Module 3: Diagnosis Flashcards
What is the primary radiograph in endo?
PA
What does the BW radiograph help evaluate
Restorability
What type of radiograph has limited use in endo.
Panorex
What should you be looking at on the radiograph?
Bone levels
Existing restorations
Pulp chamber space
Root canal space and morphology
What are the initial goals of Clinical Diagnostic Tests?
To reproduce the patient’s complaint
Use control teeth to establish a baseline
What are two important pieces of information you can get from perio testing?
Probing depths
Mobility
Why is perio testing so important?
You must be sure the tooth is sound periodontically before committing to RCT
What are the 3 periapical tests?
Percussion
Palpation
Bite
What are the 3 Sensibility (Vitality) tests
Cold
EPT
Heat
In the Palpation test, what are we trying to determine?
How far the inflammation has extended
What does a painful response indicate in the palpation test?
Periapical inflammation
What is the most valuable of the 3 periapical tests?
Percussion
What is the percussion test good at indicating?
The offending tooth
What does a sore reaction to the percussion test indicate?
Periapical inflammation
What is the VCU scale for percussion and palpation readings
N = No Pain \+ = Slight \++ = Moderate \+++ = Severe
What pathosis is the biting force test especially useful for?
Cracked teeth
What is rebound sensitivity a good indicator for?
Cracked teeth/Fractured cusp
Crack flexes and then rebounds causing pain
What instrument is used for a bite test
Tooth Sleuth
What is the temperature of endo ice
-26 C
What is the chemical in endo ice
1,1,1,2-tetrafluoroethane
Which set of teeth is cold testing more effective on: Anterior or Posterior?
Anterior
What surface is the cotton pellet placed on during cold testing
Buccal
What would you consider an abnormal response to the cold test?
Prolonged, severe pain
How does a necrotic pulp respond to a cold test?
No response
What could cause a false positive on a cold test?
Transference of stimulus to adjacent teeth or soft tissue
What could cause a false negative on a cold test
Receded on constricted pulp
Can you cold test through full coverage crowns?
Yes
What kind of cotton pellet it used for cold testing
Large #2
What is the VCU response grading to cold testing?
0 = No Pain \+ = Slight and immediate reversal \++ = Moderate and immediate reversal \+++ = Severe that does not go away immediately
Does a 0 on a cold test always mean a dead pulp?
No
Why does the EPT always restart at zero after breaking contact
To reduce chances of giving patient a shock
Is EPT more important than cold testing?
No, it is secondary to cold test
Can you perform an ept on crowns?
Not on full coverage Metal or PFM
What does an 80/80 reading on the EPT indicate?
No response to electrical stimulation
What is transillumination good at identifying?
Longitudinal cracks
What are the 2 diagnoses that must be made for an official endo diagnosis
Pulpal AND Periapical
What is the pulp diagnosis when the pulp is symptom free and normally responsive to vitality testing?
Normal pulp
What are the diagnostic findings for a Normal pulp diagnosis
Cold response of +
Or no cold response with receded or sclerotic pulp (recorded as 0)
What is the pulp diagnosis based upon subjective and objective findings indicating that the inflammation should resolve and the pulp return to normal
Reversible pulpitis
What are the diagnostic findings for reversible pulpitis
Cold response of ++
No root canal needed
What pulpal diagnosis is defined as findings that indicate the vital inflamed pulp is incapable of healing
irreversible pulpitis
What are the two additional descriptors that can be used to describe the pulp diagnosis
Symptomatic and Asymptomatic
What is the clinical diagnosis that indicates the death of the pulp
Pulp necrosis
What are the diagnostic findings for Pulp necrosis
0 for Cold Test
80/80 for EPT
What does Previously Treated mean
Tooth has had endo tx and the canals are obturated with filling material
What are the diagnostic findings for previously treated
Will respond to cold and ept the same way necrotic pulp do….unless there is still vital pulp tissue in the tooth
What is Previously Initiated Therapy
RCT started but not finished yet
What is the PA diagnosis for a tooth with normal periradicular tissues with an intact lamina dura and uniform PDL space
Normal apical tissues
What is the PA diagnosis for inflammation of the apical periodontium that produced clinical symptoms like painful response to biting and percussion. It may or MAY NOT be associated with an apical radiolucency
Symptomatic apical periodontitis
How could you describe the diagnosis “Asymptomatic apical periodontitis”
Inflammation of apical periodontium that is of pulpal origin. It appears as an apical RL with no clinical symptoms
What is the worst symptomatic diagnosis for perio
Acute apical abscess
What is the diagnosis for a patient that has a gradual onset with little or no discomfort along with intermittent discharge of pus via sinus tract
Chronic apical abscess
What pulp diagnosis would you give a tooth that has cold test score of ++?
Reversible pulpitis
What pulp diagnosis would you give a tooth with a cold test score of +++?
Irreversible pulpitis
What would the pulp diagnosis be for a cold test of 0 and an 80/80 ept?
Necrotic pulp
What is the PA ddx for a tooth that scores:
N for percussion
N for palpation
Normal apical tissues
What perio ddx would you give to a tooth with pain response to biting that may or may not have a response to palpation?
Symptomatic apical periodontitis
What is the perio ddx for a tooth with an apical RL and:
N for percussion
N for palpation
Asymptomatic apical periodontitis
What is the expected response to percussion and palpation testing for a chronic apical abscess?
Percussion negative
Palpation might be positive if sinus tract is palpated
