Endodontic Assessment and Diagnosis

Question 1

What is required for making a diagnosis?

Answer 1

Verbal history, Clinical examination, Special investigations

Question 2

What can pain cause for the patient?

Answer 2

Reduced sleep, Physical and/or emotional distress, Confusion, Reduced ability to cooperate, Abrupt communication

Question 3

What can we use to take a pain history?

Answer 3

SOCRATES

Question 4

How to take a trauma history?

Answer 4

Time, date, location of incident, Loss of consciousness, dizziness after?, MH - focus on tetanus status, seizures, bleeding disorders, allergies, any other injuries, What happened?, Emergency treatment - type, time, location, Current symptoms, Current concerns

Question 5

What to include in an extra oral examination?

Answer 5

Swellings - record site and size, Assess body temp, Note any difficulties in swallowing, Note any malaise, Manage or arrange urgent referral

Extra oral swelling is rare

Question 6

What is a serious but rare complication of endodontic pathology?

Answer 6

Extraoral swelling

Question 7

What is Ludwigs angina?

Answer 7

Bilateral swelling of the submental, sublingual and submandibular spaces that can compromise the airway

Question 8

What 4 things should you check on the intraoral exam?

Answer 8

Soft tissues, Periodontal, Hard tissues, Occlusal

Question 9

What is fremitus?

Answer 9

Vibration / movement within the tooth when teeth come into contact with each other

Question 10

What special tests can be used for the detection and diagnosis of endodontic pathology?

Answer 10

Pulp tests, PDL tests, radiographs, periodontal

Question 11

What are pulp tests used for?

Answer 11

Thermal sensitivity - hot/cold, Electric

Question 12

What PDL tests can we do?

Answer 12

Vertical percussion, lateral percussion

Question 13

What radiographs can we take?

Answer 13

Intraoral PA, CBCT

Question 14

What perio tests can we do?

Answer 14

6PPC, recession, bop, suppuration, mobility

Question 15

What other tests can we do?

Answer 15

Transillumination, Tooth sleuth

Question 16

Where should pulp test stimulus be applied?

Answer 16

At the point of the nerve plexus without contacting gingivae or other intraoral soft tissues

Question 17

What are the different things we can use for cold tests?

Answer 17

Ethyl chloride - -5°C, Tetrafluroethane - -26°C, Others inc those in Endofrost - -50°C

Question 18

Which patients are more likely to have false positives in cold tests?

Answer 18

Anxious patients, young patients, partially vital teeth, if in contact with gingival tissues or metallic restorations

Question 19

When are you more likely to get false negatives for a cold test?

Answer 19

Heavily restored teeth, older patients, traumatised teeth, partially vital teeth if undergoing orthodontics, alcohol, sedative drugs

Question 20

Why are you more likely to get a false negatives in older patients with cold tests?

Answer 20

Due to secondary and tertiary dentine

Question 21

How to do a percussion test?

Answer 21

Tap occlusal aspect of tooth with back of mirror

Question 22

Reasons for a positive response for percussion tests

Answer 22

Occlusal trauma, Excessive orthodontic forces, Acute/advanced periodontal disease, Apical periodontitis, Abscess of endodontic origin

Question 23

What can percussion tests tell us?

Answer 23

Can indicate if there is something going on in the periapical tissues

Question 24

How should we record clinical findings of special investigations?

Answer 24

In a table / matrix of the clinical findings, Include adjacent/contralateral teeth for comparison

Question 25

What are some different methods to detect cracks?

Answer 25

Tooth sleuth, transillumination, magnification, radiographs for larger cracks

Question 26

What is Normal pulp?

Answer 26

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

Question 27

What is Reversible pulpitis?

Answer 27

A clinical diagnosis based on subjective and objective findings indicating that the inflammation should resolve and the pulp return to normal.

Question 28

What is Symptomatic irreversible pulpitis?

Answer 28

A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing. Additional descriptors: lingering thermal pain, spontaneous pain, referred pain.

Question 29

What is Asymptomatic irreversible pulpitis?

Answer 29

A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing. Additional descriptors: no clinical symptoms but inflammation produced by caries, caries excavation, trauma.

Question 30

What is Pulp necrosis?

Answer 30

A clinical diagnostic category indicating death of the dental pulp. The pulp is usually nonresponsive to pulp testing.

Question 31

What is Previously treated?

Answer 31

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

Question 32

What is Previously initiated therapy?

Answer 32

A clinical diagnostic category indicating that the tooth has been previously treated by partial endodontic therapy (e.g. pulpotomy, pulpectomy).

Question 33

What is Normal apical tissues?

Answer 33

Teeth with normal periradicular tissues that are not sensitive to percussion or palpation testing. The lamina dura surrounding the root is intact, and the periodontal ligament space is uniform.

Question 34

What is Symptomatic apical periodontitis?

Answer 34

Inflammation, usually of the apical periodontium, producing clinical symptoms including a painful response to biting and/or percussion or palpation. It might or might not be associated with an apical radiolucent area.

Question 35

What is Asymptomatic apical periodontitis?

Answer 35

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

Question 36

What is Acute apical abscess?

Answer 36

An inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation and swelling of associated tissues

Question 37

What is Chronic apical abscess?

Answer 37

An inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little or no discomfort, and the intermittent discharge of pus through an associated sinus tract.

Question 38

What is Condensing osteitis?

Answer 38

Diffuse radiopaque lesion representing a localized bony reaction to a low-grade inflammatory stimulus, usually seen at apex of tooth.

Question 39

Which diagnoses do we need for every case of endodontic pathology?

Answer 39

Pulpal diagnosis and periapical diagnosis