L3 Pain Diagnosis and Indications for Extractions Flashcards
What are the features of reversible pulpitis through history taking?
- Provoked pain with stimulus (cold or sweet)
- Short lived
- Sharp pain
Clinical findings of reverisble pulpitis.
- Caries, tooth usually restorable
- Vital
- Hypersensitive to ethyl chloride
Radiographic findings associated with reversible pulpitis.
Caries in the crown of the tooth, not into the pulp. Normal apical tissues.
What is a differential diagnosis for reversible pulpitis?
Dentine hypersensitivity.
How is reversible pulpitis treated?
Caries removal and restoration.
What are the features of irreversible pulpitis through history taking?
- Spontaneous intense pain
- Cold water may help the pain, e.g. patient comes into practice holding cold water against their face
Clinical findings of irreversible pulpitis.
- Deep caries, into or very close to the pulp
- Sensibility testing may be positive or negative
- Usually not TTP
Radiographic findings of irreversible pulpitis.
Caries close to, or into, the pulp
Normal apical tissues.
How is irreversible pulpitis treated?
RCT or extraction.
In E+E full RCT would not be completed, would remove the pulp, irrigate and place a temporary filling.
What are the features of acute apical periodontitis through history taking?
- Sever aching pain
- Disrupting sleep
- Analgesia may not help
Clinical findings of acute apical periodontitis.
- Deep caries involving the pulp OR severe periodontal disease (perio-endo lesion)
- Negative response to sensibility testing, tooth is non-vital
- TTP
Radiographic features of acute apical periodontitis.
- PDL widening
- May or may not be an apical area
- If there is an apical area, it is referred to as an acute exacerbation of a chronic apical periodontitis
What are the treatment options for acute apical periodontitis?
RCT or extraction.
What are the features of chronic apical periodontitis through history taking?
- Tooth not painful
- Incidental finding
- May be a history of previous pain which has settled
Clinical findings of chronic apical periodontitis.
- Deep caries involving pulp, tooth broken down
OR - Severe periodontal disease (perio-endo lesion)
- Non-vital
- Not TTP
May see this in patients with teeth that have been crowned for a long time or previously root treated.
Radiographic findings of chronic apical periodontitis.
Apical radiolucency.
What are the treatment options for chronic apical periodontitis?
- RCT
- Extraction
Pt may prefer to have tooth left alone
What are the features of an acute apical abscess through history taking?
- Severe pain (not always in pain)
- Swelling
- May be generally unwell and pyrexic
Clinical findings of acute apical abscess.
- Swelling intra-orally and potential extra-oral swelling due to pus collection
- May be perio or endo in origin
- Non-vital tooth
- TTP
Radiographic findings of acute apical abscess.
Similair to chronic apical periodontitis.
- PDL widening
- May or may not be an apical area
If there is an apical area it is known as an acute exacerbation of a chronic apical abscess.
What is the treatment option for an acute apical abscess?
- Drain abscess
- Antibiotics prescribed if systemically unwell
What are the features of a chronic apical absccess through history taking?
- Not typically painful
- ‘Pimple on gum’
- Small swelling which come and goes (drains)
- Bad taste
Clinical findings of a chronic apical abscess.
- Small/draining sinus on gingivae
- Non-vital tooth
- Not TTP
- Can place GP point to see which tooth is affected if struggling to identify, not routine
Radiographic findings of chronic apical abscess.
Apical radiolucency
What are the treatment options for a chronic apical abscess?
RCT or extraction
