Diseases of the Pulp and Periodontium Flashcards
What are the symptoms of pulp hyperaemia (reversible pulpitis)?
Pain lasting for seconds
Pain stimulated by hot/cold or sweet foods
Pain resolves after stimulus
What are the symptoms of acute pulpitis?
Constant severe pain
Reacts to thermal stimuli
Referral of pain
No (or minimal response to analgesics)
What is acute pulpitis typically?
Cavity which has reached the pulp and causes the pulp to be inflamed and stuck in such a small space
How do you diagnose acute pulpitis?
History
Visual examination
Negative tenderness to percussion -PDL is not inflamed yet
Pulp chamber will look normal in x-rays
What are the 5 cardinal signs of inflammation?
Swelling
Redness
Heat
Pain
Loss of function
How can you diagnose acute apical periodontitis?
Tenderness to Percussion (TTP)
Slight increase in mobility
Tooth is non-vital
Radiographically
–loss of clarity of lamina dura
–radiolucent shadow
–widening of apical periodontal space
What are the symptoms of acute apical abscess when it has not yet perforated through the bone?
Severe unremitting pain
Acute tenderness in function (sore when biting)
Acute tenderness on percussion
No swelling, redness or heat yet
What are the symptoms of acute apical abscess when it has perforated the bone?
Pain often remits as there is a release of pressure
Swelling, redness and heat (in the soft tissues)
Initial reduction in tenderness to percussion of the tooth as pus escaped into the soft tissues
What are the local factors for the need of antibiotics?
Patient is systemically unwell
Airway compromised
Dysphagia (difficulty swallowing)
Trismus
Lymphadenitis
Location (e.g. floor of the mouth) can affect breathing
What are the systemic factors for the need of antibiotics?
Immunocompromised patients
–acquired causes (HIV)
–drug induced (steroids)
–Blood disorders (leukaemias)
Diabetes- poorly controlled (slower healing)
Elderly
What is reversible pulpitis?
A level of inflammation in which returning to a normal state is possible if noxious stimulus removed
I.e pulp is inflamed due to caries or existing restoration and if you deal with the cause the pulp will recover
What are the symptoms of reversible pulpitis?
Mild-moderate tooth pain when stimulated, no pain without stimulus subsides within seconds (<5 seconds), no mobility, no pain on percussion
What is irreversible pulpitis?
Treatment?
Denotes a higher level of inflammation in which dental pulp has been damaged beyond the point of recovery
Requires root canal or XLA
What are the symptoms of irreversible pulpitis?
Sharp, throbbing, severe pain upon stimulus
Pain may be spontaneous or occur without stimulation, pain persists after stimulation is removed (>5 seconds)
What is a periapical granuloma (chronic apical periodontitis)?
Mass of chronically inflamed granulation tissue at the apex of tooth (plasma cells, lymphocytes and a few histocytes with fibroblasts and capillaries)
Can see this attached to the tooth’s apex upon extraction
