Endodontic diagnosis Flashcards
What are the 2 key areas needed to be diagnosed?
Pulpal diagnosis and apical diagnosis
What factors come together to confirm the preliminary diagnosis?
MH, dental history, clinical and radiographic exam, perio evaluation and sensibility testing
How does a normal pulp respond to testing?
Mild/transient response to thermal cold testing. Lasts 1-2s after stimulus is removed
How is dentinal hypersensitivity described?
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
Reversible pulpitis
Inflammation of pulp should resolve once etiology has been appropriately managed
What stimuli are uncomfortable for reversible pulpitis
sweet and cold
Etiology of reversible pulpitis
Caries or deep restorations
No spontaneous pain
What are the characteristics of symptomatic irreversible pulpitis
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.
What is the etiology of irreversible pulpitis?
Deep caries, extensive restorations, fractures exposing pulpal tissue
What are the characteristics of asymptomatic irreversible pulpitis?
No clinical symptoms. Respond normally to thermal testing but may have had trauma or deep caries likely to involve pulpal exposure following removal.
What is pulpal necrosis?
Clinical diagnostic category indicating death of the dental pulp necessitating RCT
What are the characteristics of pulpal necrosis?
Non responsive to pulp testing and is asymptomatic. No periapical periodontitis or evidence of osseous breakdown unless pulp is infected.
What are the other reasons why a tooth might not respond to pulp testing?
- Calcification
- Recent history of trauma
- Tooth may just not be responding hence why responses should be of a comparative nature.
Characteristics of normal apical tissues
Not sensitive to percussion, palpation testing and radiographically, the lamina dura surrounding the root is intact and PDL uniform
Characteristics of AAP
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.
Characteristics of CAP
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
Characteristics of CAA
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
Characteristics of AAA
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
Characteristics of condensing osteitis
Diffuse radiopaque lesion representing a localised bony reaction to a low grade inflammatory stimulus usually seen at the apex of the tooth
What is a pulpotomy and when is it used?
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
What is pulpectomy and when is it used?
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
What is pulp extirpation?
Standard procedure when treating inflamed vital pulps in adults.
What is indirect pulp capping?
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
Which liners are used in indirect pulp capping?
CaOH2 overlaid with ZnOEu or GIC
What is direct pulp capping?
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.
What materials and instruments are used in chemo-mechanical caries removal?
Carisolv and hand instruments
