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Lecture 4 (9/12) Flashcards

1
Q

Can cold testing be done with crowns?

A

yes

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1
Q

It is ____ to often present as PURELY pulpal

A

unlikely

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2
Q

What diseases go hand-in-hand?

A

Pulpal disease & peri-radicular disease

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3
Q

How many diagnoses does each tooth need?

A

2 diagnoses

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4
Q

What are the diagnoses that each tooth needs?

A
  1. pulpal diagnosis
  2. peri-radicular diagnosis

(maybe perio & restorative also)

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5
Q

What is the first question to ask your patient that is in pain?

A

what is your chief complaint?

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6
Q

When you ask a patient to point to the tooth that hurts, you are asking them if they can:

A

localize the source of pain

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7
Q

If the source of pain is purely pulpal, your patient will likely:

A

be unable to localize the source of pain

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8
Q

Why might the patient be unable to localize the source of pain if it is purely pulpal?

A

pulpal pain = diffuse pain

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9
Q

How might we describe purely pulpal pain?

A

diffuse pain

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10
Q

It is important to understand ____ before proceeding

A

the chief complaint

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11
Q

The ____ is what brought the patient here

A

chief complaint

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12
Q

The objective of clinical testing is to:

A

find & confirm the etiology of the patient’s CC

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13
Q

Conclusions in the study “Associations between Pain Severity, Clinical Findings, and Endodontic Disease: A Cross-Sectional Study” reveals that percussion hypersensitive on healthy adjacent tooth may reveal a:

A

lowered pain threshold and heightened pain sensitization

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14
Q

Conclusions in the study “Associations between Pain Severity, Clinical Findings, and Endodontic Disease: A Cross-Sectional Study” reveals that percussion hypersensitive on healthy adjacent tooth may reveal a lowered pain threshold and heightened pain sensitization. It is also possible that the two commonly performed mechanical sensory tests, percussion and palpation sensitivity, may detect:

A

different aspects of endodontic pathophysiology and pain processing

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15
Q

Performed based on CC:

A

clinical testing

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16
Q

Some examples of clinical testing include: (5)

A
  1. Thermal
  2. EPT
  3. Percussion
  4. Palpation
  5. Periodontal probing & mobility
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17
Q

A thermal test (cold, heat) is testing the:

A

pulp vitality

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18
Q

An EPT is only done _____. This test is ____.

A

Only done if the pulpal status is in doubt. This test is NOT done routinely

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19
Q

Clinical test performed by tapping with mirror to detect PDL sensitivity:

A

percussion test

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20
Q

Clinical test performed by digital touching of gingival (detecting for inflammation, redness, swelling, & tenderness):

A

palpation

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21
Q

Periodontal probing and mobility is testing for:

A

periodontal health

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22
Q

Following clinical testing, what is the next step?

A

Obtain radiographs of suspect areas

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23
Q

When obtaining radiographs of the suspect areas, what is the minimum 3 diagnostic films that must be obtained?

A
  1. Straight-on PA film
  2. PA shift shot (20 degree change in horizontal angulation) M or D
  3. Bite-wing (to determine restorability & bone level)
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24
Q

After obtaining CC, clinical testing, and obtaining radiographs of suspect areas, you next:

A

Examine the collected data

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25
Q

What should you ask yourself when examining the collected data?

A
  1. have you interpreted the test results correctly?
  2. have you identified the radiographic results correctly?
  3. do results support the CC?
  4. is there a reason for the pulpal condition noted?
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26
Q

What might be some possible reasons for the pulpal condition?

A
  • deep caries
  • deep restoration (especially composite)
  • evidence of trauma
  • if virgin tooth - crack
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27
Q

Answering the question of “WHY?” usually leads to an ____ and a more _____.

A

accurate diagnosis; successful treatment outcome

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28
Q

How many diagnoses do you need for a tooth in endodontics?

A

two

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29
Q

It is uncommon to have a PA lesion on a radiograph for a tooth with inflamed pulp and early necrosis (T/F)

A

True

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30
Q

Reversible pulpitis would exhibit ____?

A

Cold sensitivity (non-lingering)

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31
Q

What is the diagnosis you would make for the following findings:

a) No PARL
b) sensitive to cold (non-lingering)
c) normal PDL
d) no heat sensitivity
e) no swelling
f) no response to percussion test

  • reversible pulpitis
  • symptomatic irreversible pulpitis
  • asymptomatic irreversible pulpitis
  • necrotic pulp
A

reversible pulpitis

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32
Q

You always test the suspected tooth first when doing sensitivity tests (T/F)

A

false

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33
Q

When evaluating pulpal status, it may be helpful to think of the pulp existing in only 3 basic conditions including:

A
  1. normal
  2. inflamed
  3. infected
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34
Q

The outcome of “normal” pulp should:

A

remains normal & healthy

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35
Q

What are the two categories of inflamed pulp?

A
  1. Reversible
  2. Irreversible
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36
Q

The outcome of “inflamed” pulp could:

A

recover or deteriorate

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37
Q

If someone presents with reversible inflamed pulp, what are your options? What is the outcome?

A

No treatment (if asymptomatic) or treatment (if symptomatic)

Recovery

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38
Q

If someone presents with irreversible inflamed pulp, it is most likely ____ but can be ____ (rare)

A

symptomatic; asymptomatic (rare)

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39
Q

Describe the pain with irreversible inflamed pulp?

A

pain is lingering & often spontaneous

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40
Q

Lingering and often spontaneous pain describes:

A

irreversible inflamed pulp

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41
Q

What is the outcome of infected pulp?

A

will proceed to necrosis

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42
Q

If we think of pulp as a separate entity, we end up with a total of 5 pulpal diagnostic “boxes” including:

A
  1. WNL (Normal pulp)
  2. RP (Reversible pulpitis)
  3. SIP (symptomatic irreversible pulpitis)
  4. AIP (asymptomatic irreversible pulpitis)
  5. N (Necrotic pulp)
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43
Q

What are two additional “diagnostic boxes” pertaining to the pulp that are easily seen on x-ray and reported in recent dental history of the area:

A

PT & PIT

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44
Q

Normal pulp =

A

WNL

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45
Q

What would the chief complaint of normal pulp likely be?

A

CC: None (asymptomatic currently & historically)

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46
Q

What would the results of the following clinical tests be for a normal pulp?

  1. Thermal testing
  2. EPT
  3. Percussion
  4. Radiographically
A
  1. Hot-cold WNL
  2. responsive - similar to other WNL teeth
  3. negative- WNL
  4. no radiographic changes
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47
Q

If clinical testing is all normal, minimal or no apparent damage to tooth, and no axial cracks on tooth:

A

LEAVE IT ALONE

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48
Q

Always test 2-3 adjacent teeth ___ to the tooth in question.

Why?

A

prior; to establish standard baseline

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49
Q

What would the diagnosis be for the following case:

CC: Cold Sensitive

Clinical testing:
- cold sensitivity #6 and #8- pain relieved almost immediately once stimulus is removed (does NOT linger)

  • Pt was referred for pretreatment of #7, BUT only #6 and #8 symptomatic (with cold stimulus, no lingering, no spontaneous pain)
  • Percussion negative (all 3 teeth)
  • Unsure of radiographic changes
A

Reversible pulpitis

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50
Q

CC: Cold Sensitive

Clinical testing:
- cold sensitivity #6 and #8- pain relieved almost immediately once stimulus is removed (does NOT linger)

  • Pt was referred for pretreatment of #7, BUT only #6 and #8 symptomatic (with cold stimulus, no lingering, no spontaneous pain)
  • Percussion negative (all 3 teeth)
  • Unsure of radiographic changes

What did the referring DDS miss?

A
  1. failure to LISTEN to the patients CC
  2. Improper Dx due to failure to do clinical testing
  3. No need to do hot (CC was COLD)
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51
Q

Reversible pulpitis may follow one of three outcomes including:

A
  1. if properly treated- may revert to normal
  2. May remain RP symptomatic for an extended period
  3. May deteriorate to SIP or AIP (even if properly treated)
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52
Q

RP:

A

Reversible pulpitis

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53
Q

What would the diagnosis be for the following case:

CC: Cold sensitive

Clinical Testing:
- Cold sensitivity #6 only- LINGERS 15-20 sec after stimulus is removed

  • Percussion Negative
  • Radiographic Changes: None at apex
  • Etiology present on radiograph (large cavity)
A

Irreversible pulpitis (symptomatic)

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54
Q

SIP:

A

symptomatic irreversible pulpitis

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55
Q
  1. In early SIP, ____ hurts >10 and ___
  2. Late SIP, ____ hurts, ____ helps
  3. &/OR Pain might be ___ or ___
A
  1. cold; lingers
  2. hot; cold
  3. spontaneous or awakens patient from sleep
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56
Q

What stage of SIP is being described below?

  • Hot hurts and cold helps
A

Late SIP

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57
Q

What stage of SIP is being described below?

  • Cold hurts and lingers greater than 10 seconds
A

Early SIP

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58
Q

What stage of SIP is being described below?

Pain is spontaneous and awakens patient from sleep

A

Late SIP

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59
Q

Normal teeth are NOT sensitive to ____.

A

hot

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60
Q

Gingiva are ___ sensitive to hot than teeth

A

more

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61
Q

Hot sensitivity usually indicates a:

A

deteriorating pulp= SIP

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62
Q

AIP:

A

Asymptomatic Irreversible Pulpitis

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63
Q

Rarely, deep caries ____ produce any symptoms, though clinically or radiographically, caries may extend well into the pulp.

This is indicative of:

A

will not; extend well into the pulp

irreversible pulpitis

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64
Q

Rarely, deep caries will not produce any symptoms, though clinically or radiographically, caries may extend well into the pulp. This is indicative of irreversible pulpitis.

In such cases, ___ is definitely indicated in order to _____.

A

RCT; prevent a later exacerbation

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65
Q

NP:

A

Necrotic Pulp

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66
Q

What would the diagnosis be for the following case:

CC: May be currently asymptomatic- usual history of symptomatic previously

Clinical Testing:

Cold Sensitivity: No response to cold, hot, or electric pulp tester

A

Necrotic Pulp (NP)

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67
Q

Describe the results to cold, hot, and electric pulp testing with a necrotic pulp:

A

No response to any

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68
Q

PT:

A

Previously Treated

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69
Q

PIT:

A

Previously Initiated Treatment

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70
Q

How would you label this tooth:

Obturated with final RC filling materials other than medicaments which is not healing or requires remedial treatment of some type.

A

PT

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71
Q

For a previously treated tooth:

Obturated with final RC filling materials other than medicaments which is not healing or requires remedial treatment of some type. This becomes a ____ or a ____ or simply ___ & replacement.

A

non-surgical retreatment; surgical RETX; extraction

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72
Q

In a previously initiated treatment, the tooth has been previously treated by:

A

partial endodontic therapy

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73
Q

How would you label this tooth?

A failed pulp cap or pulpotomy, or even a pulpectomy:

A

Previously Initiated Treatment (PIT)

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74
Q

Label with the correct pulpal diagnostic “box”:

Pulp is symptom free with normal response to pulp tests:

A

WNL (normal pulp)

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75
Q

Label with the correct pulpal diagnostic “box”:

Inflammation of the pulp based on subjective and objective findings that should resolve and return to normal pulp:

A

RP (reversible pulpitis)

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76
Q

Label with the correct pulpal diagnostic “box”:

Vital inflamed pulp that is incapable of healing (i.e. lingering pain to cold, sensitivity to heat, spontaneous pain)

A

SIP (symptomatic irreversible pulpitis)

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77
Q

Label with the correct pulpal diagnostic “box”:

Vital inflamed pulp incapable of healing. No clinical symptoms (i.e. inflamed due to caries - chronic hyperplastic pulpitis, caries excavation- pulp exposure, trauma- fracture with exposed pulp tissue)

A

AAP (symptomatic pulpitis)

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78
Q

Label with the correct pulpal diagnostic “box”:

Death of the dental pulp- no response to pulp test

A

NP (necrotic pulp)

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79
Q

Label with the correct pulpal diagnostic “box”:

Tooth has been endodontically treated with canals obdurated with final root canal filling materials other than medicaments:

A

PT (previously treated)

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80
Q

Label with the correct pulpal diagnostic “box”:

Tooth has been previously treated by partial endodontic therapy. i.e. pulp cap, pulpotomy/pulpectomy. RCT not completed:

A

PIT (previously initiated treatment)

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81
Q

Always remember, everything in diagnosis is:

A

continually changing

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82
Q
  • a pain which is diffuse today may be localized tomorrow
  • a severe cold sensitivity may abate overnight
  • the same tooth may become newly sensitive to bite the next day as pulp vitality succumbs to challenge

These are all examples of:

A

The diagnosis continually changing

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83
Q

If left untreated long enough both seriously inflamed and infected pulpits cases will ultimately lead to:

A

necrotic pulp

84
Q

Both seriously inflamed and infected pulpitis cases will lead to necrotic pulp if:

A

left untreated

85
Q

Our diagnostic findings are simply a ____ during this continuum

A

snap shot in time

86
Q

If you cannot arrive at a supportable diagnosis:

A

you CANNOT do any treatment

87
Q

What should occur if you are unable to arrive at a supportable diagnosis?

A

No treatment, re-examine the tooth daily, if necessary, to monitor and diagnose

88
Q

RARELY do we see ___ in cases of pure pulpitis or event necrotic pulp

A

apical radiographic changes

89
Q

Why do we rarely see apical radiographic changes in cases of pure pulpitis or even early necrotic pulp?

A

Advanced pulpal disease or necrosis of the pulp is generally required to allow infection to affect the apical tissues

90
Q

What generally required to see apical radiographic changes?

A

advanced pulpal disease or pulpal necrosis

91
Q

Diagnose after reviewing the following clinical tests:

Symptoms: None

Pulp Testing:
- hot: N/A
- cold: WNL
- EPT: N/A or WNL

Percussion: WNL
Palpation: WNL
Probing: WNL
Mobility: WNL

Swelling:
- intraoral: None
- extraoral: None
- DST: No changes

Radiographic: No changes

A

Normal Pulp (NP)

92
Q

Diagnose after reviewing the following clinical tests:

Symptoms: pain to cold

Pulp Testing:
- hot: N/A or +
- cold: + (not lingering)
- EPT: + (not lingering)

Percussion: WNL
Palpation: WNL
Probing: WNL
Mobility: WNL

Swelling:
- intraoral: None
- extraoral: None
- DST: None

Radiographic: No changes

A

Reversible Pulpitis (RP)

93
Q

Diagnose after reviewing the following clinical tests:

Symptoms: Pain to cold - possibly hot

Pulp Testing:
- hot: N/A or +
- cold: + (lingers)
- EPT: + (lingers)

Percussion: WNL
Palpation: WNL
Probing: WNL
Mobility: WNL

Swelling:
- intraoral: None
- extraoral: None
- DST: None

Radiographic: No changes

A

Symptomatic Irreversible Pulpitis (SIP)

94
Q

Diagnose after reviewing the following clinical tests:

Symptoms: No symptoms

Pulp Testing:
- hot: N/A or NR
- cold: N/A or NR
- EPT: N/A or NR

Percussion: WNL
Palpation: WNL
Probing: WNL
Mobility: WNL

Swelling:
- intraoral: None
- extraoral: None
- DST: None

Radiographic: No changes

A

Asymptomatic Irreversible Pulpitis (AIP)

95
Q

Diagnose after reviewing the following clinical tests:

Symptoms: No symptoms- unless extends into peri-radicular area

Pulp Testing:
- hot: NR
- cold: NR
- EPT: NR

Percussion: WNL
Palpation: WNL
Probing: WNL
Mobility: WNL

Swelling:
- intraoral: None
- extraoral: None
- DST: None

Radiographic: No changes

A

Necrosis (NE)

96
Q

T/F: There is very little correlation between clinical symptoms and history/pathological reality:

97
Q

T/F: We can do histology without destroying the principal tissue we are trying to preserve:

98
Q

A periapical diagnosis must be supported and documented by ____ & ____ before any treatment planning can be done

A

clinical examination & testing

99
Q

How do we support our periapical diagnosis?

A

Using evidence from clinical exam and testing (along with knowledge & experience)

100
Q

The five elements of clinical examination and testing include:

A
  1. Medical and dental history
  2. CC + signs & symptoms
  3. Clinical examination
  4. Clinical testing
  5. Radiological indications
101
Q

Radiographs which are generally of limited use in diagnosis of purely pulpal disease may become of some value in ____ diagnoses

102
Q

Although radiographs may become of some value in apical diagnoses, never attempt to:

A

make a diagnosis from radiographs alone

103
Q

Why must you NEVER attempt to make a diagnosis from radiographs alone?

A

Many unrelated non-odontogenic entities can mimic LEOs radiographically (but in face be something entirely different)

104
Q

It is important to _____ all testing and examination done

105
Q

Following pulpal necrosis, the disease process rapidly extends:

A

peri-apically

106
Q

Following pulpal necrosis, the disease process rapidly extends peri-apically, and the tooth will often become percussion + &/or spontaneous pain may appear:

A

BEFORE radiographic evidence is clear

107
Q

Following pulpal necrosis (though it takes time), ____% of medullary bone can be destroyed and no PARL

108
Q

pulpal necrosis is only visible in ____% of cortical bone

109
Q

Progression of RC system infections:

1.____ or ____ opens tubules to bacterial invasion
2. Bacteria inflame the pulp ___
3. Inflammation may overcome pulpal defenses and ____ may form in ____
4. Infection increases in pulp and ____ begins
5. Necrosis involves ___
6. Infection uses _____ (apical foramen & lateral canals) to invade ____ (apical periodontitis)
7. Periradicular infection occurs beyond the apex (_____)

A
  1. carious lesion or trauma
  2. locally
  3. localized abscess; coronal pulp
  4. necrosis
  5. entire RC system
  6. portals of exit; peri-radicular tissues
  7. apical abscess
110
Q

All peri-radicular inflammation is sensitive to:

What does this differ from?

A

percussion; differs because purely pulpal is NOT sensitive to percussion

111
Q

Why can the patient likely point to the tooth that hurts when peri-radicular inflammation comes into play?

A

mechanoreceptors (proprioceptors) are present in the PDL (not in pulp)

112
Q

When the patient is able to point to the tooth that hurts, this means that the inflammation/infection from the pulp has already:

A

reached the peri-apical tissues

113
Q

If inflammation/infection from the pulp has already reached the peri-apical tissues, the offending tooth will now be:

A

sensitive to percussion (however a lesion may not yet show on XR)

114
Q

Apical diagnostic boxes include (6):

A
  1. WNL- within normal limits
  2. SAP- symptomatic apical periodontitis
  3. AAP- asymptomatic apical periodontitis
  4. AAA- acute apical abscess
  5. CAA- chronic apical abscess
  6. CO- condensing osteitis
115
Q

AAA= _____ and may be accompanied by ____:

A

Acute Apical Abscess; swelling & fever

116
Q

CAA= _____ and may be accompanied by ____:

A

Chronic Apical Abscess (PAR+ DST)

117
Q

Whenever a DST is present this signifies:

118
Q

CO= ____ and typically has a ____ appearance on the XR and treatment is determined by ____

A

Condensing Osteitis; radiopaque appearance; symptoms

119
Q

Peri-apical diagnostic boxes:

Teeth NOT sensitive to percussion or palpation. Lamina dura is intact and the PDL is uniform and unbroken

A

WNL (normal)

120
Q

Peri-apical diagnostic boxes:

For WNL:
- percussion test:
- palpation:
- lamina dura:
- PDL:

A
  1. not sensitive to percussion
  2. not sensitive to palpation
  3. lamina dura intact
  4. PDL is unbroken
121
Q

Peri-apical diagnostic boxes:

Inflammation of the periodontium producing a painful response to biting/percussion/maybe palpation:

A

SAP: Symptomatic Apical Periodontitis

122
Q

Peri-apical diagnostic boxes:

For SAP:
- Inflammation of ____
- Percussion test
- Biting
- Palpation

A
  1. inflammation of the periodotium
  2. painful response to percussion
  3. painful response to biting
  4. possible painful response to palpation
123
Q

Peri-apical diagnostic boxes:

Inflammation and destruction of the periodontium that is of pulpal origin appearing as a radiolucent area with no clinical symptoms

A

AAP: Asymptomatic apical periodontitis

124
Q

Peri-apical diagnostic boxes:

For AAP:
- inflammation & destruction of ___ that is of ___ origin appearing as a ____ with ____

A

periodontium; pulpal origin; radiolucent area; no clinical symptoms

125
Q

Peri-apical diagnostic boxes:

“destruction of the periodontium”

A

Asymptomatic Apical Periodontitis (AAP)

126
Q

Peri-apical diagnostic boxes:

Inflammatory reaction to pulpal infection with rapid onset, spontaneous pain, tooth tender to pressure, pus formation, and swelling and fever:

A

AAA (acute apical abscess)

127
Q

Peri-apical diagnostic boxes:

For AAA:
- Inflammatory reaction to pulpal infection with ___ & ___
- The tooth is tender to _____
- ____ formation and ___ & ____

A
  • rapid onset; spontaneous pain
  • pressure
  • pus formation, swelling & fever
128
Q

Peri-apical diagnostic boxes:

” SWELLING AND FEVER”

A

AAA (Acute apical abscess)

129
Q

Peri-apical diagnostic boxes:

Inflammatory reaction to pulpal infection with gradual onset, little or no discomfort, and draining sinus tract

A

CAA (Chronic apical abscess)

130
Q

Peri-apical diagnostic boxes:

“DRAINING SINUS TRACT”

A

CAA (chronic apical abscess)

131
Q

Describe the onset of chronic apical abscess:

A

gradual onset

132
Q

Describe the onset of acute apical abscess:

A

rapid onset

133
Q

Peri-apical diagnostic boxes:

Diffuse radiopaque lesion representing a localized bony reaction to a low-grade inflammatory stimulus:

A

CO (Condensing osteitis)

134
Q

Peri-apical diagnostic boxes:

“localized bony reaction to a low-grade inflammatory stimulus”

A

CO (condensing osteitis)

135
Q

Fill in the blanks:

A
  1. Normal (WNL)
  2. SAP (symptomatic apical periodontitis)
  3. AAP (asymptomatic apical periodontitis)
  4. AAA (Acute apical abscess)
  5. CAA (Chronic apical abscess)
  6. CO (Condensing osteitis)
136
Q

Fill in the blanks:

A
  1. NO radiolucency
  2. YES/NO radiolucency
  3. YES radiolucency
  4. YES/NO radiolucency
  5. YES radiolucency
  6. Radiopaque lesion
137
Q

Fill in the blanks:

A
  1. NO PAIN
  2. PAIN
  3. NO PAIN
  4. PAIN
  5. NO PAIN
  6. NA
138
Q

Fill in the blanks for normal pulp (NP here but be careful with those abbreviation homie)

A

SYMPTOMS: None

PULP TESTING:
Hot- N/A
Cold- WNL
EPT- N/A or WNL

Percussion- WNL
Palpation- WNL
Probing- WNL
Mobility- WNL

SWELLING:
intraoral: none
extraoral: none
DST: none

Radiographic: no changes

139
Q

Fill in the blanks for reversible pulpitis: (RP)

A

SYMPTOMS: pain to cold

PULP TESTING:
Hot- N/A or +
Cold- + (not lingering)
EPT- + (not lingering)

Percussion- WNL
Palpation- WNL
Probing- WNL
Mobility- WNL

SWELLING:
intraoral: none
extraoral: none
DST: none

Radiographic: no changes

140
Q

Fill in the blanks for symptomatic irreversible pulpitis (SIP)

A

SYMPTOMS: pain to cold- possible hot

PULP TESTING:
Hot- N/A or +
Cold- + (lingering)
EPT- + (lingering)

Percussion- WNL
Palpation- WNL
Probing- WNL
Mobility- WNL

SWELLING:
intraoral: none
extraoral: none
DST: none

Radiographic: no changes

141
Q

Fill in the blanks for asymptomatic irreversible pulpitis (AIP):

A

SYMPTOMS: no symptoms

PULP TESTING:
Hot- N/A or NR
Cold- N/A or NR
EPT- N/A or NR

Percussion- WNL
Palpation- WNL
Probing- WNL
Mobility- WNL

SWELLING:
intraoral: none
extraoral: none
DST: none

Radiographic: no changes

142
Q

Fill in the blanks for necrotic pulp (NE):

A

SYMPTOMS: no symptoms unless extends to the peri-radicular area

PULP TESTING:
Hot- NR
Cold- NR
EPT- NR

Percussion- WNL
Palpation- WNL
Probing- WNL
Mobility- WNL

SWELLING:
intraoral: none
extraoral: none
DST: none

Radiographic: no changes

143
Q

What is the apical diagnosis for the following?

  1. Tooth NOT SENSITIVE to percussion or palpation
  2. Lamina dura IS INTACT
  3. PDL IS UNIFORM- No radiolucency
  4. NO SYMPTOMS- No CC
  5. All pulp TESTS WNL
  6. NO APPARENT INJURY to the tooth
144
Q

What other situations may result in similar symptoms to symptomatic apical periodontitis (SAP)?

A
  1. recent high restoration
  2. occlusal habits (bruxism)
  3. trauma (etc.)
145
Q

A thickened PDL can be caused by:

A
  1. occlusal trauma
  2. PARL
146
Q

Why is it important to check the occlusion when you see a thickened PDL?

A

a high restoration/occlusal trauma may cause a thickened PDL

147
Q

What is the apical diagnosis for the following?

  1. NO SENSITIVITY to percussion/palpation/biting
  2. PULP NON-VITAL (apical destruction of pulpal origin)
  3. THICKENED PDL space or P/A radiolucency
  4. NO SWELLING- no DST
A

Asymptomatic apical periodontitis (AAP)

148
Q

With an apical diagnosis of AAA (acute apical abscess) describe the pulp:

149
Q

With an apical diagnosis of AAA (acute apical abscess) describe response to biting, percussion, or palpation:

A

SEVERE pain

150
Q

With an apical diagnosis of AAA (acute apical abscess) describe the apical radiographic changes:

A

thickened PDL space or P/A radiolucency

151
Q

With an apical diagnosis of AAA (acute apical abscess), often mobile due to:

A

active infection in apical tissues

152
Q

With an apical diagnosis of AAA (acute apical abscess) often ____ due to active infection in apical tissues

153
Q

With an apical diagnosis of AAA (acute apical abscess), this is a rapidly developing infection so it presents with:

A
  1. intraoral swelling
  2. extraoral swelling
  3. fever

(NO DST)

154
Q

With an apical diagnosis of AAA (acute apical abscess), if the patient has rapid development of swelling (often severe), elevated temp/fever, this is considered

A

AAA with severe cellulitis

155
Q

If a patient presents with AAA with severe cellulitis the treatment involves:

A

I&D- oral surgeon if extra-oral, and patient often needs to be admitted

156
Q

With an apical diagnosis of CAA (chronic apical abscess), this is considered:

A

NOT an emergency

157
Q

What is the following apical diagnosis?

  1. Pulp necrotic
  2. Pain minimal or none
  3. Sensitivity to percussion, minimal or none
  4. Sensitivity to palpation, minimal or none
  5. Swelling generally minimal or none
  6. No fever
  7. May have been present for extended periods of time
  8. Usually draining via DST or gingival sulcus via narrow periodontal pocket
A

CAA (chronic apical abscess)- not an emergency

158
Q

Describe the pain associated with a chronic apical abscess (CAA):

A

usually no or minimal pain

159
Q

What is associated with an intraoral draining sinus tract (DST)?

160
Q

Are antibiotics required for CAA?

A

No (also no rx analgesic)

161
Q

____ is path gnomic for CAA

162
Q

Always trace out a draining sinus tract (DST) with:

A

gutta percha cone & radiograph

163
Q

What conditions may appear the same radiographically- which further emphasizes the need to diagnose based on the sum of patient history & symptoms, clinical exam, signs & testing, and radiographic interpretation:

A

SAP, AAP, AAA

164
Q

Radiopaque formative or reactive bone:

A

CO - condensing osteitis

165
Q

Treatment of CO (condensing osteitis) is based on:

166
Q

CO develops in response to a mild or _____ where bone is actually formed instead of being resorbed or destroyed

A

“sub-clinical” inflammation or infection

167
Q

If CO is asymptomatic an no apparent pathology, what treatment is recommended?

A

NO treatment- continue to monitor

168
Q

Differential diagnosis for CO:

A

Sclerotic bone (which is a non-pathology and requires no tx)

169
Q

You cannot do ANY treatment for the patient until you have a:

A

supported diagnosis

170
Q

If you cannot make a definitive DX today, support the patient with appropriate ____ and follow up

A

supportive medications

171
Q

Peri-radicular DX: SAP

  1. symptoms:
  2. Pulp testing
    hot-
    cold-
    EPT-
  3. Percussion-
    Palpation-
    Probing-
    Mobility-
  4. Swelling
    intraoral-
    extraoral-
    DST-
  5. Radiographic:
A
  1. sensitive to percussion & biting pressure
  2. variable (all)
  3. Percussion- positive
    Palpation- variable
    Probing- variable
    Mobility- variable
  4. None (all)
  5. Thickened PDL or none
172
Q

Peri-radicular DX: AAP

  1. symptoms:
  2. Pulp testing
    hot-
    cold-
    EPT-
  3. Percussion-
    Palpation-
    Probing-
    Mobility-
  4. Swelling
    intraoral-
    extraoral-
    DST-
  5. Radiographic:
A
  1. not sensitive
  2. no response to any
  3. WNL (all)
  4. none
  5. thickened PDL or none
173
Q

Peri-radicular DX: AAA

  1. symptoms:
  2. Pulp testing
    hot-
    cold-
    EPT-
  3. Percussion-
    Palpation-
    Probing-
    Mobility-
  4. Swelling
    intraoral-
    extraoral-
    DST-
  5. Radiographic:
A
  1. very sensitive to percussion & biting pressure
  2. No response to any
  3. Percussion +++, Palpation +++, Probing variable, Mobility variable
  4. rapid and extensive swelling, no DST
  5. Thickened PDL or P/A area
174
Q

Peri-radicular DX: CAA

  1. symptoms:
  2. Pulp testing
    hot-
    cold-
    EPT-
  3. Percussion-
    Palpation-
    Probing-
    Mobility-
  4. Swelling
    intraoral-
    extraoral-
    DST-
  5. Radiographic:
A
  1. may or may not be symptomatic
  2. no response to any
  3. Percussion + or none
    Palpation + or none
    Probing variable
    Mobility variable
  4. minimal or no swelling and DST present
  5. Definite P/A area
175
Q

Longitudinal tooth fractures are ____ and also called ____ tooth fractures

A

important; vertical

176
Q
  • Longitudinal tooth fracture that is confined to the enamel
  • Common and generally unimportant
  • Don’t stop light
A

Craze lines

177
Q
  • Longitudinal tooth fracture
  • Facial- lingual
  • Often involves undermined cusp and may be restorable
A

Fractured cusp (oblique shearing fracture)

178
Q
  • longitudinal tooth fracture
  • M-D fracture involving one or both marginal ridges
  • May or may not involve the pulp
  • May be confined to crown or extend to root
A

Cracked tooth (incomplete “green stick” fracture)

179
Q

A longitudinal fracture cracked tooth may also be called:

A

incomplete “greenstick” fracture

180
Q

A longitudinal fractured cusp may also be called:

A

oblique shearing fracture

181
Q
  • Longitudinal tooth fracture
  • Crack extends to a surface in all areas
  • Involves crown, root, and generally pulp
  • must remove fractured segment and determine restorability
A

split tooth

182
Q

What is the treatment for a split tooth?

A

must remove fractured segment and determine restorability

183
Q
  • Longitudinal tooth fracture
  • Begins internally at root apex or from crown
  • primarily in axial plane (may be FL or MD)
A

Vertical root fracture (VRF)

184
Q

What is the most severe type of longitudinal tooth fracture?

A

VRF (followed by split tooth)

185
Q

Horizontal fractures are also important but are generally ____ and usually associated with ____

A

easily seen; known traumatic events

186
Q

Vertical lines in the enamel of teeth:

A

craze lines

187
Q

Craze lines are common and generally ____ and ___

A

asymptomatic; not a concern for endo

188
Q

A fractured cusp is a HIGHLY VARIABLE injury meaning (treatment)

A

treatment can very from a simple intracoronal restoration to endodontic intervention to extraction

189
Q

For a fractured cusp, if the pulp tests are WNL the normal procedure is to:

A

remove the fractured cusp and see if the remaining tooth structure will support a restoration

190
Q

A cracked tooth may also be called:

A

“greenstick” fracture

191
Q

The most common site of a cracked tooth (greenstick fracture) is:

A

mandibular 2nd or 1st molar followed by maxillary pre-molars

192
Q

Cracked tooth (greenstick fractures) are often sen in teeth:

A

without caries or restorations

193
Q

A cracked tooth (greenstick fracture) is most often discovered following patient complaint of:

A

acute, sharp momentary pain upon biting or release of biting pressure

194
Q

Describe the pulp in a cracked tooth (greenstick fracture)

A

Generally pulp is vital in early stages and may remain so for some time

195
Q

A cracked tooth will continue to cause pain as long as:

A

pulp remains vital

196
Q

What syndrome is associated with a greenstick fracture?

A

Cracked tooth syndrome

197
Q

A _____ in an otherwise healthy periodontal mouth may be a tip-off that a longitudinal (axial) crack may extend into the root and therefore create a guarded or hopeless prognosis:

A

Drop-off periodontal pocket

198
Q

Whats it called when your perio measuring looks something like 3-3-3-3-8-3?

A

Drop-off periodontal pocket

199
Q

A NARROW pocket that often indicates the extension of a crown fracture into the root:

A

drop-off periodontal pocket

200
Q

A drop-off periodontal pocket may signal a ____ tooth

A

non-restorable

201
Q

What does a drop-off periodontal pocket indicate?

A

extension of a crown fracture into the root

202
Q

When looking for a vertical root fracture, look for:

A

J-shaped (HALO) apical bony lesion

203
Q

When searching for a vertical root fracture, probe for:

A

drop-off pocket

204
Q

VRF is difficult to confirm ______, unless ____ occurs

A

radiographically; separation of segments

205
Q

The only ABSOLUTE CERTAIN WAY to determine a vertical root fracture is to:

A

expose it surgically and stain (possibly microscope use)

206
Q

Label the following fracture types:

A

A- fractured cusp
B- incomplete crown fracture
C- incomplete crown-root fracture
D- split tooth
E- vertical root fracture

Endodontics (19 decks)

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