DX Flashcards
Data used to arrive at a DX
pt hx
dental hx
clinical exam
radiograph
Test used as part dx clinical exam
Percussion Palpation Ice and EPT Clinical Probing Tooth sluth Transilluminate Test cavity
what questions to ask for dental hx (emergency exam)
Duration of symptoms
Nature of the pain- changes in pain over time, pain scale
Ever had this kind of pain before
What makes it better and what makes it worse
Have you taken any medication
Any recent dental work
Clinical Exam- (6)
Swelling/sinus tracts Caries, poor resto, fractures, exposed GP Occlusion Perio- mobility, local vs gen Thermal test Percussion and palpation
Vert Root fracture
Localized deep probing depth
F/L
A delts fibers
Sharp pain
What does a PARL represent
Immune response
Pulpal Pain
Very sharp
Temp
Not very well localized
Bone Pain
Deep ache or throb
No temp
Palpation and percussion tender
Well localized
Bone pain test
Palpation
Percussion
Bitting
Radio
Pulpal testing
Thermal test
EPT
Test cavity
Selective anes- max vs man
When testing where should you begin
Not at the area of the CC
What pt to know what normal is
What are bone pain test looking for
Periradicular inflammation
Incomplete crn fracture
Percussion test
Good to find a tooth that is acutley painful with periradicular inflammation
Palpation test
Good if the inflammation has penertrated the alveolar bone
Test when a pt CC is bitting pain
A bite test
Look for signs of fracture
Goal of pulp testing
To reproduce pt CC or change the nature of their pain
- Reproduce pain
- Eliminate pain
- Chnage the severity of pain
Normal for pulp testing
Need to test adjacent teeth to determine normal to then be able to decide what is abnormal
Ice water immersion
Good for ppl whos CC is cold water and cant replicate with endo ice
- place RD and then put cold water on
- Also can use a piece of ice
- Good for cracks, open margins
Heat test
Good when heat is CC and cant chnage symptoms with cold
- RD and hot water
or CP and hot water
Casue of false positive with pulp test
Gingiva response
Anxiety
Adjacent teeth
Percussion vs temp sensation
Causes of false negatives
Calcified canals
Restorations
Trauma
Poorly done test- not cold enough etc
EPT
All or none vital or not
Tooth must be dry
Test Cavity
Last resort- Get past DEJ and no sensation–> Necrotic
Selective Anes
Good to defferenciate max from man
Radiographic exam
Caries Deep resto Previous RCT Pulp chamber and canals PDL and root surface Surrounding perio/bone
Radio exam limitations
Onlt 2-D
Misleading factors in DX
Imprecise endo testing- poor pt communication Lack of pulpal perception Referred pain Distracted but other "obvious" findings Mislead by another dx
How to avoid errors in dx
Listen to pt ask why Dont jump to radio conslusions Clinical matches radio Test are well done and thorough
Cracked tooth
Tooth sluth Trans illuminate Bite test 80% get better with cuspal coverage 20% will need RCT
