Endodontics - Diagnois Flashcards
Define a Normal pulp
Normal pulp is a clinical diagnostic category in which the pulp is symptom free and normally responsive to pulp testing.
Clinically normal pulp - responds to a thermal cold testing lasting no more than one or two seconds after stimulus is removed
Patient presents with discomfort with cold and sweat which goes away in a couple of seconds following removal.
No Significant radiographic changes in periapical region
The pain is not spontaneous
Patient has a deep restoration.
Potential diagnosis?
Reversible pulpitis
Typical aetiologies - exposed dentine( sensitivity), caries or deep restoration.
Management- caries removal plus restoration, covering the exposed dentine.
Inflammation should resolve and pulp should return to normal
Patient presents to your practice with pain, pain history is taken and this is what you find.
Sharp pain upon thermal stimulus,lingering up to 30 seconds after removal.
Spontaneous/unprovoked pain
Referred pain, pain is also provoked by postural changes
Analgesics ineffective
Patient has deep caries
Potential diagnosis and treatment?
Symptomatic irreversible pulpitis
Typical aetiology - deep caries, extensive restorations or fracture exposing the pulpal tissues.
The vital inflamed pulp is incapable of healing and root canal treatment is indicated
Why when someone has symptomatic irreversible pulpitis it may not present as TTP?
This is a difficult diagnosis as the inflammation may not of yet reached the periapical tissues leaving the patient no pain or discomfort to percussion.
Dental and thermal history are primary tools to access this diagnosis
Vital pulp is inflamed and incapable of healing and root canal treatment is indicated.
These cases have no clinical symptoms and usually respond normally to thermal testing but may have had trauma or deep caries that will likely lead to exposure following removal.
What endodontic diagnosis is being described here?
Asymptomatic irreversible pulpitis
What is pulp necrosis?
Pulp necrosis is a clinical diagnostic category indicating death of the pulp, necessitating root canal treatment
Why must all pulp testing of a comparitive nature
This is because some teeth may not be responsive to pulp-testing because of calcification, recent history of trauma or simply the tooth is just not responding.
A patient may also just not respond to thermal testing on any of the teeth
Patient presents to the surgery stating that they are having pain when biting and on clinical exam the tooth was very painful to percussion/palpation.
On radiographic examination there is a evidence of a periapical radiolucney
What is a potential diagnosis here?
Symptomatic apical periodontitis
Repressing inflammation, usually of the apical periodontium usually producing symptoms such as a painful response to biting/ percussion.
This may or may not be accompanied by radiogrpahic changes - depending upon the stages of the disease, there may be normal width of the PDL or there may be periapical radiolucney.
Severe pain to percussion/palpation is highly indicative of a degenerating pulp and root canal treatment is indicated
Patient present to your surgery with an abscess it has had a gradual onset, patient says they have little/ no discomfort from the abscess and that there is an intermittent discharge of pus.
What kind of abscess is evident here and what would you expect to find radiographically.
Chronic apical abscess - it is an inflammatory reaction to pulpal infection and necrosis
Radiographically there are signs of osseous destruction such as a radiolucnecy.
How wold you identify the source of a draining sinus tract
A gutta-percha cone is carefully placed through the stoma or opening until it stops and a radiograph is taken
Patient in your surgery has an abscess; clinical findings are
- rapid onset
- spontaneous pain
- extreme tenderness of the tooth to pressure
- pus formation
- swelling of associated tissues
What is the diagnosis here, radiographically would you see any change. Will the patient complain of anything else
Acute apical abscess
There may be no radiographic signs of destruction and the patient often experiences malaise, fever and lymphadenopathy
What is condensing osteitis
It is a diffuse radiopaque lesion representing a localised bony reaction to a low-grade inflammatory stimulus usually seen at the apex of the tooth
Mandibular right first molar had been hypersensitive to cold and sweets over the past few months but the symptoms have subsided. Now there is no response to thermal testing and there is tenderness to biting and pain to percussion. Radiographically, there are diffuse radiopacities around the root apices.
Diagnosis?
Pulp necrosis
Symptomatic apical periodontitis with condensing osteitis.
Maxillary left first molar has occlusal-mesial caries and the patient has been complaining of sensitivity to sweets and to cold liquids. There is no discomfort to biting or percussion.The tooth is hyper-responsive to ethyl-chloride with no lingering pain.
Diagnosis?
Reversible pulpitis; normal apical tissues
Mandibular right lateral incisor has an apical radiolucency that was discovered during a routine examination. There was a history of trauma more than 10 years ago and the tooth was slightly discolored. The tooth did not respond to thermal testing or to the EPT; the adjacent teeth responded normally to pulp testing. There was no tenderness to percussion or palpation in the region.
Diagnosis?
Pulpal necrosis; asymptomatic apical periodontitis
