Endodontics diagnosis

Question 1

What is normal pulp diagnosis?

Answer 1

• Pulp is symptom free and normally responsive to pulp testing
• Mild or transient response to thermal cold testing lasting no more than one or two seconds after stimulus removed
• Always test adjacent and contralateral teeth first so patient knows normal response to cold

Question 2

What is reversible pulpitis diagnosis?

Answer 2

• Based on findings that inflammation should resolve and pulp return to normal following appropriate management of aetiology
• Discomfort when cold or sweet stimulus applied and goes away within couple of seconds following removal of stimulus
• Typical aetiologies included exposed dentine (dentinal sensitivity), caries or deep restoration
• No sig radiographic changes in periapical region of suspect tooth
• Pain not spontaneous
• Following management of aetiology the tooth requires further investigation to determine whether reversible pulpitis has returned to normal status

Question 3

What can dentinal sensitivity closely mimic?

Answer 3

• Reversible pulpitis
• Symptoms closely mimic it

Question 4

What is a Symptomatic Irreversible Pulpitis diagnosis?

Answer 4

• Vital inflamed pulp incabable of healing and RCT indicated
• Sharp pain upon thermal stimulus, lingering pain (often 30secs or longer after stimulus removed)
• Spontaneous pain and referred pain
• Can be associated with lying down
• Over the counter analgesics typically ineffective
• Aetiologies inc deep caries, extensive restorations, fractures exposing pulpal tissues
• Difficult to diagnose as inflammation not yet reached periapical tissues therefore no pain or discomfort to percussion
• Dental history and thermal testing vital for pulpal status

Question 5

What is Asymptomatic Irreversible Pulpitis diagnosis?

Answer 5

• Vital inflamed pulp incapable of healing and RCT indicated
• No clinical symptoms
• Usually responds normally to thermal testing but may have had trauma or deep caries that would likely result in exposure following removal

Question 6

What is a Pulp Necrosis diagnosis?

Answer 6

• Death of dental pulp, necessitating RCT
• Pulp non-responsive to pulp testing and is asymptomatic
• Pulp necrosis itself does not cause apical periodontitis (pain to percussion or radiographic evidence of osseous breakdown) unless canal is infected
• May be due to calcification, recent history of trauma, simply tooth not responding so relies on testing adjacent and contralateral teeth

Question 7

What is a previously treated diagnosis?

Answer 7

• Tooth has been endodontically treated and canals are obturated with various filling materials other than intracanal medicament
• Typically does not respond to thermal or pulp testing

Question 8

What is a Previously Initiated Therapy diagnosis?

Answer 8

• Tooth previously treated by partial endodontic therapy such as pulpotomy or pulpectomy
• Depending on level of therapy, tooth may or may not respond to pulp testing methods

Question 9

What is a Normal Apical Tissue diagnosis?

Answer 9

• Not sensitive to percussion or palpation testing
• Radiographically the lamina dura surrounding root is intact and periodontal ligament space is uniform
• Always pulp test with adjacent and contralateral tooth

Question 10

What is a Symptomatic Apical Periodontitis?

Answer 10

• Represents inflammation, usually of apical periodontium
• Painful response to biting and or percussion or palpation
• May or may not be accompanies by radiographic changes (may be normal width of PDL or periapical radiolucency depending on progression)
• Severe pain to percussion and or palpation highly indicative of degenerating pulp and RCT needed

Question 11

What is Asymptomatic Apical Periodontitis diagnosis?

Answer 11

• Inflammation and destruction of apical periodontium that is of pulpal origin
• Appears as apical radiolucency
• No clinical symptoms

Question 12

What is a Chronic Apical Abscess diagnosis?

Answer 12

• Inflammatory reaction to pulpal infection and necrosis
• Characterised by gradual onset, little or no discomfort and intermittent discharge of pus through associated sinus tract
• Radiographically typically signs of osseous destruction like a radiolucency
• To identify source of draining sinus tract if present, a gutta-percha cone carefully placed through stoma or opening until it stops and radiograph taken

Question 13

What is an Acute Apical Abscess diagnosis?

Answer 13

• Inflammatory reaction to pulpal infection and necrosis
• Characterised by rapid onset, spontaneous pain, extreme tenderness of tooth to pressure, pus formation and swelling of associated tissues
• May be no radiographic signs of destruction and patient often experiences malaise, fever and lymphadenopathy

Question 14

What is a Condensing Osteitis diagnosis?

Answer 14

• A diffuse radiopaque lesion representing a localised bony reaction to low-grade inflammatory stimulus usually seen at apex of tooth