Endodontic Diagnosis Flashcards
What are the various pulpal diagnoses?
- normal pulp
- reversible pulpitis
- symptomatic irreversible pulpitis
- asymptomatic irreversible pulpitis
- pulp necrosis
- previously treated
- previously initiated therapy
What does a pulpal diagnosis of normal pulp indicate?
- pulp is symptom free and normally responsible to pulp testing
- vital and free of inflammation
What does a pulpal diagnosis of reversible pulpitis indicate?
- inflammation the pulp should resolve following management of the aeitology
- discomfort when stimulus applied
- lasts a few seconds
- often caries or exposed dentine
- responds to cold
- no significant radiographic changes in periapical region
- follow up required to determine if pulp has returned to normal status
What does a pulpal diagnosis of symptomatic irreversible pulpits indicate?
- vital inflamed pulp that is incapable of healing
- RCT indicated
- sharp pain
- upon thermal stimulus, particularly hot
- lingering pain
- up to 30 seconds after stimulus removal - spontaneous
- referred
- accentuated by postural changes
- OTC analgesics typically ineffective
- can test positive in sensibility tests
- pulp is stil vital
- common aetiologies:
- deep caries
- extensive restorations
- fractures exposing pulpal tissues
- inflammation has not reached periapical tissues
- no TTP
- dental history and thermal testing for assessment
What does a pulpal diagnosis of asymptomatic irreversible pulpits indicate?
- vital inflamed pulp that is incapable of healing
- RCT or extraction indicated for mature teeth
- pulpotomy, pulpectomy or extraction for immature
- no clinical symptoms
- normal response to thermal testing
- likely trauma or deep caries that would result in exposure
- pulp is likely abnormal
- considered a category of exclusion
What does a pulpal diagnosis of pulp necrosis indicate?
- death of the dental pulp
- RCT indicated
- asymptomatic
- non-responsive to pulp testing
- does not cause apical periodontitis unless canal is infected
- TTP or radiographic évidence of osseous breakdown
What does a pulpal diagnosis of previously treated indicate?
- tooth has been endodontically treated
- canals are obturate
- does not respond to thermal or electric pulp testing
- unless canal containing viable nerve tissue
What does a diagnosis of previously initiated therapy indicate?
- tooth previously treated by partial endodontic therapy
- pulpotomy
- pulpectomy
- depending on level of therapy may respond to pulp testing
What are the various apical diagnoses?
- normal apical tissues
- symptomatic apical periodontitis
- asymptomatic apical periodontitis
- chronic apical abscess
- acute apical abscess
- condensing osteitis
What does a diagnosis of normal apical tissues indicate?
- no TTP
- lamina dura in tact and uniform
What does a diagnosis of symptomatic apical periodontitis indicate?
- inflammation, usually of apical periodontium
- painful response to biting, percussion and palpation
- severe pain indicates RCT
- may be accompanied by radiographic changes
- depends on stage of disease
- periapical radiolucency
What does a diagnosis of asymptomatic apical periodontitis indicate?
- inflammation and destruction of the apical periodontium
- apical radiolucency
- no clinical symptoms
What does a diagnosis of a chronic apical abscess indicate?
- inflammatory reaction to pulpal infection and necrosis
- gradual onset
- little or no discomfort
- intermittent discharge of pus
- associated sinus tract
- sinus tract tracing possible
- radiographic signs of osseous destruction
- e.g. radiolucency
What does a diagnosis of acute apical abscess indicate?
- inflammatory reaction to pulpal infection and necrosis
- rapid onset
- spontaneous pain
- extreme tenderness to pressure
- pus formation
- swelling of associated tissues
- may be no radiographic signs of destruction
- systemic symptoms
- malaise
- fever
- lymphadenopathy
- closure of eye
- may indicate threat to airway
What does a diagnosis of condensing osteitis indicate?
- diffuse radiopaque lesion representing a localised bony reaction to a low-grade inflammatory stimulus
- usually at apex of tooth
- potential positive response to thermal testing
