Endo Exam and Testing I Flashcards
2/5 exam
An endo diagnosis consists of 2 parts:
pulpal
periapical
the pulpal diagnosis consists of
status of the nerve tissue
C- nerve fiber
A- nerve fiber
detection of temperature and sharpness
C nerve fibers detect what kind of pain
dull spontaneous ache
A nerve fibers detect what kind of pain
sharp acute intense pain
the periapical diagnosis consists of
status of the tissues surrounding the apex
proprioceptive (pressure sensing) nerve fibers
Detects chewing pressure and percussion
What do we need to do correctly for proper treatment
diagnose
If you don’t know the diagnosis after taking the history of the patient, then
you haven’t taken enough history
what do you use to verify your diagnosis
the patient exam
what is the order of the diagnostic exam
SOAP
Subjective
Objective
Assessment/Appraisal
Plan
The chief complaint is
what the patient tells you in their own words
what are subjective findings
what the patient is telling you. They may not be accurate
What must be addressed even if you find other things wrong
Chief complaint
medical history should be reviewed by the dentist how often
every visit
what medical conditions can mimic odontogenic pain
TB
Uncontrolled diabetes
Iron deficiency
leukemia
Sickle cell
multiple myeloma
acute maxillary sinusitis
Sickle cell may cause what type of pain
bone pain and loss of trabecular bone pattern- mimic odontogenic
pain and bone loss of Endodontic origin
Radiation therapy may cause what type of pain
increased sensitivity of teeth and osteoradionecrosis
Multiple Myeloma may cause what type of pain
unexplained mobility of teeth(Floating Tooth)
Trigeminal neuralgia, referred pain from cardiac angina, and multiple sclerosis may cause what type of pain
mimic tooth pain
Acute maxillary sinusitis may cause what type of pain
posterior quadrant mimic tooth pain. Teeth may be
extremely sensitive to cold and percussion
what is a systemic contraindication to endodontic therapy
uncontrolled diabetes or a recent myocardial infarction within the past 6 months
What are the 5 basic directions of questioning
Localization (where)
Commencement (when)
Intensity (1-10)
Provocation/Attenuation (produces or reduces pain)
Duration (how long)
what are objective findings
What you as the doctor clinically see and your findings
What does the extra oral exam show? Swelling, Redness, tender to palpate etc.
What does the x-ray show
Intraoral exam findings
All tests findings - percussion, thermal, observation, palpation, periodontal
probing and patient’s response to the tests.
Record normal as well as abnormal. Why?
what are extraoral exam findings
asymmetries and swelling, redness, and demeanor of patient upon arrival
palpation of submandibular and cervical lymph nodes (hard tender?)
if lymph nodes and hard, tender and
enlarged may indicate that
the infection has moved from localized to more systemic
infection
Ludwig’s Angina
Large firm red bi-lateral swelling under the chin into neck (dangerous)
External sinus tract
a stoma (opening) that never heals until generally, heal and closes once offending tooth is treated
Extraoral facial swelling is usually Endodontics in origin because
diffuse facial swelling from a periodontal abscess is rare
detail a Canine space infection
Loss of definition in the nasolabial fold to swollen red eye
Long rooted maxillary central incisors can also cause this swelling but more likely to cause the upper lip to be swollen
Buccal space infection Maxilla
Extraoral swelling in posterior cheek
Usually from the buccal roots of maxillary premolar and molars
Buccal space infection Mandibular
Usually from mandibular premolar and mandibular 1st molar
2nd and 3rd molars may also be the cause but infections with these two teeth are just as likely to exit the lingual
With a buccal space infection why is there swelling and disappearance of the nasolabial folds
Roots on maxillary lie superior to the attachment of the buccinator muscle
Roots on the mandibular lie inferior to the attachment of the buccinator muscle
Extraoral swelling associated with mandibular incisors generally will swell in what space
submittal or submandibular spaces
Infections associated with any mandibular teeth that exit the alveolar bone on the lingual and are inferior to the mylohyoid muscle attachment, will be noted as
swelling in the submandibular space
How should you examine intraoral swelling
Visualize and palpate to determine if firm, diffuse or fluctuant
In Anterior palate - most frequently from maxillary lateral incisors or maxillary
1st premolar
Swelling in the posterior palate is most likely associated with
the palatal roots of
maxillary molars
Severe infections involving the maxillary and mandibular molars can extend into the
___________ space, resulting in swelling of the tonsillar and pharyngeal areas
parapharyngeal
Sinus tract
communication directly from the source through an opening in the gingiva
called the stoma. Sometimes lined with epithelium
Fistula
an abnormal pathway between two organs or from one epithelium-lined surface to another
epithelium-lined surface.
Will there be much pain if an intraoral sinus tract is present
no
Sinus tract may have a _____ adjacent to the offending tooth or the infection may
exit at a distant site
stoma
Alveolar hard tissue near ______ should be palpated with index finger to try and detect any abnormalities.
apices (check the other side to see if it is symmetrical or or abnormal)
Tender areas may indicate
periradicular inflammation which may be Endodontics or
periodontic in origin
When apical inflammation develops after pulp necrosis, the inflammatory process may burrow its way through the
facial cortical bone and begin to affect the overlying
mucoperiosteum (may feel tender before the swelling appears)
Tenderness to percussion or biting, indicates
that there is inflammation around the
tooth(periapical). The proprioceptive nerve fibers around around the tooth (PDL) and not in the
tooth
Inflammation apically (Apical Periodontitis) can be caused from the presents of bacteria originating
from
the nerve (pulp) in the offending tooth
Start with contralateral tooth so the patient knows
what “normal” feels like
Percuss adjacent teeth both _____________ to help confirm offending tooth
medially and distally
Percussion tells _______ about the vitality of the pulp
nothing
Increased mobility indicates
a compromised periodontal attachment but tells nothing of the vitality of the
tooth
Mobility occurs because of
Acute or chronic trauma
Periodontal disease
Root fractures
Rapid orthodontic movement
Extension of pupal disease into the PDL
Any mobility greater than ___ should be considered abnormal
+1
Mobility +1
The first distinguishable sign of movement greater than normal
Mobility +2
Horizontal tooth movement no greater than 1 mm
Mobility +3
Horizontal tooth movement greater than 1 mm, with or without the visualization of rotation or vertical repressibility
Wide areas of deep probing indicate
periodontal etiology whereas isolated
narrow pocketing may indicate
a vertical root fracture or an infection that is draining
through the sulcus from a non-vital tooth
Class I Furcation involvment
can be probed but not to a significant depth
Class II Furcation involvment
can be entered but not probed completely through other side
Class III Furcation involvment
can be probed completely through opposite side
