diagnosis of endodontic issues Flashcards
What is reversible pulpitis and associated symptoms?
Common causes?
discomfort / sensitivity with cold, hot or sweet stimuli due to reversible inflammation of the pulp
disseminates after a few seconds
often caused by caries, deep restorations, intense thermal stimuli to tooth
What is symptomatic irreversible pulpitis?
Symptoms?
Common causes
Vital inflamed pulp that is incapable of healing and RCT indicated
sharp pain on stimulus for up to 30s after removal of stimuli
postural changes can cause pain
no apical issues so no percussion pain
often deep caries, fractures, or restorations
What is asymptomatic irreversible pulpitis?
Vital inflamed pulp is incapable of healing and RCT indicated, yet there is no clinical symptoms.
What is pulp necrosis
Symptoms?
death of the dental pulp
Pulp non-responsive to sensibility testing and is asymptomatic
no percussion pain unless the canal is infected
What are normal apical tissues
normal healthy apical tissues
sensitive to percussion testing
intact lamina dura and uniform PDL space
What is symptomatic apical periodontitis
Symptoms?
Radiographic signs?
inflammation, typically of the apical periodontium
symptomatic with pain on percussion or biting
- NO swelling
not always radiographic changes but can have
- PDL widening
- apical radiolucency
What is asymptomatic apical periodontitis
inflammation and destruction of apical tissues that is of pulpal origin
Apical radiolucency with the absence of clinical symptoms
What is a chronic apical abscess?
Symptoms?
Radiographic signs?
Inflammatory reaction to pulpal infection and necrosis / trauma
- gradual onset
- little or no discomfort
- intermittent discharge of pus through associated sinus tract
Radiographically
- apical radiolucency
- loss of PDL
What is acute apical abscess?
Symptoms?
Radiographic signs?
Inflammatory reaction to pulpal infection and necrosis
- very fast onset
- spontaneous pain
- tenderness to percussion
- pus formation and swelling of the tissues
Often malaise, fever and lymphadenopathy
Not always an apical radiolucency
What is condensing osteitis
A radiopaque bone lesion, bony reaction to low-grade inflammation
what are the 4 general rules for referred periodontal pain?
always radiates to the same side
anterior teeth often don’t refer pain to other teeth, or the opposite arch
posterior teeth often refer pain to opposite arch or periauricular area
mandibular posterior teeth more often refer pain to periauricular area too, more often than maxillary posteriors.
how may an active sinus tract be checked for endodontic reasons
gutta percha in the sinus tract and then X ray
What examination procedures are needed to make an Endodontic diagnosis?
MH/DH - recent treatment etc
Chief complaint - if any - SOCRATES
Clinical exam - facial symmetry, sinus tract, soft tissue, PDL status, caries, restorations (any defective or newly placed?)
Clinical testing - cold, EPT, heat test
Periapical tests - percussion, palpation, biting
Radiographic analysis - new periapicals, at least 2, bitewing or cone beam-computed tomography
Additional tests - transillumination, selective anaesthesia, test cavity
