diseases of pulp and periodontium

Question 1

pulp hyperaemia

Answer 1

excess blood flow to pulp causing pain
also known as reversible pulpitis

Question 2

clinical features of reversible pulpitis (pulp hyperaemia)

Answer 2

pain lasts only a few seconds and is sharp in characteristic
pain is stimulated e.g by cold/ sweet food
pain resolved after stimulus removed
caries aapproaching pulp but tooth can still be restored without treating pulp

Question 3

what is acute pulpitis more commonly termed

Answer 3

irreversible pulpitis

Question 4

clinical features of irreversible pulpitis (acute pulpitis)

Answer 4

constant severe pain, throbbing
reacts to thermal stimulli
poorly localised
referred pain (can refer to opposite jaw)
no or minimal response to analgesia (as they cant reach pulp chamber)

symptoms may be less severe in cases where there is pulpal exposure as pressure can be released

Question 5

how would you go about diagnosing irreversible pulpitis

Answer 5

thorough history - most useful
visual examination
usually negative to TTP as not reached apical tissues yet and PDL not inflamed
RAdiographs wont show much other than possible big cavity

removal of restorations
diagnostic LA to see if pain subsides

Question 6

acute apical periodontitis diagnostic features

Answer 6

once in apical tissues patient can pinpoint exact location
TTP - very tender. may feel high to patient due to pain, feels like biting on it before any other teeth
non vital as pulp has died
possible increase in mobility due to PDL changes
may see lamina dura loss in radiograph however no apical radiolucency at this stage

Question 7

what is the cause of traumatic periodontitis

Answer 7

parafunction - clenching or grinding

Question 7

what would aid your diagnosis of traumatic periodontitis

Answer 7

clinical exam of occlusion - signs of attrition?
positive to TTP
normal vitality
no history of acute trauma
radiographs may show generalised widening of PDL space across all teeth

Question 7

treatment of traumatic periodontitis

Answer 7

occlusal adjustment
therapy for parafunction

Question 8

what is the most common pus producing dental infection

Answer 8

acute apical abscess

Question 10

In its early stages, what might an acute apical abscess be mistaken for

Answer 10

prior to eroding through bone acute apical abscess may be confused with acute apical periodontitis
symptoms almost identical prior to bone involvement

Question 11

early symptoms of an acute apical abscess

Answer 11

severe unremitting pain
acute tenderness during function
acute tenderness on percussion

Question 12

what are the 5 cardinal signs of inflammation, all of which would be seen during a dental infection

Answer 12

heat, redness, swelling, pain, loss of function

Question 13

once an acute apical abscess perforates bone what will be seen ..

Answer 13

pain may initially lessen due to relief of pressure (unless in palate)
swelling, redness and heat in the soft tissues will become more and more apparent
as swelling increases, pain will return due to pressure
may be a reduction in TTP of tooth as pus escapes into soft tissues

Question 14

treatment of an acute apical abscess

Answer 14

provide drainage - soft tissue excision intra orally (or extra orally, max-fax)
remove source/ cause - extraction or extirpation
Occasionally antibiotics are required if particularly severe, unable to adequately drain, or compromised MH

Question 15

another name for chronic apical periodontitis

Answer 15

periapical granuloma

Question 16

what is chronic apical periodontitis (periapical granuloma)

Answer 16

mass of chronically inflamed granulation tissue at apex of tooth

Question 17

apical radicular cyst

Answer 17

periapical granuloma that has progressed to a cyst
seen around teeth that are non vital
cyst is painless and fluid filled, will grow over time

Question 18

what is a rare advancement of an apical radicular cyst

Answer 18

infected apical radicular cyst
painful

Question 19

describe a possible progression route from caries to infected apical radicular cyst

Answer 19

1. caries
2. pulp hyperaemia (reversible)
3. acute pulpitis (irreversible) ]
4. acute apical periodontitis
5. acute apical abscess
6. chronic apical infection
7. apical radicular cyst
8. infected apical radicular cyst