E/O fistula Flashcards
A. Does the size of radiolucency in the periapical regions correlate to the severity of an infection?
The size of radiolucency in the periapical regions has no correlation to the severity of an infection. A clinician should not rely solely on a radiograph to diagnose a case. Several factors, such as the path- way of bone resorption and the amount of the bone resorption and locations of the roots, all can contribute the appearance of radiolucency in a conventional digital radiograph (Bender 1997).
B. Can an extra‐oral sinus tract heal on its own after surgical intervention to drain/clean it?
If the tooth is the source of infection that caused the extra‐oral sinus tract, the sinus tract or infection will not heal even after surgical intervention to curettage the sinus tract (Goldberg &Topazian 1981). The infected tooth must be treated (Kakehashi, Stanley & Fitzgerald 1965)
C. Can a tooth with an acute apical abscess test positive with a cold test?
Generally speaking, a tooth that develops a sinus tract should test negative with a cold test. However, one needs to be aware that a patient can still give a false positive response with a cold test due to residual pulp tissue remaining (Yamasaki et al. 1994). When a patient is in moderate to severe pain, pulpal thermal tests may not be a reliable source (Chambers 1982).
D. What is the etiology of the infection for the case in this chapter?
The etiology of the infection in the illustrated case in this chapter was bacterial (Kakehashi et al. 1965).The most likely passage was the junction between the composite and enamel. The prepara- tion site might also have been contaminated during restoration procedures. Streptococcus bacteria are 0.5–2.0 micrometer in diameter. An average middle dentinal tubule diameter size is 1.2 micrometer and 2.5 micrometer near the pulp chamber. If there is bacterial contamination in the cavity preparation site, bacteria can penetrate into the pulp through dentinal tubules (Michelich, Schuster & Pashley 1980).
E. What could be done to prevent the misdiagnosis that was made by the patient’s general dentist in this chapter?
Radiographs alone should not be used for endodontic diagnosis (Bender & Seltzer 1961; Bender 1997).The clinician should listen carefully to the patient’s chief complaint, and carry out thorough intra‐ and extra‐oral exams.The new technology of cone beam‐computed tomography (CBCT) can also be a very helpful tool to help diagnose difficult cases (Lascala, Panella & Marques 2004).
