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3d. BDS3 CDS Endodontics > L8. Diagnosis in Endodontics > Flashcards

L8. Diagnosis in Endodontics Flashcards

1
Q

Who is considered the godfather of modern Endodontics?

A

Herbert Schilder

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2
Q

What is the definition of a diagnosis?

A

The identification of the nature of an illness or other problem by examination of symptoms

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3
Q

What are the three branches of the trigeminal nerve?

A
  • Ophthalmic;
  • Maxillary;
  • Mandibular.
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4
Q

What are the two types of nerve fibres involved in dental pain?

A
  • A-delta fibres;

- c-fibres.

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5
Q

What type of pain do A-delta fibres transmit?

A

Sharp, pricking sensation (early shooting pain)

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6
Q

What type of pain do c-fibres transmit?

A

Dull, aching or burning pain (late dull pain)

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7
Q

What is the definition of an endodontic emergency?

A

Pain and or swelling caused by various stages of inflammation or infection of the pulpal and/ or periapical tissues

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8
Q

What is pain?

A

An unpleasant feeling caused by intense or damaging stimuli

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9
Q

What is referred pain?

A

Perception of pain in one part of the body, distant from the source of pain (usually provoked by c-fibres)

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10
Q

Which teeth typically present with referred pain and where to?

A
  • Posterior teeth - to opposite arch or periauricular area;

- Mandibular posterior teeth refer pain periauricularly more than maxillary teeth.

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11
Q

What common medical conditions can cause non odontogenic dental pain?

A
  • TB/ lymphoma: lymph node involvement;
  • Leukaemia/ anaemia: paraesthesia;
  • Sickle cell anaemia: bone pain;
  • Multiple myeloma: tooth mobility;
  • MS/ acute maxillary sinusitis/ trigeminal neuralgia: pain.
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12
Q

What’s involved in an endodontic examination?

A
  • E/O exam;
  • I/O exam;
  • Soft tissue exam;
  • I/O swelling;
  • Sinus tracts;
  • Palpation;
  • Percussion;
  • Mobility;
  • Periodontal exam.
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13
Q

What are the two main types of sensibility testing?

A
  • Thermal;

- Electric.

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14
Q

What are the issues with sensibility testing?

A
  • Sensibility, not vitality (i.e. checks sensation within a tooth, not blood supply);
  • Subjective;
  • Contra-lateral teeth need to be checked too;
  • Assumption that nerve fibres in the pulp correlate to intact blood supply (not the case);
  • Problems with multi-rooted teeth (i.e. some roots can be vital, others not but can’t distinguish difference).
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15
Q

How do cold sensibility tests work?

A
  • Movement of dentinal fluid;
  • Hydrodynamic forces stimulate nerve;
  • Can use: frozen carbon dioxide, ethyl chloride, refrigerant spray etc.
  • Dry and isolate tooth;
  • Apply close to pulp horn.
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16
Q

How do hot sensibility tests work?

A
  • Movement of dentinal fluid;
  • Hydrodynamic forces stimulate nerve;
  • Can use: hot GP and vaseline;
  • Dry and isolate tooth;
  • Apply vaseline;
  • Apply hot GP.
17
Q

How do electric pulp (EPT) sensibility tests work?

A
  • Use of electric current to stimulate nerve fibres;
  • Primarily A-delta fibres;
  • Dry and isolate tooth;
  • Conducting medium used to complete circuit;
  • Ask pt to place probe on tooth;
  • Current slowly increases until response (pt will often remove probe when they feel this);
  • Record voltage.
18
Q

What are the issues with EPT?

A
  • No indication of reversibility of inflammation;
  • No correlation between threshold and pulp condition;
  • Unreliable with open apices.
19
Q

What control is used for sensibility testing?

A

Testing contralateral teeth

20
Q

What other special tests are sometimes used to direct a diagnosis?

A
  • Bite test (frac finder or tooth sleuth);
  • Test cavity;
  • Staining and trans-illumination;
  • Selective anaesthesia (does the pain diminish once anaesthetised?);
  • Radiography.
21
Q

What can be a useful way to divide the tooth when trying to reach/ thinking about a diagnosis?

A
  • Top of tooth (crown);
  • Middle of tooth (pulp);
  • Bottom of tooth (apex, bone and soft tissue).
22
Q

What are the 7 possible pulpal diagnoses?

A
  • Normal pulp;
  • Reversible pulpitis;
  • Symptomatic irreversible pulpitis;
  • Asymptomatic irrversible pulpitis;
  • Pulp necrosis;
  • Previously treated;
  • Previously initiated therapy..
23
Q

What does a diagnosis of ‘normal pulp’ indicate?

A
  • Symptom free;
  • Normally responsive (mild or transient response to cold testing);
  • Does not mean pulp is histologically normal.
24
Q

What does a diagnosis of ‘reversible pulpitis’ mean?

A
  • Inflammation should resolve upon management of aetiology;
  • Discomfort experienced when a stimulus is applied, but only lasts a few seconds;
  • Can be caused by significant caries, deep restorations or exposed dentine;
  • No significant radiographic changes.
25
Q

What does a diagnosis of ‘symptomatic irreversible pulpitis’ mean?

A
  • Vital inflamed pulp, incapable of healing - RCT or extraction indicated;
  • Sharp pain with hot stimuli, lingers after removal of stimuli;
  • Pain may be accentuated when lying down/ bending over;
  • If inflammation is yet to reach periapical tissues - no pain to percussion;
  • OTC medications not effective;
  • Can be caused by deep caries, extensive restorations or fractures exposing pulpal tissues.

[classic toothache]

26
Q

What does a diagnosis of ‘asymptomatic irreversible pulpitis’ mean?

A
  • Vital inflamed pulp, incapable of healing - RCT or extraction indicated;
  • No clinical symptoms, usually respond normally to thermal stimulation;
  • Can be caused by deep caries (i.e. excavation of caries would expose pulp)..
27
Q

What does a diagnosis of ‘pulpal necrosis’ mean?

A
  • Nerve within tooth is dead (liquified);
  • Non-responsive to pulp-testing;
  • Asymptomatic.
28
Q

What does a diagnosis of ‘previously treated’ mean?

A
  • Previous endodontic tx carried out;
  • Canals may be obdurated;
  • Tooth probably will not respond to pulp-testing however in multi-rooted teeth, they can (due to vital nerve present).
29
Q

What does a diagnosis of ‘previously initiated’ mean?

A
  • Previous root procedure has not been completed;
  • May be asymptomatic;
  • RCT or extraction indicated.
30
Q

What are the 6 possible apical diagnoses?

A
  • Normal apical tissues;
  • Symptomatic apical periodontitis;
  • Asymptomatic apical periodontitis;
  • Chronic apical abscess;
  • Acute apical abscess;
  • Condensing osteitis.

[sometimes more than one applicable]

31
Q

What does a diagnosis of ‘normal apical tissues’ mean?

A
  • Not sensitive to percussion or palpation;

- Radiographically the lamina dura and periodontal ligament are intact and uniform.

32
Q

What does a diagnosis of ‘symptomatic apical periodontitis’ mean?

A
  • Inflammation of the apical periodontal tissues;
  • Usually sore to touch/tap;
  • May or may not see radiographic changes (e.g. radiolucency, osseous breakdown).
33
Q

What does a diagnosis of ‘asymptomatic apical periodontitis’ mean?

A
  • No clinical symptoms;
  • Not sore to bite on or percuss;
  • Tooth may or may not have been root treated;
  • Seen by radiolucency.
34
Q

What does a diagnosis of ‘chronic apical abscess’ mean?

A
  • Can be symptomatic or asymptomatic;
  • Sinus tract may have formed;
  • Pt might complain of lump or bump that sometimes discharges;
  • Usually this is not too uncomfortable.
35
Q

What does a diagnosis of ‘acute apical abscess’ mean?

A
  • Inflammatory reaction to pulp an infection/ necrosis;
  • Rapid onset;
  • Pain/ extreme tenderness;
  • Swelling;
  • May not see radiographic changes due to quick onset;
  • Pt might experience other symptoms malaise, fever etc.
36
Q

What does a diagnosis of ‘condensing osteitis’ mean?

A
  • Localised bony response to inflammation;
  • Normally around apex of tooth;
  • Seen by dense, boney appearance on radiograph;
  • May respond positively.
37
Q

What are the available treatment options in endodontics?

A
  • RCT;
  • Re-RCT;
  • Extraction;
  • Monitor/ don’t intervene (must inform pt of risks);
  • Surgical intervention.

3d. BDS3 CDS Endodontics (8 decks)

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