Lec After Midterm 3/29 Endo Dx II

Question 1

Steps to dx:

Answer 1

chief complaint, clinical symptoms, tests, rg findings

Question 2

Tests need to confirm:

Answer 2

chief complaint and symptons

Question 3

TF? We are assessing objective complaints with subjective findings.

Answer 3

F. vice verse

Question 4

How many diagnoses to come up with for every case:

Answer 4

2: pulpal and apical

Question 5

TF? The pulp chamber is separate from the periapical diagnosis.

Answer 5

T

Question 6

How many types of endo disease?

Answer 6

1, simply a progression

Question 7

Direction of endo disease progression:

Answer 7

crown down

Question 8

Endo disease progresses from ___ to ____

Answer 8

inflammation to necrosis

Question 9

Initial irritant to pulp occurs in this region:

Answer 9

crown

Question 10

TF? Caries can spread down canals but can not affect the periradicular tissues.

Answer 10

F. Can affect

Question 11

What causes bone loss after crown down spread of necrosis?

Answer 11

antigens are released, can lead to osteoclastogenesis and bone loss

Question 12

When can you see bone loss radiographically?

Answer 12

once it breaks through cortical plate

Question 13

Once the cortical plate is broken, to where does the disease spread?

Answer 13

vestibule area: this is a sinus tract

Question 14

Disease that can lead to pulpal necrosis wo infection:

Answer 14

sickle cell anemia (platelet aggregation around apex)

Question 15

Diagnostic pulpal terms:

Answer 15

normal, reversible/ symptomatic irreversible/ asymptomatic irreversible pulpitis, pulpal necrosis, previously initiated therapy, previously treated

Question 16

Diagnostic periapical terms:

Answer 16

normal apical tissues, symptomatic / asymptomatic apical periodontitis, acute / chronic apical abscess, condensing osteitis

Question 17

Normal pulp:

Answer 17

symptom-free pulp, normal response to Ept, cold, and hot

Question 18

Normal response to pulp testing:

Answer 18

mild pain that resolves quickly

Question 19

EPT positive, normal or necrotic pulp?

Answer 19

normal

Question 20

Reversible pulpitis:

Answer 20

findings indicate the inflammation should resolve and pulp return to normal, ie exposed dentin, deep caries treated, inflammation should go away

Question 21

Test results for reversible pulpitis:

Answer 21

EPT pos, moderate response to thermai that does not linger

Question 22

Symptomatic Irreversible Pulpitis:

Answer 22

vital inflamed pulp is incapable of healing, needs RCT:

Question 23

Test results for Symptomatic Irreversible Pulpitis:

Answer 23

EPT pos, moderate to severe response to thermal tests that lingers, spontaneous pain.

Question 24

Spontaneous pain, diagnosis:

Answer 24

symptomatic Irreversible pulpitis

Question 25

How long is lingering?

Answer 25

secs to mins

Question 26

Asymptomatic Irreversible Pulpitis:

Answer 26

vital inflamed pulp is incapable of healing, caries into pulp, internal resorption, exposed pulp, no pain

Question 27

Test results, asymptomatic Irreversible Pulpitis:

Answer 27

EPT pos, normal response to thermal no symptoms

Question 28

pulpal necrosis:

Answer 28

death of dental pulp, RCT or extraction

Question 29

Test results: pulpal necrosis:

Answer 29

EPT neg (70+), no response to thermal tests

Question 30

Previously treated:

Answer 30

endo treated, canals obturated w anything but intracanal medicaments

Question 31

When to perform pulp test on previously treated teeth:

Answer 31

never

Question 32

What portion of pulp is pulp testing getting a response from?

Answer 32

chamber

Question 33

Which tests to perform on previously treated teeth:

Answer 33

percussion, palpation, probing (apical tests)

Question 34

Previously initiated therapy:

Answer 34

tooth has been previously treated by partial endo therapy (pulpotomy: removal of pulp chamber and tissues, not canals, pulpectomy: removal of pulp tissues and canals

Question 35

Do pulp test on previously initiated therapy?

Answer 35

yes, don't know how much of the pulp was removed, useful for determining anesthesia

Question 36

Last portion of tooth to get numb via anesthesia:

Answer 36

pulp

Question 37

Normal apical tissue:

Answer 37

normal periradicular tissues, not sensitive to percussion or palpation, LD intact, PDL space uniform, will feel like control tooth in testing

Question 38

Test results for normal apical tissues:

Answer 38

EPT pos or neg, thermal tests pos or neg (bc this is a pulp test w apical disease)

Question 39

Symptomatic Apical Periodontitis:

Answer 39

inflammation, usually of apical periodontium, painful response to bing and/ or percussion or palpation, may or may not be related w an apical RGL

Question 40

Test results for Symptomatic Apical Periodontitis:

Answer 40

At least biting, PERCUSSION OR PALPATION MUST BE POSITIVE, w any other results

Question 41

Asymptomatic Apical periodontitis:

Answer 41

inflammation / destruction of apical periodontium of pulpal origin, a RGL, no cx symptoms,

Question 42

Asymptomatic Apical periodontitis, test results:

Answer 42

MUST HAVE LEO AND PULP BE NECROTIC, EPT: neg, thermal: neg

Question 43

Acute Apical Abscess:

Answer 43

inflammatory reaction to pulpal infection and necrosis, rapid onset, spontaneous pain, tenderness of tooth to pressure, pus formation, swelling of assoc tissues, MUST SEE SWELLING

Question 44

Acute Apical abscess, test results:

Answer 44

must have swelling, necrotic pulp, EPT: neg, Thermal: neg, MAY OR MAY NOT HAVE A LESION (USUALLY NOT)

Question 45

Why don't initial acute apical abscesses have lesions:

Answer 45

bc they occur quickly and often wo being caught by X-ray

Question 46

Chronic apical abscess:

Answer 46

inflammatory reaction to pulpal infection and necrosis, gradual onset, little or no discomfort, intermittent discharge of pus through a SINUS TRACT (must see)

Question 47

Chronic apical abscess, test results:

Answer 47

Must have a SINUS TRACT, pulp necrotic, EPT: neg, Thermal: neg

Question 48

Condensing osteitis:

Answer 48

diffuse, RGO, localized, reaction to low-grade inflammatory stimulus, usually at tooth apex

Question 49

This leads to bone build up in condensing osteitis:

Answer 49

low grade chronic inflammation

Question 50

Condensing osteitis, test results:

Answer 50

MUST HSVE RGO LESION, uncommon, VITAL PULP, may become necrotic if stimulus in increased, RGO eventually becomes RGL

Question 51

Dx, EPT: 80, no response to hot or cold, response to percussion, palpation, A mobility:

Answer 51

Pulpal dx: pulpal necrosis, periapical dx: asymptomatic apical periodontitis

Question 52

Determines the difference bw reversible and irreversible pulpitis:

Answer 52

linger pain = irreversible

Question 53

Dx: EPT: 39, strong response to cold, lingering, response to hot, inc response to percussion and normal response to palpation

Answer 53

symptomatic irreversible pulpitis, symptomatic apical periodontitis