Endodontic Diagnoses Flashcards
What aspects of a clinical history are necessary for an endo examination?
Medical/dental history
C/O and HPC- SOCRATES
Have you taken any pain relief for it? Has it worked?
Have you lost sleep as a result of this pain?
Does the pain come and go or is it constant?
Sensitive to hot or cold?
During the endodontic examination, what special tests may be required?
Pulp tests- electric pulp test, endo-frost (minus 50 degrees).
Periapical tests- Percussion, palpation, tooth slooth (biting).
Radiographs- bitewing (caries), periodicals, CBCT.
Test cavity, selective anaesthesia, transillumination.
During an endodontic examination, what would you wish to investigate?
E/O- facial symmetry, speech, swellings.
- TMJ
- MOM- if there is trismus, how many fingers can you get in?
- Nodes
- Nerves
- Bones
I/O- lips, buccal mucosa, labial mucosa, tongue, floor of the mouth, gingivae, hard palate, soft palate.
Intr-oral swellings
Chart teeth, caries, restorations (defective or newly placed?)
BPE, mobility.
What is the guidance called for endodontic diagnosis?
American Association of Endodontists- Endodontic Diagnosis.
What is the definition of a normal pulp?
Pulp is symptom-free and produces a normal response to thermal testing.
Mild or transient response to cold testing, which lasts for 1 or 2 seconds after the stimulus is removed.
Adjacent and contralateral teeth must also be tested, to allow the patient to understand what the sensation should feel like.
What is the definition of Reversible pulpitis?
Inflammation should resolve and the pulp return to normal following appropriate management of the aetiology.
What clinical findings would suggest reversible pulpitis?
Discomfort (dull ache) is felt with a cold or sweet stimulus.
Discomfort goes away within a few seconds of stimulus being removed from the tooth.
Non-spontaneous pain.
No PA pathology on radiograph.
Typical aetiologies include exposed dentine, caries, or deep restorations.
What management would be advised in reversible pulpitis?
Caries removal and restoration.
Coverage of exposed dentine with composite.
Evaluate the tooth further once this is done to ensure it is reversible pulpitis.
What is Symptomatic Irreversible Pulpitis?
Vital inflamed pulp is incapable of healing and that root treatment is indicated.
What clinical signs would suggest symptomatic irreversible pulpitis?
Spontaneous pain
Sharp pain to hot
Lingering pain that remains, even when stimulus is removed for over 30 seconds
Referred pain- typically mandible or ear
Pain worse when laying down or bending over
No relief from analgesia
Typical aetiologies include- deep caries, extensive restorations, fractures exposing the pulpal tissues.
No pain on percussion
- infection has not reached the periodical tissues yet.
Increased blood flow in the pulp.
What would be the management of a tooth diagnosed as having symptomatic irreversible pulpitis?
RCT
What is asymptomatic irreversible pulpitis?
Vital inflamed pulp is incapable of repair and that root canal treatment is indicated.
What clinical findings would suggest asymptomatic irreversible pulpitis?
No clinical symptoms, usually respond normally to pulp testing nut may have had trauma or deep caries which would result in exposure following removal.
What is pulp necrosis?
Death of the dental pulp, necessitating root canal treatment.
What are the signs and symptoms of pulp necrosis?
Asymptomatic tooth
Non-responsive to pulp testing
Pulpal necrosis itself does not cause apical periodontitis, unless the canal is infected.
So you won’t necessarily see PA radiolucency or TTP.
