Lecture 4 (9/12) Flashcards
1
Q
Can cold testing be done with crowns?
A
yes
1
Q
It is ____ to often present as PURELY pulpal
A
unlikely
2
Q
What diseases go hand-in-hand?
A
Pulpal disease & peri-radicular disease
3
Q
How many diagnoses does each tooth need?
A
2 diagnoses
4
Q
What are the diagnoses that each tooth needs?
A
- pulpal diagnosis
- peri-radicular diagnosis
(maybe perio & restorative also)
5
Q
What is the first question to ask your patient that is in pain?
A
what is your chief complaint?
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
7
Q
If the source of pain is purely pulpal, your patient will likely:
A
be unable to localize the source of pain
8
Q
Why might the patient be unable to localize the source of pain if it is purely pulpal?
A
pulpal pain = diffuse pain
9
Q
How might we describe purely pulpal pain?
A
diffuse pain
10
Q
It is important to understand ____ before proceeding
A
the chief complaint
11
Q
The ____ is what brought the patient here
A
chief complaint
12
Q
The objective of clinical testing is to:
A
find & confirm the etiology of the patient’s CC
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
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
15
Q
Performed based on CC:
A
clinical testing
16
Q
Some examples of clinical testing include: (5)
A
- Thermal
- EPT
- Percussion
- Palpation
- Periodontal probing & mobility
17
Q
A thermal test (cold, heat) is testing the:
A
pulp vitality
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
19
Q
Clinical test performed by tapping with mirror to detect PDL sensitivity:
A
percussion test
20
Q
Clinical test performed by digital touching of gingival (detecting for inflammation, redness, swelling, & tenderness):
A
palpation
21
Q
Periodontal probing and mobility is testing for:
A
periodontal health
22
Q
Following clinical testing, what is the next step?
A
Obtain radiographs of suspect areas
23
Q
When obtaining radiographs of the suspect areas, what is the minimum 3 diagnostic films that must be obtained?
A
- Straight-on PA film
- PA shift shot (20 degree change in horizontal angulation) M or D
- Bite-wing (to determine restorability & bone level)
24
After obtaining CC, clinical testing, and obtaining radiographs of suspect areas, you next:
Examine the collected data
25
What should you ask yourself when examining the collected data?
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?
26
What might be some possible reasons for the pulpal condition?
- deep caries
- deep restoration (especially composite)
- evidence of trauma
- if virgin tooth - crack
27
Answering the question of "WHY?" usually leads to an ____ and a more _____.
accurate diagnosis; successful treatment outcome
28
How many diagnoses do you need for a tooth in endodontics?
two
29
It is uncommon to have a PA lesion on a radiograph for a tooth with inflamed pulp and early necrosis (T/F)
True
30
Reversible pulpitis would exhibit ____?
Cold sensitivity (non-lingering)
31
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
reversible pulpitis
32
You always test the suspected tooth first when doing sensitivity tests (T/F)
false
33
When evaluating pulpal status, it may be helpful to think of the pulp existing in only 3 basic conditions including:
1. normal
2. inflamed
3. infected
34
The outcome of "normal" pulp should:
remains normal & healthy
35
What are the two categories of inflamed pulp?
1. Reversible
2. Irreversible
36
The outcome of "inflamed" pulp could:
recover or deteriorate
37
If someone presents with reversible inflamed pulp, what are your options? What is the outcome?
No treatment (if asymptomatic) or treatment (if symptomatic)
Recovery
38
If someone presents with irreversible inflamed pulp, it is most likely ____ but can be ____ (rare)
symptomatic; asymptomatic (rare)
39
Describe the pain with irreversible inflamed pulp?
pain is lingering & often spontaneous
40
Lingering and often spontaneous pain describes:
irreversible inflamed pulp
41
What is the outcome of infected pulp?
will proceed to necrosis
42
If we think of pulp as a separate entity, we end up with a total of 5 pulpal diagnostic "boxes" including:
1. WNL (Normal pulp)
2. RP (Reversible pulpitis)
3. SIP (symptomatic irreversible pulpitis)
4. AIP (asymptomatic irreversible pulpitis)
5. N (Necrotic pulp)
43
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:
PT & PIT
44
Normal pulp =
WNL
45
What would the chief complaint of normal pulp likely be?
CC: None (asymptomatic currently & historically)
46
What would the results of the following clinical tests be for a normal pulp?
1. Thermal testing
2. EPT
3. Percussion
4. Radiographically
1. Hot-cold WNL
2. responsive - similar to other WNL teeth
3. negative- WNL
4. no radiographic changes
47
If clinical testing is all normal, minimal or no apparent damage to tooth, and no axial cracks on tooth:
LEAVE IT ALONE
48
Always test 2-3 adjacent teeth ___ to the tooth in question.
Why?
prior; to establish standard baseline
49
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
Reversible pulpitis
50
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?
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)
51
Reversible pulpitis may follow one of three outcomes including:
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)
52
RP:
Reversible pulpitis
53
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)
Irreversible pulpitis (symptomatic)
54
SIP:
symptomatic irreversible pulpitis
55
1. In early SIP, ____ hurts >10 and ___
2. Late SIP, ____ hurts, ____ helps
3. &/OR Pain might be ___ or ___
1. cold; lingers
2. hot; cold
3. spontaneous or awakens patient from sleep
56
What stage of SIP is being described below?
- Hot hurts and cold helps
Late SIP
57
What stage of SIP is being described below?
- Cold hurts and lingers greater than 10 seconds
Early SIP
58
What stage of SIP is being described below?
Pain is spontaneous and awakens patient from sleep
Late SIP
59
Normal teeth are NOT sensitive to ____.
hot
60
Gingiva are ___ sensitive to hot than teeth
more
61
Hot sensitivity usually indicates a:
deteriorating pulp= SIP
62
AIP:
Asymptomatic Irreversible Pulpitis
63
Rarely, deep caries ____ produce any symptoms, though clinically or radiographically, caries may extend well into the pulp.
This is indicative of:
will not; extend well into the pulp
irreversible pulpitis
64
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 _____.
RCT; prevent a later exacerbation
65
NP:
Necrotic Pulp
66
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
Necrotic Pulp (NP)
67
Describe the results to cold, hot, and electric pulp testing with a necrotic pulp:
No response to any
68
PT:
Previously Treated
69
PIT:
Previously Initiated Treatment
70
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.
PT
71
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.
non-surgical retreatment; surgical RETX; extraction
72
In a previously initiated treatment, the tooth has been previously treated by:
partial endodontic therapy
73
How would you label this tooth?
A failed pulp cap or pulpotomy, or even a pulpectomy:
Previously Initiated Treatment (PIT)
74
Label with the correct pulpal diagnostic "box":
Pulp is symptom free with normal response to pulp tests:
WNL (normal pulp)
75
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:
RP (reversible pulpitis)
76
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)
SIP (symptomatic irreversible pulpitis)
77
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)
AAP (symptomatic pulpitis)
78
Label with the correct pulpal diagnostic "box":
Death of the dental pulp- no response to pulp test
NP (necrotic pulp)
79
Label with the correct pulpal diagnostic "box":
Tooth has been endodontically treated with canals obdurated with final root canal filling materials other than medicaments:
PT (previously treated)
80
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:
PIT (previously initiated treatment)
81
Always remember, everything in diagnosis is:
continually changing
82
- 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:
The diagnosis continually changing
83
If left untreated long enough both seriously inflamed and infected pulpits cases will ultimately lead to:
necrotic pulp
84
Both seriously inflamed and infected pulpitis cases will lead to necrotic pulp if:
left untreated
85
Our diagnostic findings are simply a ____ during this continuum
snap shot in time
86
If you cannot arrive at a supportable diagnosis:
you CANNOT do any treatment
87
What should occur if you are unable to arrive at a supportable diagnosis?
No treatment, re-examine the tooth daily, if necessary, to monitor and diagnose
88
RARELY do we see ___ in cases of pure pulpitis or event necrotic pulp
apical radiographic changes
89
Why do we rarely see apical radiographic changes in cases of pure pulpitis or even early necrotic pulp?
Advanced pulpal disease or necrosis of the pulp is generally required to allow infection to affect the apical tissues
90
What generally required to see apical radiographic changes?
advanced pulpal disease or pulpal necrosis
91
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
Normal Pulp (NP)
92
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
Reversible Pulpitis (RP)
93
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
Symptomatic Irreversible Pulpitis (SIP)
94
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
Asymptomatic Irreversible Pulpitis (AIP)
95
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
Necrosis (NE)
96
T/F: There is very little correlation between clinical symptoms and history/pathological reality:
True
97
T/F: We can do histology without destroying the principal tissue we are trying to preserve:
False
98
A periapical diagnosis must be supported and documented by ____ & ____ before any treatment planning can be done
clinical examination & testing
99
How do we support our periapical diagnosis?
Using evidence from clinical exam and testing (along with knowledge & experience)
100
The five elements of clinical examination and testing include:
1. Medical and dental history
2. CC + signs & symptoms
3. Clinical examination
4. Clinical testing
5. Radiological indications
101
Radiographs which are generally of limited use in diagnosis of purely pulpal disease may become of some value in ____ diagnoses
apical
102
Although radiographs may become of some value in apical diagnoses, never attempt to:
make a diagnosis from radiographs alone
103
Why must you NEVER attempt to make a diagnosis from radiographs alone?
Many unrelated non-odontogenic entities can mimic LEOs radiographically (but in face be something entirely different)
104
It is important to _____ all testing and examination done
document
105
Following pulpal necrosis, the disease process rapidly extends:
peri-apically
106
Following pulpal necrosis, the disease process rapidly extends peri-apically, and the tooth will often become percussion + &/or spontaneous pain may appear:
BEFORE radiographic evidence is clear
107
Following pulpal necrosis (though it takes time), ____% of medullary bone can be destroyed and no PARL
100%
108
pulpal necrosis is only visible in ____% of cortical bone
40%
109
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 (_____)
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
All peri-radicular inflammation is sensitive to:
What does this differ from?
percussion; differs because purely pulpal is NOT sensitive to percussion
111
Why can the patient likely point to the tooth that hurts when peri-radicular inflammation comes into play?
mechanoreceptors (proprioceptors) are present in the PDL (not in pulp)
112
When the patient is able to point to the tooth that hurts, this means that the inflammation/infection from the pulp has already:
reached the peri-apical tissues
113
If inflammation/infection from the pulp has already reached the peri-apical tissues, the offending tooth will now be:
sensitive to percussion (however a lesion may not yet show on XR)
114
Apical diagnostic boxes include (6):
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
AAA= _____ and may be accompanied by ____:
Acute Apical Abscess; swelling & fever
116
CAA= _____ and may be accompanied by ____:
Chronic Apical Abscess (PAR+ DST)
117
Whenever a DST is present this signifies:
CAA
118
CO= ____ and typically has a ____ appearance on the XR and treatment is determined by ____
Condensing Osteitis; radiopaque appearance; symptoms
119
Peri-apical diagnostic boxes:
Teeth NOT sensitive to percussion or palpation. Lamina dura is intact and the PDL is uniform and unbroken
WNL (normal)
120
Peri-apical diagnostic boxes:
For WNL:
- percussion test:
- palpation:
- lamina dura:
- PDL:
1. not sensitive to percussion
2. not sensitive to palpation
3. lamina dura intact
4. PDL is unbroken
121
Peri-apical diagnostic boxes:
Inflammation of the periodontium producing a painful response to biting/percussion/maybe palpation:
SAP: Symptomatic Apical Periodontitis
122
Peri-apical diagnostic boxes:
For SAP:
- Inflammation of ____
- Percussion test
- Biting
- Palpation
1. inflammation of the periodotium
2. painful response to percussion
3. painful response to biting
4. possible painful response to palpation
123
Peri-apical diagnostic boxes:
Inflammation and destruction of the periodontium that is of pulpal origin appearing as a radiolucent area with no clinical symptoms
AAP: Asymptomatic apical periodontitis
124
Peri-apical diagnostic boxes:
For AAP:
- inflammation & destruction of ___ that is of ___ origin appearing as a ____ with ____
periodontium; pulpal origin; radiolucent area; no clinical symptoms
125
Peri-apical diagnostic boxes:
"destruction of the periodontium"
Asymptomatic Apical Periodontitis (AAP)
126
Peri-apical diagnostic boxes:
Inflammatory reaction to pulpal infection with rapid onset, spontaneous pain, tooth tender to pressure, pus formation, and swelling and fever:
AAA (acute apical abscess)
127
Peri-apical diagnostic boxes:
For AAA:
- Inflammatory reaction to pulpal infection with ___ & ___
- The tooth is tender to _____
- ____ formation and ___ & ____
- rapid onset; spontaneous pain
- pressure
- pus formation, swelling & fever
128
Peri-apical diagnostic boxes:
" SWELLING AND FEVER"
AAA (Acute apical abscess)
129
Peri-apical diagnostic boxes:
Inflammatory reaction to pulpal infection with gradual onset, little or no discomfort, and draining sinus tract
CAA (Chronic apical abscess)
130
Peri-apical diagnostic boxes:
"DRAINING SINUS TRACT"
CAA (chronic apical abscess)
131
Describe the onset of chronic apical abscess:
gradual onset
132
Describe the onset of acute apical abscess:
rapid onset
133
Peri-apical diagnostic boxes:
Diffuse radiopaque lesion representing a localized bony reaction to a low-grade inflammatory stimulus:
CO (Condensing osteitis)
134
Peri-apical diagnostic boxes:
"localized bony reaction to a low-grade inflammatory stimulus"
CO (condensing osteitis)
135
Fill in the blanks:
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
Fill in the blanks:
1. NO radiolucency
2. YES/NO radiolucency
3. YES radiolucency
4. YES/NO radiolucency
5. YES radiolucency
6. Radiopaque lesion
137
Fill in the blanks:
1. NO PAIN
2. PAIN
3. NO PAIN
4. PAIN
5. NO PAIN
6. NA
138
Fill in the blanks for normal pulp (NP here but be careful with those abbreviation homie)
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
Fill in the blanks for reversible pulpitis: (RP)
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
Fill in the blanks for symptomatic irreversible pulpitis (SIP)
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
Fill in the blanks for asymptomatic irreversible pulpitis (AIP):
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
Fill in the blanks for necrotic pulp (NE):
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
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
WNL
144
What other situations may result in similar symptoms to symptomatic apical periodontitis (SAP)?
1. recent high restoration
2. occlusal habits (bruxism)
3. trauma (etc.)
145
A thickened PDL can be caused by:
1. occlusal trauma
2. PARL
146
Why is it important to check the occlusion when you see a thickened PDL?
a high restoration/occlusal trauma may cause a thickened PDL
147
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
Asymptomatic apical periodontitis (AAP)
148
With an apical diagnosis of AAA (acute apical abscess) describe the pulp:
necrotic
149
With an apical diagnosis of AAA (acute apical abscess) describe response to biting, percussion, or palpation:
SEVERE pain
150
With an apical diagnosis of AAA (acute apical abscess) describe the apical radiographic changes:
thickened PDL space or P/A radiolucency
151
With an apical diagnosis of AAA (acute apical abscess), often mobile due to:
active infection in apical tissues
152
With an apical diagnosis of AAA (acute apical abscess) often ____ due to active infection in apical tissues
mobile
153
With an apical diagnosis of AAA (acute apical abscess), this is a rapidly developing infection so it presents with:
1. intraoral swelling
2. extraoral swelling
3. fever
(NO DST)
154
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
AAA with severe cellulitis
155
If a patient presents with AAA with severe cellulitis the treatment involves:
I&D- oral surgeon if extra-oral, and patient often needs to be admitted
156
With an apical diagnosis of CAA (chronic apical abscess), this is considered:
NOT an emergency
157
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
CAA (chronic apical abscess)- not an emergency
158
Describe the pain associated with a chronic apical abscess (CAA):
usually no or minimal pain
159
What is associated with an intraoral draining sinus tract (DST)?
CAA
160
Are antibiotics required for CAA?
No (also no rx analgesic)
161
____ is path gnomic for CAA
DST
162
Always trace out a draining sinus tract (DST) with:
gutta percha cone & radiograph
163
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:
SAP, AAP, AAA
164
Radiopaque formative or reactive bone:
CO - condensing osteitis
165
Treatment of CO (condensing osteitis) is based on:
symptoms
166
CO develops in response to a mild or _____ where bone is actually formed instead of being resorbed or destroyed
"sub-clinical" inflammation or infection
167
If CO is asymptomatic an no apparent pathology, what treatment is recommended?
NO treatment- continue to monitor
168
Differential diagnosis for CO:
Sclerotic bone (which is a non-pathology and requires no tx)
169
You cannot do ANY treatment for the patient until you have a:
supported diagnosis
170
If you cannot make a definitive DX today, support the patient with appropriate ____ and follow up
supportive medications
171
Peri-radicular DX: SAP
1. symptoms:
2. Pulp testing
hot-
cold-
EPT-
3.
Percussion-
Palpation-
Probing-
Mobility-
4. Swelling
intraoral-
extraoral-
DST-
5. Radiographic:
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
Peri-radicular DX: AAP
1. symptoms:
2. Pulp testing
hot-
cold-
EPT-
3.
Percussion-
Palpation-
Probing-
Mobility-
4. Swelling
intraoral-
extraoral-
DST-
5. Radiographic:
1. not sensitive
2. no response to any
3. WNL (all)
4. none
5. thickened PDL or none
173
Peri-radicular DX: AAA
1. symptoms:
2. Pulp testing
hot-
cold-
EPT-
3.
Percussion-
Palpation-
Probing-
Mobility-
4. Swelling
intraoral-
extraoral-
DST-
5. Radiographic:
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
Peri-radicular DX: CAA
1. symptoms:
2. Pulp testing
hot-
cold-
EPT-
3.
Percussion-
Palpation-
Probing-
Mobility-
4. Swelling
intraoral-
extraoral-
DST-
5. Radiographic:
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
Longitudinal tooth fractures are ____ and also called ____ tooth fractures
important; vertical
176
- Longitudinal tooth fracture that is confined to the enamel
- Common and generally unimportant
- Don't stop light
Craze lines
177
- Longitudinal tooth fracture
- Facial- lingual
- Often involves undermined cusp and may be restorable
Fractured cusp (oblique shearing fracture)
178
- 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
Cracked tooth (incomplete "green stick" fracture)
179
A longitudinal fracture cracked tooth may also be called:
incomplete "greenstick" fracture
180
A longitudinal fractured cusp may also be called:
oblique shearing fracture
181
- Longitudinal tooth fracture
- Crack extends to a surface in all areas
- Involves crown, root, and generally pulp
- must remove fractured segment and determine restorability
split tooth
182
What is the treatment for a split tooth?
must remove fractured segment and determine restorability
183
- Longitudinal tooth fracture
- Begins internally at root apex or from crown
- primarily in axial plane (may be FL or MD)
Vertical root fracture (VRF)
184
What is the most severe type of longitudinal tooth fracture?
VRF (followed by split tooth)
185
Horizontal fractures are also important but are generally ____ and usually associated with ____
easily seen; known traumatic events
186
Vertical lines in the enamel of teeth:
craze lines
187
Craze lines are common and generally ____ and ___
asymptomatic; not a concern for endo
188
A fractured cusp is a HIGHLY VARIABLE injury meaning (treatment)
treatment can very from a simple intracoronal restoration to endodontic intervention to extraction
189
For a fractured cusp, if the pulp tests are WNL the normal procedure is to:
remove the fractured cusp and see if the remaining tooth structure will support a restoration
190
A cracked tooth may also be called:
"greenstick" fracture
191
The most common site of a cracked tooth (greenstick fracture) is:
mandibular 2nd or 1st molar followed by maxillary pre-molars
192
Cracked tooth (greenstick fractures) are often sen in teeth:
without caries or restorations
193
A cracked tooth (greenstick fracture) is most often discovered following patient complaint of:
acute, sharp momentary pain upon biting or release of biting pressure
194
Describe the pulp in a cracked tooth (greenstick fracture)
Generally pulp is vital in early stages and may remain so for some time
195
A cracked tooth will continue to cause pain as long as:
pulp remains vital
196
What syndrome is associated with a greenstick fracture?
Cracked tooth syndrome
197
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:
Drop-off periodontal pocket
198
Whats it called when your perio measuring looks something like 3-3-3-3-8-3?
Drop-off periodontal pocket
199
A NARROW pocket that often indicates the extension of a crown fracture into the root:
drop-off periodontal pocket
200
A drop-off periodontal pocket may signal a ____ tooth
non-restorable
201
What does a drop-off periodontal pocket indicate?
extension of a crown fracture into the root
202
When looking for a vertical root fracture, look for:
J-shaped (HALO) apical bony lesion
203
When searching for a vertical root fracture, probe for:
drop-off pocket
204
VRF is difficult to confirm ______, unless ____ occurs
radiographically; separation of segments
205
The only ABSOLUTE CERTAIN WAY to determine a vertical root fracture is to:
expose it surgically and stain (possibly microscope use)
206
Label the following fracture types:
A- fractured cusp
B- incomplete crown fracture
C- incomplete crown-root fracture
D- split tooth
E- vertical root fracture
207
