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ENDO I > lecture 4 > Flashcards

lecture 4 Flashcards

1
Q

this is recorded in pts own words

A

chief complaint

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2
Q

patient interview

A

subjective examination

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3
Q

clinical examination and testing outline:
SUBJECTIVE EXAMINATION(patient interview)

A

A. subjective examination (patient interview)
1. chief complaint (record in patients own words)
2. dental history
3. medical history (list of active medical issues, medications, and allergies)

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4
Q

a. patient interview: medical history and meds:

A
  1. complete medical history (supplemental as necessary)
    -blood glucose
    -PT time
    -pregnancy test
  2. Rx medications
    -taken(dose/frequency)
  3. supplements
    or other non Rx DRUGS
  4. chief complaint
    -relevant dental history
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5
Q

do what together with the patient starting with the walk back from the waiting area

A

patient interview and vital signs

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6
Q

patient interview
a. get accurate:
b. patients:
c.
d.

A

a. get accurate: health history and meds taken (document)
b. patients: chief complaint, symptoms, and related dental history (document)
c. are other tests needed? (MD, consult)
d. how can you help them expectations, desires, (document)

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7
Q

clinical examination and testing outline:
OBJECTIVE EXAMINATION

A
  1. vital signs
  2. extraoral examination
  3. intraoral examination
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8
Q

vital signs:

A

-blood pressure
-respiratory rate
-pulse

-temperature should be taken in patients reporting swelling or signs and symptoms

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9
Q

extraoral examination general appearance

A

-skin tone
-facial asymmetry
-swelling
-discoloration, redness
-extraoral scars or sinus tract
-lymphadenopathy (enlargement of lymphnodes)

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10
Q

intraoral examination: palpation
look for

A

-palpation: gently feel the tissues

look for:
-tenderness
-swelling
-unusual texture, color or composition
-draining sinus tract DST

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11
Q

periodontal and mobility testing

A

take at least 6 probings on each tooth
*blanching is important!!

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12
Q

why probe?

A

status of PDL and prognosis

endo component always in contact with perio component

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13
Q

to test mobility:

A

turn the probe around; add a mirror handle on the lingual/palatal and wiggle the tooth

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14
Q

intraoral exam: percussion
look for

A

gently tap on the tooth
NEVER start on the suspected tooth

you are trying to establish a BASE-LINE of normal response for this patient

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15
Q

begin your percussion testing for intraoral exam in an area of mouth (related/not related) to the area of suspicion.

maintain a consistancy of percussion technique on:

A

NOT related

on all teeth tested

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16
Q

radiographs must be ______in quality

A

diagnostic

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17
Q

______are required to see the surrounding tissues

A

peri-apical films

-straight-on and angled PA

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18
Q

_____on posteriors to determine restorability

A

bite wing film

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19
Q

assessment of the pulp sensory response

A

pulp sensibility test

20
Q

sensibility test is defined as a ability to respond to ______, and hence this is an accurate and appropriate term for typical and common clinical pulp tests such as ____ and _____ tests given that they do not detect or measure the blood supply of the dental pulp!!!

A

stimulus
thermal
electrical

21
Q

what do pulp sensibility tests not measure

A

the blood supply of the dental pulp

22
Q

thermal and EPT testing in the mouth

A
  1. teeth to be tested properly ISOLATED AND DRY
  2. place COLD COTTON pellet on facial tooth surface (establish base-line first)
  3. patient’s hand should go up immediately (if NOT: hold cotton on tooth until does)
    [stimulating a-delta fibers which are sharp and quick]
  4. observe the seconds until patient’s hand goes down (NOTE)
  5. then go to next tooth and repeat
23
Q

what are you looking for with thermal and EPT testing

A
  1. what is normal for this pt
  2. what is decidely different for particular tooth
  3. the time to recovery is much more important than the severity of pain
24
Q

the intensity of discomfort is not generally significant, but this is

A

the period of time to return to normal following cold stimulation

must be noted before continuing

25
Q

this time is significant to test and record

A

20-30 seconds (lingering of discomfort)

26
Q

what is normal time for pulp sens test

A

3-8 seconds but varies

27
Q

all results are nothing without _____for each pt

A

base-line

28
Q

sensitivity of cold is considered to be a symptom of

A

early pulpal inflammation

29
Q

sensitivity to hot is

A

a late stage of pulpal inflammation indicating that gas is being produced via deterioration of the pulp

pt get relief from cold water

30
Q

this is not performed unless chief complaint of the pt is pain produced by warm liquids

A

heat testing

31
Q

normal teeth (are/are not) sens to hot

A

not

32
Q

how to heat test

A

isolate tooth, use water at 140 F and drip on tooth. keep cold stuff nearby

33
Q

what if you get no response on single tooth with normal base-line?

A

may mean necrotic pulp- RCT indicated

34
Q

what if you get no response on most or all teeth?

A

probably older person and then test with EPT(electrical pulp test)

35
Q

explain electric pulp testing

A
  1. dry teeth and isolate with cotton rolls
  2. place small dab of tooth paste (conductor) on facial of each tooth to be tested
  3. must develop base-line first here also
36
Q

EPT readings meaning

A

EPT=80 = tooth necrotic
EPT= not 80= vital

37
Q

what if you have symptoms on a tooth with no caries, no trauma, no restorations??

A

suspect an axial crack

38
Q

how to prove axial crack

A
  1. radiographs (j shape)
  2. bite tests with tooth slooth
  3. periodontal probing
  4. transillumination
39
Q

the bite test with tooth slooth allows us to have the patient bite on:

A

individual cusp tips to help identify axial crack

release and it hurts=crack

40
Q

[use of transillumination]
what tooth lights up like a light bulb?
what tooth doesnt?

A

does= normal tooth
doesnt= cracked tooth

41
Q

the restoration may need to be removed to view the crack; this might be indicated

A

staining

42
Q

number 1 and 2 prevalence of cracked teeth

A
  1. mand 2nd molar
  2. max premolars
43
Q

when is crack in tooth treatable/not

A

treatable: only in crown
not: in root

44
Q

what does cold testing and EPT work on/what do they not?

A
  1. cold test works on crowns and restorations [metal is a conductor]
  2. EPT test works on restorations but NOT metal/crowns
45
Q

the accuracy of your diagnosis and the appropriateness of your treatment depends entirely on

A

thoroughness of clinical exam and testing
interpretation of results, sympt, and radiographs

ENDO I (11 decks)

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