Endodontics- Diagnosis Flashcards
What are the 5 steps in the process of diagnosis
- why is the patient seeking advice
- history and symptoms prompting visit
- objective clinical tests
- correlation of objective findings and subjective details to create differential diagnosis
- formulation of definitive diagnosis
What are the main fibres that cause dental pain?
A -delta fibres
C fibres
With regards to dental pain what kind of pain is felt from A-delta fibres?
sharp pricking sensation
early shooting pain
With regards to dental pain what kind of pain is felt from C fibres?
Dull, aching or burning
late dull pain
What is the definition of an endodontic emergency ?
Pain and or swelling caused by various stages of inflammation or infection of the pulpal and /or periapical tissues
What can it be difficult to discriminate location of pulpal pain?
referred pain
what are some general rules when dealing with referred pain in teeth?
-always radiates to ipsilateral side (same side)
- anterior teeth seldom refer pain to other teeth or opposite arch
- posterior teeth often refer to opposite arch or periauricular area, but rarely to anterior teeth
- mandible posterior teeth refer pain to periauricular area (ear) more often than maxillary
What things are included in an endodontic examination?
- extraoral exam
- intraoral exam
- soft tissue exam
- intraoral swelling
- sinus tracts
- palpation
- percussion
- mobility
- periodontal exam
What can be seen here?
spreading cellulitis
eye closed due to swelling of a maxillary tooth
(would send to max fax in ambulance)
Give 4 examples of sensibility/vitality testing- pulp tests
- thermal
- electric
- laser doppler flowmetry
- pulse oximetry
What should be used for heat tests?
hot gutta percha- use vaseline
hot water and dental dam
Why should you not place too much heat on a tooth?
it can cause irreversible pulpitis
What is an electric pulp test and what fibres are primarily affected?
electric current used to stimulate sensory nerves
primarily A-delta fast conducting fibres
(unmyelinated C-fibres may not respond)
What are the stages of carrying out an EPT?
-dry teeth and isolate
-probe place on incisal edge or cusp (close to pulp horn proximity)
- conducting medium used
- circuit completed
- current slowly increases until response
Does EPT have any correlation between threshold and pulp condition?
no
Does EPT give any indication of reversibility of inflammation?
no
True/False: EPT of teeth with open apices is reliable
False
Name some examples of other special tests…
bite test (frac finder or tooth sleuth)
test cavity
staining and trans-illumination
selective anaesthesia
How many pre-op radiographs should be required?
two from different angulations
When assessing a radiograph what order should you review it?
crown
pulp
apex/bone/soft tissue
Name 7 pulpal diagnoses?
Normal Pulp
Reversible Pulpitis
Symptomatic Irreversible Pulpitis
Asymptomatic Irreversible Pulpitis
Pulp Necrosis
Previously Treated
Previously Initiated Therapy
What is the definition of a normal pulp?
Pulp is symptom-free and normally responsive to pulp testing
Pulp may not be histologically normal
“Clinically” normal pulp results in a mild or transient response to thermal cold testing, lasting no more than one to two seconds after the stimulus is removed
Compare the tooth in question with adjacent and contralateral teeth. Test other teeth first so that the patient is familiar with the experience of a normal response to cold
How should reversible pulpitis be treated?
appropriate management of the aetiology
Reversible pulpitis, when a stimulus is applied does discomfort only apply for a short period of time or long
discomfort only for a few seconds
What three things can cause reversible pulpitis
exposed dentine
caries
deep restorations
Is the pain experiences with reversible pulpitis spontaneous?
no
What are the characteristics of symptomatic irreversible pulpitis ?
Characteristics may include sharp pain upon thermal stimulus, lingering pain (often 30 seconds or longer after stimulus removal), spontaneity (unprovoked pain) and referred pain
What is meant by symptomatic irreversible pulpitis and how is it treated?
Vital inflamed pulp is incapable of healing and that root canal treatment is indicated
How might pain be accentuated with symptomatic irreversible pulpitis?
postural changes such as lying down or bending over
Are OTC analgesics effective in treating the pain from symptomatic irreversible pulpitis?
no
What are some of the common aetiologies for symptomatic irreversible pulpitis?
deep caries
extensive restorations
fractures exposing the pulpal tissues
What are the primary tools for assessing pulpal status for irreversible pulpitis?
dental history
thermal testing
What is the definition of asymptomatic irreversible pulpitis?
vital inflamed pulp is incapable of healing and that rool canal treatment is indicated
Does asymptomatic irreversible pulpitis respond normally to thermal testing?
yes
Definition of pulp necrosis
diagnostic category indicating death of the dental pulp, necessitating root canal treatment
Would a tooth with pulp necrosis respond normally to pulp testing?
no- non responsive
How might you diagnoses pulp necrosis?
pain to percussion
radiographic evidence of osseous breakdown
(UNLESS canal if infected)
What are some reasons why teeth might be non-responsive to pulp testing?
calcification
recent history of trauma
simply the tooth is just not responding
Definition of “previously treated” and how would this tooth typically respond to thermal or electric pulp testing
clinical diagnostic category indicating that the tooth has been endodontically treated
the tooth typically does NOT respond to thermal or electric pulp testing
What is meant by “previously initiated”
clinical diagnostic category indicating that the tooth has been previously treated by partial endodontic therapy such as pulpotomy and pulpectomy
if a tooth has been previously initiated how will it respond to pulp testing?
it may or may not respond to pulp testing
Name 6 apical diagnoses
Normal Apical Tissues
Symptomatic Apical Periodontitis
Asymptomatic Apical Periodontitis
Chronic Apical Abscess
Acute Apical Abscess
Condensing Osteitis
How would you define a tooth that has normal apical tissues?
- not sensitive to percussion or palpation testing and radiographically, the lamina dura
- surrounding the root is intact and the periodontal ligament space is uniform
When carrying out percussion testing etc, which teeth should you begin with?
- comparative testing for percussion and palpation should always begin with normal teeth as a base line for the patient
How would you define symptomatic apical periodontitis
represents inflammation, usually of the apical periodontium
How would a tooth with symptomatic apical periodontitis respond to percussion/palpation?
painful response
How might symptomatic apical periodontitis present on a radiograph?
change in width of the periodontal ligament or there may be a periapical radiolucency
How would a tooth with aymptomatic apical periodontitis respond to percussion/palpation?
no pain
How would you define a chronic apical abscess? and how is it characterised
inflammatory reaction to pulpal infection and necrosis
gradual onset, little or no discomfort and an intermittent discharge or pus through an associated sinus tract
What is the definition of an acute apical abscess?
inflammatory reaction to pulpal infection and necrosis
How is an acute apical abscess characterised?
RAPID onset, spontaneous pain, extreme tenderness of the tooth to pressure, pus formation and swelling of associated tissues
What are some other things a patient may experience if they have an acute apical abscess?
malaise
fever
lymphadenopathy
What is this apical diagnosis?
condensing osteitis
What is the definition of condensing osteisis?
diffuse radiopaque lesion representing a localised bony reaction to a low-grade inflammatory stimulus usually seen at the apex of the tooth
name 5 treatment options for an apical pathology..
root canal treatment
re root canal treatment
extract the tooth
monitor/don’t intervene
surgical intervention
