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BDS3 Endodontics > Endo Dx > Flashcards

Endo Dx Flashcards

1
Q

normal pulp

A

a clinical diagnostic category in which the pulp is symptom free and normally responsive to pulp testing

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2
Q

reversible pulpitis

A

a clincal diagnosis based on subjective and objective findings indicating that the viral inflammation should resolve and the pulp return to normal

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3
Q

symptomatic irreversible pulpitis

A

a clinical diagnosis based on subjective and objective findings indicating that the viral inflammed pulp is incapable of healing

additional descriptors: lingering thermal pain, spontaneous pain, referred pain

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4
Q

asymptomatic irreversible pulpitis

A

a clinical diagnosis based on subjective and objective findings indicating that the vira inflamed pulp is incapable of healing

additional descriptors: no clinical symptoms but inflammatino produced by caries, caries excavation, trauma

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5
Q

pulp necrosis

A

a clinical diagnosis category indicating death of dental pulp

the pulp is usually nonresponsive to pulp testing

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6
Q

previously treated pulp

A

clinical diagnosis category indicating that the tooth has been endodontically treated and the canals are obturated with various filling materials other than intracanal medicaments

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7
Q

normal apical tissues

A

teeth with normal periradicular tissues that are not sensitive to percussion or palpitation

the lamina dura surroudning the root is intact and the periodontal ligament space is uniform

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8
Q

previously initiaed pulp therapy

A

a clinical diagnositc category indicating that the tooth has been previously treated by partial endodotic therapy (e.g. pulpotomy, pulpectomy)

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9
Q

sytompactic apical periodontitis

A

inflammation, ususally of the apical periodontium, producing clincial symptoms including painful response to biting and/or percussion or palpation, it might or might not be associated with an apical radiolucent area

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10
Q

asymptomatic apical periodontitis

A

inflammmation and destruction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area

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11
Q

acute apical abscess

A

an inflammatory reaction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area and does not produce clincal symptoms

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12
Q

chronic apical abscess

A

an inflammatory reaction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area and does not produce clinical symptoms

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13
Q

condensing osteitis

A

diffuse radiopaque lesion representing a localised bony reactino to a low-grade inflammatory stimulus, usually seen at apex of tooth

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14
Q

how to obtain probably diagnosis

A

compare tooth in Q with adjacent and contralateral tooth

test these first so pt aware of normal response i.e. to cold

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15
Q

examination procedures required to make an endodontic diagnosis

A
  • medical and dental history
  • chief complaint (if any)
  • clinical testing
  • radiographic analysis
  • additional tests
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16
Q

medical dental history

A

past/recent tx, drugs

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17
Q

chief complaint (if any)

A

how long

symptoms

duration of pain

location

onset

stimuli

relief

referred

medications

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18
Q

SOCRATES

pain history

A

sight

onset

character

radiation

associated features

time

exacerbating factors

severity

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19
Q

clinical testing

A

pulp test - cold, EPT, heat

periapical test - percussion, palpation, tooth slooth (biting)

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20
Q

radiographic analysis

A

new periapical (at least 2)

bitewing

CBCT

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21
Q

possible additional tests for endo dx

A

transillumination selective anaesthesia test cavity

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22
Q

normal pulp characteristics

A

symptom free

may not be histologically normal but is clinically normal

  • mild or transient response to thermal cold testing
  • lasting no more than 1-2 secnds after stimulus removed
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23
Q

reversible pulpitis characteristics

A
  • Discomfort experience when stimulus applied, goes away in couple of seconds
  • Aetiologies: exposed dentine, caries, deep restorations
  • No significant radiographic changes in periapical region
  • Pain not spontaneous
  • Manage aetiology, then further evaluate to determine if reversible pulpitis has returned to normal
    • Dentine sensitivity mimics these symptoms but not an inflammatory process
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24
Q

symptomatic irreversible pulpitis

A
  • Sharp pain on thermal stimulus
  • Lingering pain (30 secs +)
  • Spontaneity (unprovoked) pain
  • Referred pain
  • Can be accentuated by postural changes e.g. lying down, bending
  • Over the counter analgesics typically ineffective
  • Aetiologies: deep caries, extensive restorations, fractures exposing the pulpal tissues
  • Difficult to diagnose as inflammation not yet reach the periapical tissues, thus no pain/discomfort on percussion
    • Dental history and thermal testing needed
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25
Q

asymptomatic irreversible pulpitis

A
  • RCT needed
  • respond normally to thermal testing
  • can have trauma or deep caries that will be exposed following removal
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26
Q

pulp necrosis characteristics

A
  • Death of dental pulp, needing RCT
  • No responsive to pulp testing and is asymptomatic (due to calcification, recent trauma or simply tooth not responding)
    • Need to have comparative tests – e.g. pt not respond to thermal test on any tooth
  • Normal teeth = baseline for pt
  • Doesn’t cause apical periodontitis by itself (pain on percussion or radiographic evidence of osseous breakdown) unless canal infected
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27
Q

previously treated pulp characteristics

A

does not respond to thermal or EPT

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28
Q

previously initiated therapy pulp characteristics

A

depending on level of therapy the tooth may or may not respond to pulp tests

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29
Q

normal apical tissues characteristics

A

not sensitive to percussion/palpation test

radiographically - lamina dura intact, PDL uniform

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30
Q

symptomatic apical periodontitis characteristics

A

Inflammation (usually apically periodontium)
Clinical symptoms: pain to biting, percussion, palpitation
Radiographic changes potentially

  • Depending on stage of disease
    • Normal with of PDL, or periradicular radiolucency

Degenerative pulp, RCT needed

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31
Q

asymptomatic apical periodontitis

A
  • Inflammation and destruction of apical periodontium and is of pulpal origin
  • Apical radiolucency
  • No clinical symptoms
32
Q

chronic apical abscess symptoms

A
  • inflammatory reaction to pulpal infection and necrosis characterised by gradual onset, little or no discomfort and an intermittent discharge of pus
  • Typically signs of osseous destruction and radiolucency
  • ID source of draining sinus with GP cone through stoma or opening until it stops, take radiograph
33
Q

acute apical abscess characteristics

A
  • Inflammatory reaction to pulpal infection and necrosis characterised by rapid onset, pain and tenderness of tooth to pressure, pus and swelling of tissues
  • Maybe no radiographic signs of destruction
  • Pt often has malaise, fever and lymphadenopathy
34
Q

condensing osteitis characteristics

A

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

35
Q

diagnosis

A

identification of a nature of an illness or other problem by examination of symptoms

36
Q

process of diagnosis (5)

A
  1. why is the pt seeking advice
  2. history and symptoms prompting visit
  3. objective findings and subjective details to create differential diagnosis
  4. formulation of defintive diagnosis
37
Q

art and science of dx

A
  • Questioning
  • Listening
  • Testing
  • Interpreting
  • Answering “Why?”
  • Not just gathering data
  • Data interpretation
  • Data processing
  • Questionable versus Significant
  • Active dialogue

–> accurate diagnosis and successful Tx plan

38
Q

endo dx requires

A
  • Patient history
  • Clinical (endodontic) examination
  • Radiographs
  • Special investigations
  • Clinical reasoning!

Diagnoses then treatment.

39
Q

presenting complaint

A
  • reason for attendance > test results
  • Serves as clue to diagnosis
  • History of presenting complaint
  • Document using patient’s own words
40
Q

history of presenting complaint

A
  • Chronology of events leading to P.C.
  • Past and present symptoms – once, twice, all the time, previous restorations
  • Procedures or trauma

Clinician led conversation to produce clear and concise narrative
Clinical Notes 26/07/18

  • C/O -*
  • HPC – (Use SOCRATES)*
  • PMH -*
  • PDH -*
  • Social History - Exam*
  • E/0 (TMJ, nodes, swelling or asymmetry)*
  • I/O – endo assessment and BPE*
  • Special investigations - Diagnoses - Treatment options and risks / prognosis - Agreed treatment – Signed /date*
41
Q

pain originations

A
  • Odontogenic
  • Non odontogenic
  • Trigeminal nerve branches
    • Ophthalmic
    • Maxillary
    • Mandibular
  • Primarily transmit pain in response to thermal, mechanical, or chemical stimuli
42
Q

a delta nerve fibres

A

myelinated

sharp pricking sensaiton

early shooting pain

43
Q

c fibres

A

unmyelinated

dull aching or burning

late dull pain

44
Q

endodontic emergency

A

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

  • Cohens pathways of the pulp
  • Many pt think that if nerve/pulp removed then no more pain, but inflammation of PDL and alveolar bone still possible
45
Q

pain definition

A

an unpleasant feeling often caused by intense or damaging stimuli, such as stubbing a toe, burning a finger, putting alcohol on a cut, and bumping the funny bone

46
Q

agony definition

A

Acute physical or mental pain or anguish
The suffering or struggle preceding death

47
Q

Qs to ask relating to pain

A
  • Where is the pain ? (maxilla / mandible , front or back of mouth)
  • What does it feel like (short sharp / dull ache)
  • How bad is it?
  • How long is it there for? ( constant/ few minutes)
  • Does anything take pain away? (pain killers / cold)
  • What makes it worse? (heat, chewing)
  • Does it keep you awake at night?
  • Does the pain come on randomly / spontaneously?
  • Have you had this before?
  • Have you had any dental work recently?
  • Have you suffered any trauma?
48
Q

referred pain

A
  • Perception of pain in one part of body distant from source of pain
  • Difficult to discriminate location of pulpal pain – esp in heavily restored dentition

Referred pain usually provoked by intense stimulation of C-fibres leading to intense slow, dull pain
Always radiates to ipsilateral side

  • Anterior teeth seldom refer pain to other teeth or opposite arch
  • Posterior teeth often refer to opposite arch or periauricular area, but seldom to anterior teeth
  • Mandibular posterior teeth refer pain to periauricular area more often than maxillary
49
Q

MHx inc

A

Medical conditions and medications that impact on management
Medical conditions that may have oral manifestations or mimic dental pathosis

50
Q

dental origins of TB and lymphoma

A

lymph node involvement

51
Q

dental origins of leuakaemia and anaemia

A

paraesthesia

52
Q

dental origins sickle cell anaemia

A

bone pain

53
Q

dental origins multiple myeloma

A

tooth mobility

54
Q

dental origins MS, acute maxillary sinusitis, trigeminal neuralgia

A

pain

55
Q

clinical reasoning

A

Why do we decide to do what we do?

  • Critical thinking
  • Decision making.

Clinical reasoning. Clinical judgement

56
Q

how do we process info

A
  • Higher order thinking in which the health care provider, guided by best evidence or theory, observes and relates concepts and phenomena to develop an understanding of their significance.
  • The use of a patient’s history, physical signs, symptoms, laboratory data, and radiological images to arrive at a diagnosis and formulate a plan of treatment.

The way we assimilate and interpret information has implications for the treatment we provide. Critical reasoning /decision making can be affected by attitude, preconceptions, bias, previous experience or perspective. Mood? Time?

  • Even though we have the right information do we make the correct decision?
    • The fear of shame
    • Saying I don’t know
    • Educated guesswork?
    • Protecting your reputation?
57
Q

process of examination

A

systematic

document the process

think

discuss process and findings with pt

58
Q

endo exam

A

Extraoral exam

Intraoral exam

  • Soft tissue exam
  • Intraoral swelling
  • Sinus tracts – communications between route and oral cavity
  • Palpation
  • Percussion
  • Mobility
  • Periodontal exam – long deep pockets = crack
59
Q

EO assessments

A
  • cellulitis
  • Ludwig’s angina – compromise airway
  • Swelling to eye

Emergency – refer immediately max fax/oral surgery
IV antibiotics, surgical incision potential

extra oral sinus - pus breaking through skin

60
Q

soft tissue assessment

A

swellings lumps bumps abnormal

61
Q

hard tissue assessment

A

Is the tooth restorable? Caries free, amalgam, crown placement

62
Q

root fracture assessment

A

Excavator between cusps can tell if tooth split
Radiographs can help detect if crown on tooth

63
Q

sensibility/vitality testing

A

Pulp tests

  • Thermal
  • Electric
  • Laser doppler flowmeter
  • Pulse oximetry

Sensibility not vitality

  • Subjective (can be misinterpreted by pt)
    • Contra-lateral teeth should be tested
  • Assumption made that nerve fibres in pulp correlates to intact blood supply
    • not appropriate
    • problems with multi rooted teeth
64
Q

cold sensibility

A
  • Hydrodynamic forces
  • Cold/Hot tests
  • Frozen Carbon Dioxide (-78 degrees celcius)
  • Ice less reliable
  • Ethyl chloride
  • Refrigerant spray
  • Dry and isolate
  • Close to pulp horn
  • Fairly reliable
65
Q

heat tests

A
  • Too much heat may cause irreversible pulpitis
  • Hot gutta percha – use Vaseline
  • “Hot” water and dental dam
66
Q

electric pulp tests

A

Electric current used to stimulate sensory nerves

  • Primarily A-delta fast conducting fibres
  • Unmyelinated C-fibres may or may not respond

Dry teeth and isolate Probe place on incisal edge or cusp tip (pulp horn proximity) Conducting medium used Circuit completed Current slowly increases until response
No indication of reversibility of inflammation

No correlation between threshold and pulp condition
Negative response reliable indicator (generally)
EPT of teeth with open apices unreliable

67
Q

clinical note

pulp test grid

A
68
Q

e.g. special tests

A
  • Bite test (fracture finder or tooth sleuth/sloth)
  • Test cavity – drill into tooth, multi rooted tooth limited effect and not popular
  • Staining and trans-illumination
  • Selective anaesthesia
69
Q

radiographic examination and interpretation

A

One of most useful diagnostic tests, but can make premature diagnoses based on them
Without a proper history and clinical exam and testing a radiograph alone may lead to misinterpretation of normality and pathosis

  • Do not look at radiograph in isolation

Two pre-op radiographs from different angulations
Subjective nature of the radiographic appearance of endodontic pathosis
CBCT

70
Q

sinus tract tracing

A

GP cone into sinus and see if tracks into particular tooth
Infection source

71
Q

clinical notes - radiographic report

A

PA of tooth 46: Grade A (what of and what grade)
Shows

  • Large restoration, deep distally
  • Recession of pulp
  • No obvious PA lesion present
  • Pulp chamber reduced in size, canals visible in middle, coronal third, not at apex
  • Perio bone level adequate

Remember the other teeth! (48,46,45,44 present)

  • Occlusal restoration 45, no PA lesion
  • 44 unrestored, no pa lesion
  • Calculus interproximally
  • Perio - bone levels
72
Q

areas to think of in dx

A

Top of tooth (crown)
Middle of tooth (pulp)
Bottom of tooth (apex, bone, and soft tissue)

73
Q

categories for pulpal dx (7)

A
  • Normal Pulp
  • Reversible Pulpitis
  • Symptomatic Irreversible Pulpitis
  • Asymptomatic Irreversible Pulpitis
  • Pulp Necrosis
  • Previously Treated
  • Previously Initiated Therapy
74
Q

apical dx categories (6)

A
  • Normal Apical Tissues
  • Symptomatic Apical Periodontitis
  • Asymptomatic Apical Periodontitis
  • Chronic Apical Abscess
  • Acute Apical Abscess
  • Condensing Osteitis
75
Q

tx options (5)

A
  • Root canal treatment
  • Re root canal treatment
  • Extract the tooth
  • Monitor / don’t intervene
  • Surgical intervention
76
Q

dx challenges

A

use history and examination to pinpoint pain

getting it wrong

77
Q

clinical notes

dx

A

Diagnosis tooth 46 – Secondary caries, irreversible pulpitis Apical periodontitis.

  • (If they had swelling also be acute apical abcess)
    • Multiple diagnoses for one tooth

Treatment options

  • Monitor - ? Risks and prognosis
  • Root canal treat – risks and consent
  • Extract – risks and prosthetic options
  • Surgery – not first line treatment

BDS3 Endodontics (10 decks)

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