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BDS3 OSCE > Endodontics - diagnosis > Flashcards

Endodontics - diagnosis Flashcards

1
Q

What are the 7 pulp diagnoses

A
  1. normal pulp
  2. reversible pulp
  3. symptomatic irreversible pulpitis
  4. asymptomatic irreversible pulpitis
  5. pulpal necrosis
  6. previously treated
  7. previously initiated
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2
Q

Describe what would be expected from a normal pulp

A
  • no symptoms
  • responsive to pulp testing
  • mild response to thermal testing, lasting no more than 1-2 seconds after stimulus removed
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3
Q

What should you always remember to do when thermal testing

A

compare to adjacent and contralateral teeth

test other teeth first to ensure patient familiar with it

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4
Q

What is reversible pulpitis

A

vital but inflamed pulp

inflammation will resolve with management

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5
Q

What would we expect from a patient who has reversible pulpitis

A

discomfort is experienced from a stimulus only lasting a few seconds

pain is not spontaneous

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6
Q

What are causes of reversible pulpitis

A
  • exposed dentine
  • caries
  • deep restorations
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7
Q

Which other condition presents very similarly to reversible pulpitis

A

dentine sensitivity

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8
Q

What is symptomatic irreversible pulpitis

A

Vital, inflamed pulp is incapable of healing

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9
Q

What treatment is required for irreversible pulpptis

A

RCT is indicated (or extraction)

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10
Q

What are the characteristics of symptomatic irreversible pulpitis

A

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
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11
Q

What are the common aetiologies of symptomatic irreversible pulpitis

A

deep caries

extensive restorations

fractures exposing vital pulp tissues

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12
Q

Why can teeth with symptomatic irreversible pulpitis be difficult to diagnose

A

inflammation is yet to reach periapical tissues therefore resulting in no pain or discomfort to percussion

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13
Q

What are the primary tools for assessing pulp status

A

dental history

thermal testing

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14
Q

What is asymptomatic irreversible pulpitis

A

VITAL inflamed pulp that is incapable of healing and that RCT is indicated

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15
Q

What makes asymptomatic irreversible pulpitis different to symptomatic irrevresible pulpitis

A

No clinical symptoms and usually normal responses to thermal testing

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16
Q

What are potential causes of asymptomatic irreversible pulpitis

A

Deep caries (that would likely result in pulp exposure upon removal)

Trauma

17
Q

What is the difference between reversible and irreversible pulpitis

A

Reversible Pulpitis:

Pain to cold, lasts a short time

Irreversible /Pulpitis:

Spontaneous pain, intermittent, sleep disturbance

Negative to cold, pain to hot

18
Q

What is pulpal necrosis defined as

A

Diagnostic category indicating death of the dental pulp, necessitating RCT

19
Q

What would you expect from a patient with pulpal necrosis

A
  • Nonresponsive to pulp testing and is asymptomatic
  • Pain to percussion or radiographic evidence of osseous breakdown (unless the canal is infected)
20
Q

What are treatment options for pulpal necrosis

A
  • Mature teeth (closed apices):
    • RCT
    • Extraction
  • Immature teeth (open apices):
    • Pulpotomy
    • Pulpectomy then RCT
    • Extraction
21
Q

What is meant by previously treated

A

Clinical diagnostic category indicating that the tooth has been previously endodontically treated

o Canals are obturated with various filling materials other than intracanal medicaments

22
Q

What would be expected from a tooth that is previously treated

A

The tooth typically does not respond to any thermal or electrical pulp testing

23
Q

What is meant by previously initiated

A

Clinical diagnostic category indicating that the tooth has been previously treated by a partial endodontic therapy such as a pulpotomy or pulpectomy

24
Q

What would be expected from a patient who has a previously initiated pulp

A

Depending on the level of therapy, the tooth may or may not respond to pulp testing modalities

Needs to be extracted or RCT completed

25
Q

What are the 6 apical diagnoses

A
  1. normal
  2. symptomatic apical periodontitis
  3. asymptomatic apical periodontitis
  4. chronic apical abscess
  5. acute apical abscess
  6. condensing osteitis

*can have more than 1

26
Q

What would we expect with normal apical tissue

A

Not sensitive to percussion or palpation testing

Radiographically the lamina dura is intact and the PDL space is uniform in thickness

27
Q

What is symptomatic apical periodontitis

A

Represents inflammation, usually of the apical periodontium

28
Q

What would we expect clinically with a patient who has symptomatic apical periodontitis

A

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

29
Q

If there is radiographic changes with symptomatic apical periodontitis, what would we expect

A

periapical radiolucency

30
Q

What is asymptomatic apical periodontitis

A

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

31
Q

How does asymptomatic apical periodontitis present

A

apical radiolucency and does not present clinical symptoms (no TTP or pain)

32
Q

What is a chronic apical abscess

A

inflammatory reaction to pulpal infection and necrosis

33
Q

What is chronic apical abscess characterised by

A
  • 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
34
Q

What would we expect radiographically for someone with a chronic apical abscess

A

radiographically signs of osseous breakdown e.g. radiolucency

35
Q

What is an acute apical abscess

A

Inflammatory reaction to pulpal infection and necrosis

36
Q

What is an acute apical abscess characterised by

A

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

37
Q

When is an acute apical abscess an emergency

A

eyes closed or airway threatened

38
Q

What is condensing osteitis

A

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

BDS3 OSCE (65 decks)

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