Endo Diagnosis Flashcards
What is the 5-step process of diagnosis?
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
What nerve fibres are responsible for dental pain?
A-delta and C fibres
What kind of dental pain is associated with A-delta fibres?
Sharp pricking sensation
Early shooting pain
What kind of dental pain is associated with C-fibres?
Dull, aching or burning
Late dull pain
What is the definition of an endodontic emergency?
Pain and/or swelling caused by various stages of inflammation or infection of the pulpal and/or periapical tissues
Why can it be difficult to discriminate the location of pulpal pain?
Can get referred pain
what are some general rules when dealing with referred pain in teeth?
- 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
What do we use to help decide what we do with a patient?
Clinical reasoning
What things can influence our critical reasoning/decision making?
- mood
- bias
- preconceptions
- previous experience
- time restrictions
What things would you assess/look for in an endodontic examination?
- extra-oral exam
- Intra-oral exam
- soft tissue exam
- any intraoral swelling
- sinus tracts
- palpation
- percussion
- mobility
- periodontal exam
What can be seen here?
- spreading cellulitis
- eye closed due to swelling of a maxillary tooth
(would send to max fax in ambulance)
When you diagnose via radiographs, how can you logically diagnose things?
- look at the crown first
- then middle of the tooth (pulp)
-Finally bottom of the tooth (apex, bone and soft tissue)
What are the 7 pulpal diagnoses?
- normal pulp
- reversible pulpitis
- symptomatic irreversible pulpitis
- asymptomatic irreversible pulpitis
- pulp necrosis
- previously treated
- previously initiated therapy
Describe normal pulp.
Symptom free and normally responsive to pulp testing
Even though pulp can be diagnosed as clinically normal, where might not be classed as normal?
Might not be histologically normal
How will clinically normal pulp respond to thermal testing?
Have a mild or transient response, lasting no more than one or two secs after the stimulus is removed
When testing with a thermal test, what should be tested first?
The adjacent teeth to the tooth in question so the P is familiar with the experience of a normal response to cold
What is reversible pulpitis?
Inflammation of the pulp that is caused by some sort of irritation that should resolve following appropriate management of the aetiology
What things can cause reversible pulpitis?
Exposed dentine (dentine sensitivity), caries, deep restorations
What are the symptoms of reversible pulpitis?
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
Describe the radiographic changes seen in reversible pulpitis.
no significant radiographic changes
What is required after treatment of reversible pulpitis?
Follow-up to determine whether the pulp has returned to a normal status
What is irreversible pulpitis?
Vital inflamed pulp that is incapable of healing (RCT indicated)
What are some symptoms/characteristics of symptomatic irreversible pulpitis?
- 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)
Are over the counter analgesics effective in symptomatic irreversible pulpitis?
Typically ineffective
What are some common aetiologies of irreversible pulpitis?
- deep caries
- extensive restorations
-fractures exposing the pulpal tissue
Why might teeth with symptomatic irreversible pulpitis be difficult to diagnose?
Because the inflammation has not yet reached the periapical tissues, thus resulting in no pain or discomfort to percussion
What are the primary tools for assessing pulpal status?
Dental history and thermal testing
Describe how asymptomatic irreversible pulpitis presents?
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)
What is pulp necrosis?
Indicates death of the dental pulp (RCT required)
How does pulp necrosis present?
non-responsive to pulp testing and is asymptomatic
Does pulp necrosis cause apical periodontitis? (pain to percussion or radiographic evidence of osseous breakdown)
no unless the canal is infected
Describe what a diagnosis of previously treated means?
Indicates the tooth has ben endodontically treated
-Canals are obtured with various filling materials other than intracanal medicaments
Does a previously treated tooth respond to thermal or electric pulp testing?
Typically doesn’t response
although rare can get a 4th canal in a tooth with some vital tissue
What does the diagnostic category previously initiated mean?
Indicates that the tooth has been previously treated by partial endo therapy such as pulpotomy or pulpectomy
Will previously initiated teeth response to pulp testing?
May or may not depending on level of therapy
What are the 6 apical diagnoses?
- Normal apical tissues
- Symptomatic apical periodontitis
- asymptomatic apical periodontitis
- chronic apical abscess
- acute apical abscess
- condensing osteitis
Describe normal apical tissue and how they would appear/respond to testing.
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)
What should be done before noting results for percussion and palpation on tooth in question?
Comparative testing on other teeth for a normal baseline
What is symptomatic apical periodontitis?
represents inflammation, usually of the apical periodontium
How will symptomatic apical periodontitis respond to tests/present?
Painful response to biting and/or percussion or palpation
What radiographic changes might be seen with symptomatic apical periodontitis?
May or may not have changes radiographically
Will either see normal width of the PDL space or there may be a periapical radiolucency
What is asymptomatic apical periodontitis?
Inflammation and destruction of the apical periodontium that is of pulpal origin
How does asymptomatic apical periodontitis present?
- no clinical symptoms (no pain on percussion or palpation)
- appears as an apical radiolucency (dark circle around rooth)
What is a chronic apical abscess?
Inflammatory reaction to pulpal infection and necrosis
How does a chronic apical abscess present including radiographic appearance?
- 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
What is an acute apical abscess?
-inflammatory reaction to pulpal infection and necrosis
How does an acute apical abscess present?
- 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
What is condensing osteitis?
A diffuse radiopaque lesion representing a localized bony reaction to a low-grade inflammatory stimulus usually seen at the apex of the tooth
What are treatment option for endodontics?
- RCT
- re root canal treatment
- extraction
- monitor/dont intervene
- surgical intervention
