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BDS3 Endo > Endo Diagnosis > Flashcards

Endo Diagnosis Flashcards

1
Q

What is the 5-step process of diagnosis?

A

1 - why is the patient seeking advice/come in?
2 - History and symptoms of P complaint

3 - Objective clinical tests

4 - Correlation of objective findings and subjective details to create differential diagnosis

5 - Formulation of definitive diagnosis

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2
Q

What nerve fibres are responsible for dental pain?

A

A-delta and C fibres

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3
Q

What kind of dental pain is associated with A-delta fibres?

A

Sharp pricking sensation

Early shooting pain

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4
Q

What kind of dental pain is associated with C-fibres?

A

Dull, aching or burning

Late dull pain

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5
Q

What is the definition of an endodontic emergency?

A

Pain and/or swelling caused by various stages of inflammation or infection of the pulpal and/or periapical tissues

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6
Q

Why can it be difficult to discriminate the location of pulpal pain?

A

Can get referred pain

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7
Q

what are some general rules when dealing with referred pain in teeth?

A
  • always radiates to ipsilateral side (same side)
  • anterior teeth seldom refer pain to other teeth or opposite arch
  • posterior teeth often refer to opposite arch or periauricular area, but seldom anterior teeth
  • mandible posterior teeth refer pain to periauricular area (ear) more often than maxillary
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8
Q

What do we use to help decide what we do with a patient?

A

Clinical reasoning

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9
Q

What things can influence our critical reasoning/decision making?

A
  • mood
  • bias
  • preconceptions
  • previous experience
  • time restrictions
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10
Q

What things would you assess/look for in an endodontic examination?

A
  • extra-oral exam
  • Intra-oral exam
  • soft tissue exam
  • any intraoral swelling
  • sinus tracts
  • palpation
  • percussion
  • mobility
  • periodontal exam
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11
Q

What can be seen here?

A
  • spreading cellulitis
  • eye closed due to swelling of a maxillary tooth

(would send to max fax in ambulance)

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12
Q

When you diagnose via radiographs, how can you logically diagnose things?

A
  • look at the crown first
  • then middle of the tooth (pulp)

-Finally bottom of the tooth (apex, bone and soft tissue)

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13
Q

What are the 7 pulpal diagnoses?

A
  • normal pulp
  • reversible pulpitis
  • symptomatic irreversible pulpitis
  • asymptomatic irreversible pulpitis
  • pulp necrosis
  • previously treated
  • previously initiated therapy
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14
Q

Describe normal pulp.

A

Symptom free and normally responsive to pulp testing

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15
Q

Even though pulp can be diagnosed as clinically normal, where might not be classed as normal?

A

Might not be histologically normal

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16
Q

How will clinically normal pulp respond to thermal testing?

A

Have a mild or transient response, lasting no more than one or two secs after the stimulus is removed

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17
Q

When testing with a thermal test, what should be tested first?

A

The adjacent teeth to the tooth in question so the P is familiar with the experience of a normal response to cold

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18
Q

What is reversible pulpitis?

A

Inflammation of the pulp that is caused by some sort of irritation that should resolve following appropriate management of the aetiology

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19
Q

What things can cause reversible pulpitis?

A

Exposed dentine (dentine sensitivity), caries, deep restorations

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20
Q

What are the symptoms of reversible pulpitis?

A

Discomfort when a stimulus such as cold or sweet is applied but only lasting a few seconds after stimulus removal

Note: pain is NOT spontaneous

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21
Q

Describe the radiographic changes seen in reversible pulpitis.

A

no significant radiographic changes

22
Q

What is required after treatment of reversible pulpitis?

A

Follow-up to determine whether the pulp has returned to a normal status

23
Q

What is irreversible pulpitis?

A

Vital inflamed pulp that is incapable of healing (RCT indicated)

24
Q

What are some symptoms/characteristics of symptomatic irreversible pulpitis?

A
  • Sharp pain upon thermal stimulus (hot)
  • lingering pain (30 secs or longer after stimulus removal)
  • spontaneous, unprovoked pain
  • referred pain
  • pain accentuates by postural changes such as lying down or bending over

(classic toothache)

25
Q

Are over the counter analgesics effective in symptomatic irreversible pulpitis?

A

Typically ineffective

26
Q

What are some common aetiologies of irreversible pulpitis?

A
  • deep caries
  • extensive restorations

-fractures exposing the pulpal tissue

27
Q

Why might teeth with symptomatic irreversible pulpitis be difficult to diagnose?

A

Because the inflammation has not yet reached the periapical tissues, thus resulting in no pain or discomfort to percussion

28
Q

What are the primary tools for assessing pulpal status?

A

Dental history and thermal testing

29
Q

Describe how asymptomatic irreversible pulpitis presents?

A

NO clinical symptoms and usually respond normally to thermal testing but may have had trauma or deep caries that would likely result in exposure following removal

NOTE: can be a category of exclusion (no other diagnosis fits)

30
Q

What is pulp necrosis?

A

Indicates death of the dental pulp (RCT required)

31
Q

How does pulp necrosis present?

A

non-responsive to pulp testing and is asymptomatic

32
Q

Does pulp necrosis cause apical periodontitis? (pain to percussion or radiographic evidence of osseous breakdown)

A

no unless the canal is infected

33
Q

Describe what a diagnosis of previously treated means?

A

Indicates the tooth has ben endodontically treated

-Canals are obtured with various filling materials other than intracanal medicaments

34
Q

Does a previously treated tooth respond to thermal or electric pulp testing?

A

Typically doesn’t response

although rare can get a 4th canal in a tooth with some vital tissue

35
Q

What does the diagnostic category previously initiated mean?

A

Indicates that the tooth has been previously treated by partial endo therapy such as pulpotomy or pulpectomy

36
Q

Will previously initiated teeth response to pulp testing?

A

May or may not depending on level of therapy

37
Q

What are the 6 apical diagnoses?

A
  • Normal apical tissues
  • Symptomatic apical periodontitis
  • asymptomatic apical periodontitis
  • chronic apical abscess
  • acute apical abscess
  • condensing osteitis
38
Q

Describe normal apical tissue and how they would appear/respond to testing.

A

Not sensitive to percussion or palpation testing and radiographically, the lamina dura surround the root is intact and the PDL space is uniform (no PDL destruction)

39
Q

What should be done before noting results for percussion and palpation on tooth in question?

A

Comparative testing on other teeth for a normal baseline

40
Q

What is symptomatic apical periodontitis?

A

represents inflammation, usually of the apical periodontium

41
Q

How will symptomatic apical periodontitis respond to tests/present?

A

Painful response to biting and/or percussion or palpation

42
Q

What radiographic changes might be seen with symptomatic apical periodontitis?

A

May or may not have changes radiographically

Will either see normal width of the PDL space or there may be a periapical radiolucency

43
Q

What is asymptomatic apical periodontitis?

A

Inflammation and destruction of the apical periodontium that is of pulpal origin

44
Q

How does asymptomatic apical periodontitis present?

A
  • no clinical symptoms (no pain on percussion or palpation)

- appears as an apical radiolucency (dark circle around rooth)

45
Q

What is a chronic apical abscess?

A

Inflammatory reaction to pulpal infection and necrosis

46
Q

How does a chronic apical abscess present including radiographic appearance?

A
  • gradual onset
  • little or no discomfort and intermittent discharge of pus through an associated sinus tract

-radiographically signs of osseous destruction such as a radiolucency

NOTE: sinus tract tracing possible

47
Q

What is an acute apical abscess?

A

-inflammatory reaction to pulpal infection and necrosis

48
Q

How does an acute apical abscess present?

A
  • rapid onset
  • spontaneous pain
  • extreme tenderness of tooth to pressure
  • puss formation
  • swelling of associates tissues
  • may be no radiographic signs
  • malaise, fever and lymphadenopathy
49
Q

What is condensing osteitis?

A

A diffuse radiopaque lesion representing a localized bony reaction to a low-grade inflammatory stimulus usually seen at the apex of the tooth

50
Q

What are treatment option for endodontics?

A
  • RCT
  • re root canal treatment
  • extraction
  • monitor/dont intervene
  • surgical intervention

BDS3 Endo (9 decks)

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