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Endodontics > Lecture 4 (9/12) > Flashcards

Lecture 4 (9/12) Flashcards

1
Q

Can cold testing be done with crowns?

A

yes

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2
Q

It is ____ to often present as PURELY pulpal

A

unlikely

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3
Q

What diseases go hand-in-hand?

A

Pulpal disease & periradicular disease

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4
Q

How many diagnoses does each tooth need?

A

2 diagnoses

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5
Q

What are the two diagnoses that each tooth need?

A
  1. pulpal diagnosis
  2. periradicular diagnosis

(maybe perio & restorative also)

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6
Q

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

A

What is you chief complaint?

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7
Q

When you ask the 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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8
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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9
Q

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

A

Pulpal pain = diffuse pain

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10
Q

How might we describe purely pulpal pain?

A

Diffuse pain

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11
Q

It is important to understand the ____ before proceeding

A

Chief complaint

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12
Q

The _____ is what brought the patient here

A

Chief complaint

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13
Q

The objective of clinical testing is to:

A

Find and confirm the etiology of the patients CCs

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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 hypersensitivity on healthy adjacent tooth may reveal a:

A

Lowered pain threshold and heightened pain sensitization

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15
Q

Conclusions in the study “associations between pain severity, clinical findings, and endodontic disease: a cross-sectional study” reveals that a lowered pain threshold and heightened pain sensitization. It is also possible that the two commonly performed mechanical sensory tests, percussion and palpation hypersensitivity may detect:

A

Different aspects of endodontic pathophysiology and pain processing

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16
Q

Performed based on chief complaint:

A

Clinical testing

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17
Q

Some examples of clinical testing include: (5)

A
  1. thermal
  2. EPT
  3. Percussion
  4. Palpation
  5. Periodontal probing and mobility
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18
Q

The thermal test (cold, heat) is testing he:

A

Pulp vitality

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19
Q

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

A

Only done if pulpal status is in doubt; NOT done routinely

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20
Q

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

A

Percussion test

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21
Q

Clinical test performed by digital touching of gingiva, detecting for inflammation, redness, swelling and tenderness:

A

Palpation

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22
Q

Periodontal probing and mobility is testing for:

A

Periodontal health

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23
Q

Following clinical testing what is the next step?

A

Obtain radiographs of the suspect areas

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24
Q

When obtaining radiographs of the suspect areas, what is the minimum three diagnostic films that must be taken:

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 and bone level)
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25
Q

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

A

Examine the collected data

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26
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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27
Q

What might be some possible reasons for the noted pulpal condition?

A

-deep caries
-deep restoration especially composite
-evidence of trauma
-if virgin tooth- crack

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28
Q

Answering the question of “why?” usually leads to a _____ and more _____

A

Accurate diagnosis; successful treatment outcome

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29
Q

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

A

two

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30
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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31
Q

Reversible pulpitis would exhibit ______?

A

Cold sensitivity (non-lingering)

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32
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 tests

  • Reversible pulpitis
  • Symptomatic irreversible pulpitis
  • Asymptomatic irreversible pulpitis
  • Necrotic pulp
A

Reversible pulpitis

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33
Q

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

A

False

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34
Q

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

A
  1. normal
  2. inflamed
  3. infected
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35
Q

The outcome of “normal” pulp should:

A

Remains normal and healthy

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36
Q

What are the two categories of inflamed pulp?

A
  1. Reversible
  2. Irreversible
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37
Q

The outcome of “inflamed” pulp could:

A

recover or deteriorate

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38
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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39
Q

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

A

symptomatic; asymptomatic (rare)

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40
Q

Describe the pain associated with irreversible inflamed pulp:

A

Pain is lingering and often spontaneous

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41
Q

Lingering and often spontaneous pain describes:

A

Irreversible inflamed pulp

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42
Q

What is the outcome of infected pulp?

A

Will proceed to necrosis

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43
Q

If we think of pulp as a separate entity, we end up with a total of five 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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44
Q

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

A

PT & PIT

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45
Q

Normal pulp =

A

WNL

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46
Q

What would the CC of normal pulp likely be?

A

CC: None (asymptomatic currently & historically)

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47
Q

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

  1. Thermal testing
  2. EPT
  3. Percussion
  4. Radiographically
A
  1. Hot-cold WNL
  2. EPT responsive (similar to other WNL teeth)
  3. Negative (WNL)
  4. No radiographic changes
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48
Q

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

A

LEAVE IT ALONE

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49
Q

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

Why?

A

prior; establish a standard base-line

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50
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 remove (NO LINGERING)

-Patient was referred for retreatment of #7 but only #6 and #8 symptomatic (with cold stimulus, not lingering, no spontaneous pain)

-Percussion negative (all three teeth)

-Unsure of radiographic changes

A

Reversible pulpitis

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51
Q

For the following case, what did the referring DDS miss? (3)

CC: Cold sensitive

Clinical testing:
-Cold sensitivity #6 and #8 - pain relieved almost immediately once stimulus remove (NO LINGERING)

-Patient was referred for retreatment of #7 but only #6 and #8 symptomatic (with cold stimulus, not lingering, no spontaneous pain)

-Percussion negative (all three teeth)

-Unsure of radiographic changes

A
  1. failure to listen to patient’s CC
  2. Improper diagnosis due to failure to perform clinical testing
  3. No need to do hot (CC was COLD)
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52
Q

Reversible pulpitis may follow 1 if 3 outcomes including:

A
  1. if properly treated - may revert to normal
  2. may remain reversible pulpitis symptomatic for extended period
  3. May deteriorate to SIP or AIP (even if properly treated)
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53
Q

RP:

A

Reversible pulpitis

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54
Q

What would the diagnosis be for the following case:

CC: cold sensitive

Clinical testing:
-cold sensitivity #6 only that lingers 15-20 seconds after stimulus is removed

-percussion: negative

-radiographic changes: none at apex

-etiology present on radiograph (large cavity on #6)

A

Irreversible pulpitis (symptomatic)

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55
Q

SIP:

A

Symptomatic irreversible pulpitis

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56
Q
  1. In early SIP _____ hurts > 10 and ____
  2. In late SIP ____ hurts - ____ helps
  3. &/or pain might be ______ or ______
A
  1. cold; lingers
  2. hot; cold
  3. spontaneous; awakes patient from sleep
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57
Q

What stage of SIP is being described below?

-Cold hurts > 10 and lingers

A

Early SIP

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58
Q

What stage of SIP is being described below?

-Hot hurts - cold helps

A

Late SIP

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59
Q

What stage of SIP is being described below?

-Pain is spontaneous or awakes the patient from sleep

A

Late SIP

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60
Q

Normal teeth are NOT sensitive to ____

A

Hot

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61
Q

Gingiva are _____ sensitive to hot than teeth

A

More

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62
Q

Hot sensitivity usually indicates _____ = ____

A

Deteriorating pulp = SIP

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63
Q

AIP:

A

Asymptomatic irreversible pulpitis

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64
Q

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

This is indicative of:

A

not; asymptomatic irreversible pulpitis

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65
Q

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

In such cases ______ is definitely indicated in order to prevent _____

A

RCT; a later exacerbation

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66
Q

NP:

A

Necrotic pulp

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67
Q

What would the diagnosis be for the following case:

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

Clinical testing:
-No response to cold, hot or electric pulp tester

A

Necrotic pulp

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68
Q

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

A

No response to any

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69
Q

PT:

A

Previously treated

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70
Q

PIT:

A

Previously initiated treatment

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71
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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72
Q

For a previously treated tooth:

Obturated with final RC 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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73
Q

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

A

Partial endodontic therapy

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74
Q

How would you label this tooth:

A failed pulp cap pr pulpotomy, or even a pulpectomy

A

Previously initiated treatment

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75
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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76
Q

Label with the correct pulpal diagnostic “box”

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

A

RP (Reversible pulpitis)

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77
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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78
Q

Label with the correct pulpal diagnostic “box”

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

A

AAP (Asymptomatic irreversible pulpitis)

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79
Q

Label with the correct pulpal diagnostic “box”

-Death of the dental pulp. (No response to pulp tests)

A

NP (Pulpal necrosis)

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80
Q

Label with the correct pulpal diagnostic “box”

-Tooth has been endodontically treated with canals obturated with final root canal filling materials other than medicaments

A

PT (Previously treated)

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81
Q

Label with the correct pulpal diagnostic “box”

-Tooth has been previously treated by partial endodontic therapy, i.e. pulp cap, pulpotomy/pulpectomy (RCT is NOT completed)

A

PIT (Previously initiated treatment)

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82
Q

Always remember, everything in diagnosis is:

A

Continually changing

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83
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 nest day as pulp vitality succumbs to challenge

these are all example of:

A

The diagnosis continually changing

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84
Q

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

A

lead to a necrotic pulp

85
Q

Both seriously inflamed and infected pulpits cases will ultimately lead to a necrotic pulp if:

A

Left untreated long enough

86
Q

Our diagnostic findings are simply a ______ during this continuum

A

snapshot in time

87
Q

if you cannot arrive at a supportable diagnosis:

A

you CANNOT do any treatment

88
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

89
Q

RARELY do we see _______ in cases of of pure pulpits or even early necrotic pulp

A

apical radiograph changes

90
Q

Why do we rarely see apical radiograph changes in cases of pure pulpits 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

91
Q

What is generally required to see apical radiographic changes?

A

Advanced pulpal disease or pulpal necrosis

92
Q

Diagnose after reviewing all 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: None

Radiographic: No changes

A

Normal pulp (NP)

93
Q

Diagnose after reviewing all 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 pulpits (RP)

94
Q

Diagnose after reviewing all 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)

95
Q

Diagnose after reviewing all 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 pulpits (AIP)

96
Q

Diagnose after reviewing all clinical tests:

Symptoms: No symptoms - unless extends to per-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)

97
Q

(True/False): There is very little correlation between clinical symptoms and histo/pathological reality

98
Q

(True/False): We can do histology without destroying the principle tissue we are trying to preserve

99
Q

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

A

clinical examination & testing

100
Q

How do we support our peri-apical diagnosis?

A

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

101
Q

The 5 elements of clinical examination & testing include:

A
  1. medical & dental history
  2. CC + signs & symptoms
  3. Clinical examination
  4. Clinical testing
  5. Radiological indications
102
Q

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

103
Q

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

A

Make a diagnosis from radiographs alone

104
Q

Why must you NEVER attempt to make a diagnosis based on a radiograph alone?

A

Many unrelated, non-odontogentic entitites can mimic LEOs radiographically (but in fact be something entirely different)

105
Q

It is important to _____ all testing & examination done

106
Q

Following pulpal necrosis, the disease process rapidly extends:

A

Peri-apically

107
Q

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

A

BEFORE radiographic evidence is clear

108
Q

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

109
Q

Pulpal necrosis is only visible in _____% of cortical bone

110
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. Peri-radicular infection occurs beyond the apex (_______)
A
  1. carious lesion or trauma
  2. locally
  3. localized abscess; coronal pulp
  4. necrosis
  5. the entire RC system
  6. portals of exit; peri-radicular tissues
  7. apical abscess
111
Q

All peri-radicular inflammation is sensitive to:

(What does this differ from?)

A

Percussion

This differs from purely pulpal pain as it is NOT sensitive to percussion

112
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 the pulp)

113
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

(we are dealing with an apical diagnosis of some type)

114
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)

115
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 osteoitis)
116
Q

AAA = ________ and may be accompanied by _____

A

acute apical abscess (swelling & fever)

117
Q

CAA= _______ and is typically accompanied by _____

A

Chronic apical abscess (PAR + DST)

118
Q

Whenever a DST is present this signifies:

119
Q

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

A

Condensing osteitis; radiopaque appearance; symptoms

120
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)

121
Q

Peri-apical diagnostic “boxes”

For WNL:
-Percussion test:
-Palpation test:
-Lamina dura:
-PDL:

A
  1. not sensitive to percussion
  2. not sensitive to palpation
  3. lamina dura is intact
  4. PDL is not broken
122
Q

Peri-apical diagnostic “boxes”

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

A

SAP (symptomatic apical periodontitis)

123
Q

Peri-apical diagnostic “boxes”

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

A
  1. inflammation of the periodontium
  2. painful response to percussion
  3. painful response to biting
  4. possible painful response to palpation
124
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)

125
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 clincial symptoms

126
Q

Peri-apical diagnostic “boxes”

“Destruction of the periodontium”

A

Asymptomatic apical periodontitis (AAP)

127
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)

128
Q

Peri-apical diagnostic “boxes”

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

A

-rapid onset; spontaneous pain
-pressure
-pus formation, swelling & fever

129
Q

Peri-apical diagnostic “boxes”

“SWELLING AND FEVER”

A

AAA (acute apical abscess)

130
Q

Peri-apical diagnostic “boxes”

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

A

CAA (chronical apical abscess)

131
Q

Peri-apical diagnostic “boxes”

“DRAINING SINUS TRACT”

A

CAA (Chronic apical abscess)

132
Q

Describe the onset of chronic apical abscess:

A

Gradual onset

133
Q

Describe the onset of acute apical abscess:

A

Rapid onset

134
Q

Peri-apical diagnostic “boxes”

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

A

CO (condensing osteitis)

135
Q

Peri-apical diagnostic “boxes”

“Localized bony reaction to a low-grade inflammatory stimulis”

A

(CO) condensing osteitis

136
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)
137
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
138
Q

Fill in the blanks:

A
  1. NO PAIN
  2. PAIN
  3. NO PAIN
  4. PAIN
  5. NO PAIN
  6. N/A
139
Q

Fill in the blanks for normal pulp (NP here but dont confuse this with necrotic pulp):

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

140
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

141
Q

Fill in the blanks for symptomatic irreversible pulpitis (SIP):

A

SYMPTOMS: Pain to cold - possibly 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

142
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

143
Q

Fill in the blanks for necrotic pulp (NE):

A

SYMPTOMS: No symptoms unless extends to 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

144
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 TEST WNL
  6. NO APPARENT INJURY to the tooth
145
Q

What other situations may result in similar symptoms to symptomatic apical periodontitis (SIP):

A
  1. Recent high restoration
  2. Occlusal habits (bruxism)
  3. Trauma, etc.
146
Q

A thickened PDL can be caused by:

A
  1. occlusal trauma
  2. PARL
147
Q

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

A

A high restoration/occlusal trauma may caused a thickened PDL

148
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 of P/A radiolucency
  4. NO SWELLING - no DST
A

Asymptomatic apical periodontitis

149
Q

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

150
Q

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

A

SEVERE pain

151
Q

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

A

-thickened PDL space or P/A radiolucency

152
Q

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

A

active infection in apical tissues

153
Q

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

154
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)

155
Q

With 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

156
Q

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

A

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

157
Q

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

A

NOT an emergency

158
Q

What is the following apical diagnosis:

  1. pulp necrotic
  2. pain minimal or none
  3. sensitivity to percussion, minimal or none
  4. sensitive 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 drainage via DST or gingival sulcus via narrow periodontal pocket
A

CAA (Chronic apical abscess) - not an emergency

159
Q

Describe the pain that associated with a chronic apical abscess:

A

Usually no/minimal pain

160
Q

What is associated with an intraoral draining sinus tract?

161
Q

Are antibiotics required for CAA?

A

No (also no Rx analgesic)

162
Q

______ is pathognomic for CAA

163
Q

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

A

Gutta percha cone & radiograph

164
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 & symptoms and + radiographic interpretation:

A

SAP, AAP, AAA

165
Q

Radiopaque formative or reactive bone:

A

CO (Condensing osteitis)

166
Q

Treatment of CO (Condensing osteitis) is based on:

167
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

168
Q

If CO is asymptomatic and no aparent pathology is present, how would you treat?

A

No treatment- continue to monitor

169
Q

Differential diagnosis for CO:

A

Sclerotic bone (which is a non-pathology & requires no treatment)

170
Q

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

A

supported diagnosis

171
Q

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

A

supportive medications

172
Q

Peri-radicular diagnosis: 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 three)
  3. Percussion: +
    Palpation: Variable
    Probing: Variable
    Mobility: Variable
  4. None
  5. Thickened PDL or none
173
Q

Peri-radicular diagnosis: 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. Radiographic: Thickened PDL or none
174
Q

Peri-radicular diagnosis: 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 & extensive swelling with no DST
  5. Thickened PDL or P/A area
175
Q

Peri-radicular diagnosis: 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 PA area
176
Q

Longitudinal tooth fractures are ______ and also called _____ tooth fractures

A

Important; vertical

177
Q

-Longitudinal tooth fracture that is confined to the enamel
-common & generally unimportant
-don’t stop light

A

Craze lines

178
Q

-Longitudinal tooth fracture
-facial to lingual
-often involves undermined cusps & may be restorable

A

Fractured cusp (oblique shearing fracture)

179
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 “greenstick” fracture)

180
Q

A longitudinal fracture- cracked tooth, may also be called:

A

Incomplete “greenstick” fracture

181
Q

A longitudinal fracture cusp, may also be called:

A

Oblique shearing fracture

182
Q

-Longitudinal tooth fracture
-fracture extends to a surface in all areas
-involves crown, root & generally pulp
-must remove fractured segment & determine restorability

A

Split tooth

183
Q

What is the treatment for a split tooth?

A

must remove fractured segment & determine restorability

184
Q

-Longitudinal tooth fracture
-begins internally (at root apex or from crown)
-primarily in axial plane (may be F-L or M-D)

A

Vertical root fracture (VRF)

185
Q

What is the most severe type of longitudinal tooth fracture?

A

Vertical root fracture (VRF) followed by split tooth

186
Q

Horizontal fractures are also important but are generally ______ and usually associated with _____

A

easily seen; known traumatic events

187
Q

Vertical lines in the enamel of teeth:

A

Craze lines

188
Q

Craze lines are common and generally _____ and ______

A

asymptomatic; not a concern for endo

189
Q

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

A

Treatment can vary from a simple intracoronal restoration, to endodontic intervention to extraction

190
Q

For a fracture cusp, if the pulp tested WNL, the normal procedure is to:

A

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

191
Q

A cracked tooth may also be called:

A

“greenstick” fracture

192
Q

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

A

mandibular 2nd molar or 1st molar followed by maxillary premolars

192
Q

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

A

without caries or restorations

192
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 pressuer

193
Q

Describe the pulp in a cracked tooth (greenstick fracture):

A

Generally pulps is vital in early stages & may remain so for some time

193
Q

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

A

Pulp remains vital

194
Q

What syndrome is associated with a greenstick fracture?

A

Cracked tooth syndrome

195
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

196
Q

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

A

Drop-off periodontal pocket

197
Q

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

A

Drop-off periodontal poclet

198
Q

A drop-off periodontal pocket may signal a _____ tooth

A

Nonrestorable

199
Q

What does a drop-off periodontal pocket indicate?

A

extension of a crown fracture into the root

200
Q

When looking for a vertical root fracture, look for:

A

J-shaped (halo) apical bony lesion

201
Q

When searching for a vertical root fracture, probe for:

A

Drop-off pocket

202
Q

VRFs are difficult to confirm ______ unless ______ occurs

A

Radiographically; separation of segments

203
Q

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

A

expose it surgically & stain (possibly microscope use)

204
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 (17 decks)

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