endodontics need to know

Question 1

what would be included in a clinical exam when trying to determine an endodontic diagnosis of a tooth?

Answer 1

facial symmetry
sinus tract
soft tissue
periodontal status (probing, mobiliy)
caries
restorations (defective, newly placed)

Question 2

which clinical tests can be carried out to determine a pulpal diagnosis?

Answer 2

cold- ethyl chloride
heat- GP
electric pulp test

Question 3

what tests can be carried out to determine a periapical diagnosis?

Answer 3

percussion
palpation
tooth slooth (biting)

Question 4

what radiographic analysis should be carried out during endodontic diagnosis?

Answer 4

new periapicals (at least 2)
bitewing
cone beam-computed tomography

Question 5

how would you define a ‘normal pulp’?

Answer 5

the pulp is symptom free and normally responsive to pulp testing
mild or transient response to thermal cold testing, lasting no more than 1/2 secs after stimulus removed

Question 6

define reversible pulpitis

Answer 6

based upon subjective and objective findings indicating that the inflammation should resolve and the pulp return to normal following management of the aetiology
discomfort is experienced when a cold stimulus is applied, but stops within a few seconds of removal of the stimulus
no significant radiographic changes in periapical region

Question 7

what are the typical aetiologies of reversible pulpitits?

Answer 7

exposed dentine (dentine sensitivity)
caries
deep restoration

Question 8

define symptomatic irreversible pulpitis

Answer 8

based on subjective and objective findings that the vital inflamed pulp is incapable of healing anf that root canal treatment is indicated
charp pain upon stimulus, lingering for 30+ seconds after removal, spontaneous pain, usually keep patient up at night, referred pain
pain can be made worse by lying down/bending over
OTC analgesics usually ineffective

Question 9

why are teeth with symptomatic irreversible pulpitis usually not tender to percussion?

Answer 9

infection has not reached the periapcial tissues

Question 10

define asymptomatic irreversible pulpitis

Answer 10

based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing and that root canal treatment is indicated
no clinical symptoms
usually respond normally to thermal testing
may have had trauma/deep caries

Question 11

define pulp necrosis

Answer 11

death of the pulp- root canal necaessary
pulp is non-responsive to testing and is asymptomatic

Question 12

describe ‘normal apical tissues’

Answer 12

not sensitive to percussion or palpation testing
the lamina dura root is intect
the PDL space is uniform

Question 13

describe symptomatic apical periodontitis

Answer 13

inflammation, usually of apical periodontium, producing clinical symptoms involving painful response to biting and/or percussion or palpation
there may be a periapical radiolucency, depending on stage of disease

Question 14

describe asymptomatic apical periodontitis

Answer 14

inflammation and destruction of apical periodontium that is of pulpal origin
appears as apical radiolucency
no clinical symtoms

Question 15

desribe a chronic apical abscess

Answer 15

A
inflammatory reaction to pulpal infection and necrosis
characterised by by gradual onset, little/no discomfort and an intermittent discharge of pus through an associated sinus tract
typically signs of osseous destruction such as a radiolucency

Question 16

how would you identify the source of a draining sinus in a chronic apical abscess?

Answer 16

place a gutta-percha cone through the stoma/opening until it stops and a radiograph is taken

Question 17

define an acute apical abcess

Answer 17

inflammatory reaction to pulpal infection and necrosis characterised by rapid onset, apontaneous pain, extreme tenderness of the tooth to pressure, pus formation and swelling of associated tissues
may be no radiographic signs of destruction
patient often feels malaise, fever and lymphadenopathy

Question 18

define condensing osteitis

Answer 18

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

Question 19

give reasons for obturating

Answer 19

entomb remaining surviving microorganisms within the root canal system
prevent ingress of fluid into root canal space which will promote the growth of surviving microorganisms
prevent entry of microbes from the oral environment due to coronal leakage

Question 20

what are the functions of a sealer during endodontic treatment?

Answer 20

lubricate the canal
seal space between dentinal wall and core
fill voids and irregularities within the canal and between GP cones during lateral compaction