Endodontics - diagnosis Flashcards
What are the 7 pulp diagnoses
- normal pulp
- reversible pulp
- symptomatic irreversible pulpitis
- asymptomatic irreversible pulpitis
- pulpal necrosis
- previously treated
- previously initiated
Describe what would be expected from a normal pulp
- no symptoms
- responsive to pulp testing
- mild response to thermal testing, lasting no more than 1-2 seconds after stimulus removed
What should you always remember to do when thermal testing
compare to adjacent and contralateral teeth
test other teeth first to ensure patient familiar with it
What is reversible pulpitis
vital but inflamed pulp
inflammation will resolve with management
What would we expect from a patient who has reversible pulpitis
discomfort is experienced from a stimulus only lasting a few seconds
pain is not spontaneous
What are causes of reversible pulpitis
- exposed dentine
- caries
- deep restorations
Which other condition presents very similarly to reversible pulpitis
dentine sensitivity
What is symptomatic irreversible pulpitis
Vital, inflamed pulp is incapable of healing
What treatment is required for irreversible pulpptis
RCT is indicated (or extraction)
What are the characteristics of symptomatic irreversible pulpitis
Sharp pain upon thermal stimulus
- Lingering pain (often >30 seconds after stimulus removed)
- Spontaneous pain
- Referred pain
- May be accentuated by postural changes (bending and lying)
- OTC analgesia ineffective
What are the common aetiologies of symptomatic irreversible pulpitis
deep caries
extensive restorations
fractures exposing vital pulp tissues
Why can teeth with symptomatic irreversible pulpitis be difficult to diagnose
inflammation is yet to reach periapical tissues therefore resulting in no pain or discomfort to percussion
What are the primary tools for assessing pulp status
dental history
thermal testing
What is asymptomatic irreversible pulpitis
VITAL inflamed pulp that is incapable of healing and that RCT is indicated
What makes asymptomatic irreversible pulpitis different to symptomatic irrevresible pulpitis
No clinical symptoms and usually normal responses to thermal testing
What are potential causes of asymptomatic irreversible pulpitis
Deep caries (that would likely result in pulp exposure upon removal)
Trauma
What is the difference between reversible and irreversible pulpitis
Reversible Pulpitis:
Pain to cold, lasts a short time
Irreversible /Pulpitis:
Spontaneous pain, intermittent, sleep disturbance
Negative to cold, pain to hot
What is pulpal necrosis defined as
Diagnostic category indicating death of the dental pulp, necessitating RCT
What would you expect from a patient with pulpal necrosis
- Nonresponsive to pulp testing and is asymptomatic
- Pain to percussion or radiographic evidence of osseous breakdown (unless the canal is infected)
What are treatment options for pulpal necrosis
- Mature teeth (closed apices):
- RCT
- Extraction
- Immature teeth (open apices):
- Pulpotomy
- Pulpectomy then RCT
- Extraction
What is meant by previously treated
Clinical diagnostic category indicating that the tooth has been previously endodontically treated
o Canals are obturated with various filling materials other than intracanal medicaments
What would be expected from a tooth that is previously treated
The tooth typically does not respond to any thermal or electrical pulp testing
What is meant by previously initiated
Clinical diagnostic category indicating that the tooth has been previously treated by a partial endodontic therapy such as a pulpotomy or pulpectomy
What would be expected from a patient who has a previously initiated pulp
Depending on the level of therapy, the tooth may or may not respond to pulp testing modalities
Needs to be extracted or RCT completed
What are the 6 apical diagnoses
- normal
- symptomatic apical periodontitis
- asymptomatic apical periodontitis
- chronic apical abscess
- acute apical abscess
- condensing osteitis
*can have more than 1
What would we expect with normal apical tissue
Not sensitive to percussion or palpation testing
Radiographically the lamina dura is intact and the PDL space is uniform in thickness
What is symptomatic apical periodontitis
Represents inflammation, usually of the apical periodontium
What would we expect clinically with a patient who has symptomatic apical periodontitis
Painful response to biting and/or percussion or palpation
Highly indicative of degenerating pulp and RCT required
Patient may tell you it’s sore to bite
If there is radiographic changes with symptomatic apical periodontitis, what would we expect
periapical radiolucency
What is asymptomatic apical periodontitis
inflammation and destruction of the apical periodontium that is of pulpal origin
How does asymptomatic apical periodontitis present
apical radiolucency and does not present clinical symptoms (no TTP or pain)
What is a chronic apical abscess
inflammatory reaction to pulpal infection and necrosis
What is chronic apical abscess characterised by
- gradual onset
- little or no discomfort
- intermittent discharge of pus through an associated sinus tract
- lump or bump next to tooth leaving clear liquid or blood is indicative
- bad taste in mouth
What would we expect radiographically for someone with a chronic apical abscess
radiographically signs of osseous breakdown e.g. radiolucency
What is an acute apical abscess
Inflammatory reaction to pulpal infection and necrosis
What is an acute apical abscess characterised by
Rapid onset (may not be radiographic as such sudden onset)
Spontaneous pain
Extreme tooth tenderness to pressure
Pus formation
Swelling of associated tissues - may also experience malaise, fever and lymphadenopathy
When is an acute apical abscess an emergency
eyes closed or airway threatened
What is condensing osteitis
Diffuse radiopaque lesion representing a localised bony reaction to a low-grade inflammatory stimulus usually seen at the apex of the tooth
