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BDS2b: Endodontics > Endodontics Diagnosis > Flashcards

Endodontics Diagnosis Flashcards

1
Q

What type of pain/sensation is associated with A-delta fibres?

A
  1. Sharp pricking sensation

2. Early shooting pain

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2
Q

What type of pain/sensation is associated with C fibres?

A
  1. Dull aching or burning

2. Late dull pain

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3
Q

What is the term given for the perception of pain in one part of the body distant from the source of pain?

A

Referred pain

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4
Q

What causes referred pain?

A

Usually caused by intense stimulation of C- fibres

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5
Q

What are 4 general rules of referred pain?

A
  1. Always radiates to the ipsilateral (same) side
  2. Anterior teeth seldom refer pain to other teeth or opposite arch
  3. Posterior teeth often refer to opposite arch or periauricular area, but seldom to anterior teeth
  4. Mandibular posterior teeth refer pain to periauricular area more often than maxillary
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6
Q

List the components that make up an endodontic examination

A
  1. Extra oral exam
  2. Intra oral exam
  3. Soft tissue exam
  4. Intra oral swelling
  5. Sinus tracts
  6. Palpation
  7. Percussion
  8. Mobility
  9. Periodontal exam
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7
Q

What is a complication of sensibility/vitality testing in a multi rooted tooth?

A

Tooth may respond positively to test, but there may still be a necrotic or irreversibly damaged root canal

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8
Q

What is a complication of heat tests?

A

Too much heat can cause irreversible pulpitis

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9
Q

What nerves are primarily stimulated by electric pulp test?

A

A-delta fast conducting fibres

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10
Q

What is an advantage of an electric pulp test (EPT)?

A

Negative response is a reliable indicator

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11
Q

What are some drawbacks of EPT?

A
  1. No indication of reversibility of inflammation
  2. No correlation between threshold and pulp condition
  3. EPT off teeth with open apices is unreliable
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12
Q

List 4 special tests aside from heat, cold and EPT

A
  1. Bite test (using frac finder)
  2. Test cavity (not popular)
  3. Staining and trans-illumination
  4. Selective anaesthesia
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13
Q

How should you think in terms of diagnosing features of a radiograph?

A
  1. Top of tooth: crown
  2. Middle of tooth: pulp
  3. Bottom of tooth: apex, bone and soft tissue
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14
Q

What are the 7 main pulpal diagnoses?

A
  1. Normal pulp
  2. Reversible pulpitis
  3. Symptomatic irreversible pulpitis
  4. Asymptomatic irreversible pulpitis
  5. Pulp necrosis
  6. Previously treated
  7. Previously initiated therapy
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15
Q

Describe some features that can help identify irreversible pulpititis

A
  1. Inflammation should resolve following appropriate management of the aetiology
  2. Discomfort is experienced when a stimulus is applied only lasting a few seconds
  3. Periapical region of the suspect tooth appears normal on radiograph
  4. Pain experienced is not spontaneous
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16
Q

What are characteristics of symptomatic irreversible pulpitis?

A
  1. Sharp pain upon thermal stimulus
  2. Lingering pain often 30 seconds or longer after stimulus removal
  3. Spontaneous pain (unprovoked)
  4. Referred pain
17
Q

What are common aetiologies of irreversible pulpitis?

A
  1. Deep caries
  2. Extensive restorations
  3. Fractures exposing pulpal tissues
18
Q

What can make symptomatic irreversible pulpitis hard to diagnose?

A

If Inflammation has not yet reached periapical tissues, resulting in no pain or discomfort to percussion

19
Q

What are the main methods for testing pulpal status?

A

Dental history

Thermal testing

20
Q

Describe the normal clinical presentation of asymptomatic irreversible pulpitis

A
  1. No clinical symptoms, usually responds normally to thermal testing
  2. However may have had trauma or deep caries that would likely result in pulp exposure following removal
21
Q

What does pulp necrosis indicate?

A

Indicates death of the dental pulp and need for root canal treatment

22
Q

How does a tooth with necrotic pulp respond to pulp testing?

A

Non- responsive to pulp testing and is asymptomatic

23
Q

Does necrotic pulp cause apical periodontitis?

A

No

24
Q

Can previously treated teeth respond to thermal or electric pulp testing?

A

Typically no, however in maxillary molars if there is a 4th root canal, some nerve tissue may cause a response

25
Q

What are 6 possible apical diagnoses?

A
  1. Normal apical tissues
  2. Symptomatic apical periodontitis
  3. Asymptomatic apical periodontitis
  4. Chronic apical abscess
  5. Acute apical abscess
  6. Condensing Osteitis
26
Q

What is a strong indicator of symptomatic apical periodontitis?

A

Painful response to biting/percussion or palpation

27
Q

Can radiographs next used to identify asymptomatic periodontitis?

A

Yes, look for periapical radiolucency.

However this may not be present during early stage of disease

28
Q

What is a highly indicative sign of degenerating pulp?

A

Severe pain to percussion and/or palpation.

Root canal treatment is needed

29
Q

What is asymptomatic apical periodontitis?

A

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

30
Q

How does asymptomatic periodontitis appear on a radiograph?

A

Appears as apical radiolucency and does not present clinical symptoms

31
Q

What is an acute apical abscess?

A

Inflammatory reaction to pulp infection and necrosis

32
Q

What are the characteristics of an acute apical abscess?

A
  1. Rapid onset
  2. Spontaneous pain
  3. Extreme tenderness of the tooth to pressure
  4. Pus formation
  5. Swelling of associated tissues
33
Q

What signs can accompany an acute apical abscess?

A
  1. Malaise
  2. Fever
  3. Lymphadenopathy

(May be no radiographic signs)

34
Q

What is condensing osteitis?

A

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

35
Q

What are the various treatment options for endodontic problems?

A
  1. RCT
  2. Re RCT
  3. Extraction
  4. Surgical intervention
  5. Monitor/don’t intervene
36
Q

Summarise the key points in making a diagnoses

A
  1. Listen to patient, ask correct questions
  2. Clinical reasoning/decision making fundamental
  3. Present cases to clinicians and your opinion
  4. Know diseases and treatment options
  5. Document findings in clinical notes
  6. Write diagnoses

BDS2b: Endodontics (4 decks)

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