Endodontic diagnosis

Question 1

Referred pain - features

Answer 1

always radiates to ipsilateral side
anterior teeth rarely refer pain to other teeth or opposite arch
posterior teeth often refer to opposite arch or periauricular area, but seldom to anterior teeth
mandibular posterior teeth refer pain to periauricular area more often than maxillary

Question 1

How to take an EPT

Answer 1

dry teeth and isolate
place probe on incisal edge or cusp tip
conducting medium used
circuit completed
current slowly increases until response

Question 2

Normal pulp - define

Answer 2

• pulp is symptom free and normally responsive to pulp testing
• pulp may not be histologically normal
• mild or transient response to thermal cold testing, lasting no more than 1-2 seconds after stimulus removed

Question 3

Reversible pulpits features

Answer 3

• discomfort experienced when stimulus applied only lasting a few seconds
• no significant radiographic changes in periodical region of suspect tooth
• pain experienced is not spontaneous
• inflammation should resolve following appropriate management of aetiology

Question 4

Reversible pulpits causes

Answer 4

caries
deep restorations
exposed dentine - dentinal sensitivity

Question 5

Symptomatic irreversible pulpitis features

Answer 5

pulp vital
inflammation - pulp incapable of healing
- sharp pain upon thermal stimulus
- lingering pain, 30 seconds or longer after stimulus removed
- spontaneous pain
- referred pain
pain may be accentuated by postural changes e.g. lying down
- OTC analgesics typically ineffective

Question 6

Common causes of symptomatic irreversible pulpitis

Answer 6

• deep caries
• extensive restorations
• fractures exposing pulpal tissues

Question 7

Asymptomatic irreversible pulpitis features

Answer 7

viatal inflamed pulp
incapable of healing
no clinical symptoms
usually respond normal to thermal testing

Question 8

pulp necrosis features

Answer 8

death of dental pulp
non-responsive to pulp testing
tooth asymptomatic

Question 9

Normal apical tissues - features

Answer 9

not sensitive to percussion or palpation testing
surrounding the root is intact - PDL space is uniform
comparative testing for percussion and palpation should be done first as a baseline

Question 10

symptomatic apical periodontitis

Answer 10

inflammation, usually of apical periodontium
painful response to biting and/or percussion or palpation
may or may not be accompanies by radiographic changes
- dependent o disease progression

Question 11

asymptomatic apical periodontitis features

Answer 11

inflammation and destruction of the apical periodontium that is of pulp origin
appears as an apical radiolucency and does not present clinical symptoms

Question 12

chronic apical abscess features

Answer 12

inflammatory reaction to pulpal infection and necrosis
characterised by gradual onset
- little or no discomfort
- intermittent discharge of pus through associated sinus tract
- sinus tract tracing possible
radiographically, signs of osseous destruction such a radiolucency

Question 13

acute apical abscess

Answer 13

inflammatory reaction to pulpal infection and necrosis
rapid onset, spontaneous pain, extreme tenderness of the tooth to pressure, pus formation and swelling of associated tissues
may be no radiographic signs of destruction
patient often experiences fever and lymphadenopathy

Question 14

condensing osteitis features

Answer 14

diffuse radiopaque lesion representing bony reaction to low-grade inflammatory stimulus