Endodontics L2: pulpal and periapical diagnosis Flashcards
Q18: people with irreversible pulpitis may experience excruciating pain, which can momentarily be relieved by the application of what?
Application of something cold.
Q59: what type of tooth crack is this?
Cracked tooth
Q42: what is suppuration?
The production/festering of pus.
Q49: when can the diagnosis of dentine hypersensitivity be given?
When dentine hypersensitivity cannot be attributed to any other dental cause such as caries, defective restoration.
Q37: what would be the signs and symptoms of acute periapical abscess?
Rapid onset, pain – extreme, tender to tooth, pus formation, mobility of tooth, systemic involvement and swelling
Q21: why wont a radiograph help determine early irreversible pulpitis?
No periapical changes radiographically.
Q65: how would you treat a fractured cusp?
Treat fractured cusp by removing cusp and restoring.
Q26: which two partial endodontic therapy counts as previously initiated therapy?
Pulpotomy and pulpectomy
Q17: would you expect spontaneous or unspontaneous pain with irreversible pulpitis?
Spontaneous
Q60: what type of tooth crack is this?
Fractured cusp
Q8: when would a pulpotomy be performed?
Pulpotomy is performed only when the inflamed pulp is confided to the crown.
Q9: if a tooth has a normal pulp, what symptoms would you expect to see?
You would expect it to be symptom free.
Q5: endodontic treatment are any procedures designed to maintain the health of the pulp (vital pulp therapy). What is the stepwise excavation procedure?
Stepwise excavation is method of managing deep/extensive/advanced dentinal carious lesions to reduce the risk of pulpal exposure and pulpal pathosis (disease state) by removing the caries lesion in separate appointments with > 6-month intervals.
Q7: endodontic treatment are any procedures designed to maintain the health of the pulp (vital pulp therapy). What is the pulpotomy procedure?.
In a pulpotomy, the dentist only removes the pulp in the tooths crown, while leaving the pulp in the roots
Q31: what is periapical tissue?
Periapical tissue is the tissue surrounding the apex a of a tooth, including the apical portion of the periodontal membrane and the alveolar bone.
Q66: on what condition would you do a root canal treatment with a fractured cusp?
Only root canal treatment if crack affects pulp.
Q35: radiographically what would you expect to see in someone with symptomatic periapical periodontitis?
Loss of lamina dura and widening of PDL and some form of periapical radiolucency.
Q54: cracked teeth is difficult to diagnose. If unrecognised and untreated what can it lead to?
Vertical root fracture and extraction of tooth.
Q30: what would you expect to see when you perform percussion and palpation testing on someone with normal periapical tissues?
Teeth will be non-sensitive
Q15: what is pulp allodynia?
painful response to a normally innocuous stimulus.
Q33: a tooth with a vital pulp with reversible/irreversible pulpitis; would you expect to see normal periapical tissues?
Yes, until the necrosis has made its way along the root and into the apex of the tooth to the surrounding tissues only then will you see abnormal periapical tissues.
Q10: what would you do to test if the pulp is vital?
Sensibility and sensitivity testing (mild responses that subsides immediately when stimulus is removed)
Q36: What causes acute periapical abscess?
Bacteria have progressed into the periapical tissues and the patient’s immune response cannot defend against the invasion.
Q6: endodontic treatment are any procedures designed to maintain the health of the pulp (vital pulp therapy). What is the indirect pulp cap procedure?
Indirect pulp cap treatment works by the application of a bacteriostatic/bactericidal liner, such as calcium hydroxide, over the carious dentin to induce remineralization and protect the pulp.
Q41: what does exude mean?
To discharge pus
Q55: what is the aetiology of cracked teeth:
occlusal forces,
abnormal chewing habits,
accidental trauma,
structural fatigue
Q19: irreversible pulpitis can be difficult to diagnose, where you confuse maxillary and mandibular arches in the early stages. Why might this be the case?
Referred pain.
Q64: how would you diagnose craze lines?
Transillumination
Q57: there are 5 defining types of cracks, what are they?
Craze lines,
fractured cusp,
cracked tooth,
split tooth and
vertical root fracture.
Q53: what is a cracked teeth?
Incomplete fracture of a posterior tooth with a vital pulp, which includes dentine and possibly the pulp?
Q32: what would you expect to see radiographically, in someone with normal periapical tissue?
Intact lamina dura and a uniform periodontal ligament space
Q4: when there is not enough tooth substance to hold a restoration (such as a crown) a dentist may do a root canal treatment where the pulp is replaced by a metal/fibre post so that the tooth can hold the crown?
What type of root canal treatment is this? Elective root canal treatment.
Q14: treatment of reversible pulpitis involves conservative pulp therapy in conjunction with removal of the cause and pathway of irritation. Why might you review the status of the pulp, after 3 months.
The pulp may become irreversible after a later date, that’s why review is important.
Q29: what are the 5 periapical diagnosis?
Normal periapical tissues,
symptomatic periapical periodontitis,
asymptomatic periapical periodontitis,
acute periapical abscess and
chronic periapical abscess.
Q46: what causes asymptomatic periapical periodontitis?
It is important to remember that symptomatic would involve the apex of the tooth. With asymptomatic periapical periodontitis the bacterial products from a necrotic or pulpless tooth slowly ingress the periapical tissues.
Q69: in reference to location of the abscess how does a periodontal abscess differ from a periapical abscess?
A periodontal abscess is usually situated at the gingival margin, whereas a periapical abscess is allot lower.
Q34: symptomatic periapical periodontitis is caused by the inflammation of the periapical tissues, what would be the pulpal status at this time?
Irreversibly inflamed or necrotic.
Q61: what type of tooth crack is this?
Split tooth
Q68: when would a cracked tooth not be treatable?
When the crack extends pass the crown sub gingivally.
Q24: pulpal necrosis is usually asymptomatic unless inflammation has?
Progressed to periapical tissues.
Q43: if the apical abscess is not localised and is below the apex of the tooth, how would you go abouts draining it?
Through root canal, by creating access into the root canal(s) and placing a small file beyond the root apex.
Q38: why would the swelling depend on the location of apices and muscle attachment?
Depending on which tooth the periapical abscess is, will determine whether it will stay localised or diffuse to other muscle attachments.
Q1: a branch of dental science concerned with the study of form, function, health of, injuries to and diseases of the dental pulp and periradicular tissues: is the definition of what?
Endodontology
Q3: these diseases; irreversible pulpitis, pulpal necrosis, and periapical disease will result in which type of treatment?
Root canal treatment.
Q23: once the correct tooth has been located what are the treatment option for someone with IP if the tooth is not restorable?
Extraction.
Q22: once the correct tooth has been located what are the treatment option for someone with IP if the tooth is restorable?
Root canal treatment or pulpotomy.
Q62: what type of tooth crack is this?
Vertical root fracture
Q58: what type of tooth crack is this?
Craze lines
Q11: what are the symptoms for reversible pulpitis in reference to pain?
Pain would be short and sharp.
Q40: what would you do to treat an apical abscess?
Emergency drainage.
Q44: what must you never do after performing drainage via root canal?
Never leave a tooth on open drainage.
Q51: if a patient suffers from hypersensitivity through a specific factor such as caries or recent restoration. Leading to symptoms identical to dentine hypersensitivity however, the diagnosis cannot be dentine hypersensitivity, what would the diagnosis be?
Reversible pulpitis.
Q25 would you expect a tooth which has undergone pulpal necrosis to respond to a sensibility testing?
no
Q48: following history, clinical examination, and special investigations a diagnosis will be made. What must the diagnosis always be?
This diagnosis must always be pulpal and periapical.
Q27: periapical pathology begins with microbes and by-products reaching the periapical tissues. Periapical pathology begins with the resorption of the surrounding bone. What causes this resorption?
Inflammation and immunological response.
Q2: the clinical discipline that deals with the prevention, diagnosis, and treatment of endodontic disease: is the definition of what?
Endodontics
Q12: would you expect a short, sharp pain spontaneously in reversible pulpitis?
No, the pain would be a result from a stimulus such as cold, sweet, or sometimes hot ingested substance.
Q63: craze lines only effect what part of the tooth?
The enamel
Q47: an inflammatory reaction to pulpal infection and necrosis characterised by gradual onset, little or no discomfort and intermittent discharge through an associated sinus tract. This best describes which periapical abscess?
Chronic periapical abscess.
Q28: epithelial cells in the periodontal ligament proliferate to form a?
granuloma or cyst
Q50: what are the two causes of dentine hypersensitivity?
Gingival recession and tooth surface loss
Q39: what would you expect to see happen to the PDL radiographically in acute periapical abscess?
The PDL space may be normal, slightly widened.
Q45: open drainage is no longer practiced, what would be the right procedure when exuding apical abscess via root canal.
It is important to irrigate the root canal until all suppuration is cleared. Followed by chemical application of calcium hydroxide and then a temporary dressing.
Q16: what type of pain would you expect to feel with irreversible pulpitis?
Sharp pain on thermal stimulus which lingers for about 30 seconds.
Q20: in early irreversible pulpitis, the tooth will not be tender to pressure/percussion, why?
Inflammation has not yet reached the periapical tissues
Q13: what are the 4 common causes of reversible pulpitis?
Caries into dentine,
fractures,
restorative procedures,
and trauma.
Q52: which fibres are activated by the fluid movement in dentinal tubules?
Alpha delta fibres
Q56: what type of pain would you expect to feel when biting on hard objects, with cracked teeth?
Sharp shooting pain.
Q67: where does a cracked tooth initiate?
Initiates at the crown and extends sub gingivally
