth are present
What tooth is our focus tooth
What grade the radiograph is
What the radiograph shows eg. large restoration, deep distally, recession of pulp etc
Level of surrounding bone.
28
Q

What is the 7 different pulpal diagnoses?

A 
Normal pulp
Reversible pulpitis
Symptomatic irreversible pulpitis
Asymptomatic irreversible pulpitis
Pulp necrosis
Previously treated
Previously initiated therapy.
29
Q

What is reversible pulpitis?

A

Inflammation should resolve following appropriate management of the aetiology
Discomfort is experienced when a stimulus applied but only lasts 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 non-spontaneous
Follow up required to determine whether this inflammation has resolved
Although dentinal sensitivity per se is not an inflammatory process, all of the symptoms of this entity mimic those of reversible pulpitis.

30
Q

What are the features of symptomatic irreversible pulpitis?

A

Vital inflammed pulp is incapable of healing and that RCT is indicated
Characteristics- sharp pain upon thermal stimulus, lingering pain (often 30 seconds or longer after stimulus removal) and referred pain
Pain may be made worse by postural changes
OTC painkillers usually ineffective
May be caused by deep caries, extensive restorations, or fractures exposing fractured tissues
May be difficult to diagnose because the inflammation has not yet reached the periapical tissues- no pain to percussion
-dental history and thermal testing are the primary tools for assessing pulpal status.

31
Q

What are the characteristics of asymptomatic irreversible pulpitis?

A

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

32
Q

What is pulp necrosis?

A

Diagnostic category indicating the death of the pulp, needs RCT
Non-responsive to pulp testing and is asymptomatic
Does not by itself cause apical periodontitis
(pain to percussion or radiographic evidence of ossseous breakdown)- unless the canal is infected.

33
Q

What are the characteristics of a previously treated endo tooth?

A

Clinical diagnostic category indicating that the tooth has been previously endodontically treated
Canals are obturated with various other filling materials other than intra canal medicaments
THE TOOTH TYPICALLY DOES NOT RESPOND TO THERMAL OR ELECTRIC PULP TESTING.

34
Q

What are the characteristics of a previously initiated endo tooth?

A

Clinical diagnostic category indicating that the tooth has previously been treated by partial endodontic therapy such as pulpotomy or pulpectomy
DEPENDING ON THE LEVEL OF THERAPY THE TOOTH MAY OR MAY NOT RESPOND TO PULP TESTING MODALITIES.

35
Q

What are the 6 apical diagnoses?

A
  • normal apical tissues
  • symptomatic apical peridontitis
  • asymptomatic apical periodontitis
  • chronic apical absess
  • acute apical absess
  • condensing osteitis.
36
Q

What are the characteristics of a normal apical tissues tooth?

A

Not sensitive to percussion or palpation testing and radiographically- the lamina dura
Surrounding the root is intact and the PDL space is uniform
Comparative testing for percussion and palpation should always begin with normal teeth as a baseline for the patient.

37
Q

What are the characteristics of a symptomatic apical periodontitis tooth?

A

Represents inflammation usually of the periapical periodontium
Painful response to biting and or percussion/palpation
May or may not be accompanied by radiographic changes (depending upon the stage of the disease, there may be normal width of the PDL or there may be a periapical radiolucency)
Severe pain to percussion/palpation is highly indicative of a degenerating pulp and root canal treatment is needed.

38
Q

What are the characteristics of a asymptomatic apical periodontitis tooth?

A

Inflammation and destruction of the apical periodontium that is of pulpal origin
Appears as an apical radiolucency and does not present clinical symptoms (no pain to percussion or palpation).

39
Q

What are the characteristics of a chronic apical absess?

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
Radiographically signs of osseous destruction such as a radiolucency
Sinus tract tracing possible.

40
Q

What are the characteristics of a acute apical absess?

A

Inflammatory response to pulpal infection and necrosis
Characterised by rapid onset, spontaneous pain, extreme tenderness of the tooth and pressure, pus formation and swelling of associated tissues
May be no radiographic signs of destruction and the patient often appears malaise, fever and lymphadenopathy.

41
Q

What are the characteristics of condensing osteitis?

A

Diffuse radiopaque lesion representing a localised bony reaction to a low grade inflammatory stimulus usually seen at the apex of a tooth.

42
Q

How do you write an endodontic clinical diagnosis in your notes?

A

-Diagnosis tooth 46- secondary caries, irreversible pulpitis, apical periodontitis
(if they had swelling would also be an acute apical absess)
-Multiple diagnosis for one tooth

Treatment options
MONITOR (risks and prognosis)
RCT (risks and consent)
EXTRACT (risks and prosthetic options)
SURGERY (not first line).

BDS3 - Endodontics (10 decks)

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