Endodontic diagnosis

Question 1

What are the 2 key areas needed to be diagnosed?

Answer 1

Pulpal diagnosis and apical diagnosis

Question 2

What factors come together to confirm the preliminary diagnosis?

Answer 2

MH, dental history, clinical and radiographic exam, perio evaluation and sensibility testing

Question 3

How does a normal pulp respond to testing?

Answer 3

Mild/transient response to thermal cold testing. Lasts 1-2s after stimulus is removed

Question 4

How is dentinal hypersensitivity described?

Answer 4

Clinically described as an exaggerated response to application of stimulus to exposed dentine regardless of location.

Short sharp pain typically in response to thermal stimuli or evaporative, tactile, osmotic or chemical.

Cannot be attributed to any other pathology

Question 5

Reversible pulpitis

Answer 5

Inflammation of pulp should resolve once etiology has been appropriately managed

Question 6

What stimuli are uncomfortable for reversible pulpitis

Answer 6

sweet and cold

Question 7

Etiology of reversible pulpitis

Answer 7

Caries or deep restorations

No spontaneous pain

Question 8

What are the characteristics of symptomatic irreversible pulpitis

Answer 8

Pulp incapable of healing and RCT indicated

Sharp pain upon thermal stimulus, lingering pain, 30s or longer after stimulus is removed, spontaneous pain and referred pain. Postural changes elicit pain. Analgesics ineffective.

Question 9

What is the etiology of irreversible pulpitis?

Answer 9

Deep caries, extensive restorations, fractures exposing pulpal tissue

Question 10

What are the characteristics of asymptomatic irreversible pulpitis?

Answer 10

No clinical symptoms. Respond normally to thermal testing but may have had trauma or deep caries likely to involve pulpal exposure following removal.

Question 11

What is pulpal necrosis?

Answer 11

Clinical diagnostic category indicating death of the dental pulp necessitating RCT

Question 12

What are the characteristics of pulpal necrosis?

Answer 12

Non responsive to pulp testing and is asymptomatic. No periapical periodontitis or evidence of osseous breakdown unless pulp is infected.

Question 13

What are the other reasons why a tooth might not respond to pulp testing?

Answer 13

1. Calcification
2. Recent history of trauma
3. Tooth may just not be responding hence why responses should be of a comparative nature.

Question 14

Characteristics of normal apical tissues

Answer 14

Not sensitive to percussion, palpation testing and radiographically, the lamina dura surrounding the root is intact and PDL uniform

Question 15

Characteristics of AAP

Answer 15

Painful response to percussion, biting or palpation

Inflammation of the apical periodontium

Pain on percussion is highly indicative of degenerating pulp and RCT being needed.

Question 16

Characteristics of CAP

Answer 16

Inflammation and destruction of the apical periodontium that is of pulpal origin

Apical radiolucency and does not present clinical symptoms

No pain/percussion on palpation

Question 17

Characteristics of CAA

Answer 17

Inflammatory reaction to pulpal infection and necrosis characterised by gradual onset, little or no discomfort and an intermittent discharge of pus through a sinus tract

Osseous destruction

Question 18

Characteristics of AAA

Answer 18

Inflammatory reaction to pulpal infection and necrosis characterised by rapid onset, spontaneous pain, extreme tenderness of the tooth to pressure, pus and swelling of associated tissues.

May be no radiographic signs of destruction and patient often experiences malaise, fever and lymphadenopathy

Question 19

Characteristics of condensing osteitis

Answer 19

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

Question 20

What is a pulpotomy and when is it used?

Answer 20

Most widely used endo technique in primary dentition

Amputate the inflamed coronal pulp and preserve vitality of the radicular pulp thereby facilitating the normal exfoliation of the primary tooth

Question 21

What is pulpectomy and when is it used?

Answer 21

Complete removal of the pulp from the crown and the roots

Tooth is then filled with material that can be resorbed by the body

Performed on baby teeth

RCT begins with pulpectomy but gets permanent filling/crown and GP is not resorbed by the body

Question 22

What is pulp extirpation?

Answer 22

Standard procedure when treating inflamed vital pulps in adults.

Question 23

What is indirect pulp capping?

Answer 23

Cavity prep is close to pulp but with no visible exposure

2 stage (stepwise) caries removal - deep carious dentin which may be left on the floor of the prep if it’s removal might cause pulpal exposure

Question 24

Which liners are used in indirect pulp capping?

Answer 24

CaOH2 overlaid with ZnOEu or GIC

Question 25

What is direct pulp capping?

Answer 25

Alternative to pulp extirpation

Tx of a vital pulp by sealing pulpal wound with CaOH2, mineral trioxide aggregate (MTA) or biodentine to facilitate the formation of reparative dentine and maintenance of vital pulp.

Question 26

What materials and instruments are used in chemo-mechanical caries removal?

Answer 26

Carisolv and hand instruments