Pain Diagnosis and Indications for Extractions Flashcards
What does Tx mean?
Treatment
What is normal mouth opening?
35mm (3 fingers)
What should you describe about a swelling?
Size, site, and firm/soft
What are the common special tests?
Tender to Tap Test, Millers Mobility Index, sensitivity testing (ethyl chloride, EPT), periodontal pocketing, radiographs (usually IOPA/OPG)
What is grade 0 of Millers Mobility Index?
No mobility
What is grade 1 of Millers Mobility Index?
<1mm mobility in buccolingual direction
What is grade 2 of Millers Mobility Index?
> 1mm and <2mm mobility
What is grade 3 of Millers Mobility Index?
> 2mm mobility/depressibility in socket
What does one deep pocket often indicate?
Root fracture
What is the general rule of radiographs for extractions?
> 12 months old take a new radiograph
What is the radiograph of choice prior to extractions for third molars?
OPG (ID canal)
What is the radiograph of choice prior to extractions with the exception of third molars?
Periapical
What structures are adjacent to the upper 6’s?
Maxillary sinus
What structures are adjacent to the lower third molars?
ID canal
When can a treatment plan be formulated?
Only once a diagnosis has been made
What are the types of dental pain?
Reversible pulpitis, irreversible pulpitis, acute apical periodontitis, chronic apical periodontitis, acute apical abscess, and chronic apical abscess
What are the features of history of reversible pulpitis?
Provoked, pain with stimulus (cold/ sweet), short lived, and sharp pain
What are the usual clinical findings of reversible pulpitis?
Caries and tooth usually restorable
What is the usual sensibility testing for reversible pulpitis?
Hypersensitive to cold test and vital
What is the TTP for reversible pulpitis?
Negative
What are the usual radiographic findings for reversible pulpitis?
Caries in tooth, not into pulp and normal apical tissues
What is the usual treatment of reversible pulpitits?
Removal of caries and restoration
What are the features of history of irreversible pulpitis?
Spontaneous intense pain, pain lasts much longer than stimulus, and some patients find cold water helps pain
What are the usual clinical findings of irreversible pulpitis?
Deep caries, usually into/very close to pulp
What is the sensibility testing for irreversible pulpitis?
May be positive/no response
What is the TTP for reversible pulpitis?
Usually, negative
What are the radiographic findings for irreversible pulpitis?
Caries in tooth, usually into pulp, and normal apical tissues
What is the usual treatment for irreversible pulpitits?
RCT/extraction
What are the features of history of acute apical periodontitis?
Severe aching pain, keeping patient awake at night, analgesia may not be helping
What are the usual clinical findings of acute apical periodontitis?
Deep caries, involving pulp/severe periodontal disease (perio-endo lesion)
What is the sensibility testing for acute apical periodontitis?
Negative and non-vital
What is the TTP for acute apical periodontitis?
Positive
What are the radiographic findings for acute apical periodontitis?
PDL widening, may/may not be an apical area
If an apical area also known as ‘acute exacerbation of a chronic apical periodontitis’
What is the usual treatment for acute apical periodontitis?
RCT/extraction
What are the features of history of chronic apical periodontitis?
Tooth not painful, may be an incidental finding, and may be a history of previous pain which has settled
What are the usual clinical findings for chronic apical periodontitis?
Deep caries, involving pulp and tooth broken down/severe periodontal disease (perio-endo lesion)
What is the sensibility testing for chronic apical periodontitis?
Negative and non-vital
What is the TTP for chronic apical periodontitis?
Negative
What are the radiographic findings for chronic apical periodontitis?
Apical radiolucency
What is the usual treatment for chronic apical periodontitis?
RCT/extraction
What are the features of history of acute apical abscess?
Severe pain, swelling, and may be feeling unwell with a fever
What are the usual clinical findings of acute apical abscess?
Swelling (intra oral +/- extra oral swelling) pus collection, and may be perio/endo in origin
What is the sensibility testing of acute apical abscess?
Negative and non-vital
What is the TTP of acute apical abscess?
Positive
What are the radiographic findings of acute apical abscess?
PDL widening, may/may not be an apical area
What is acute apical abscess known as if radiographic findings of an apical area?
Acute exacerbation of a chronic apical abscess
What is the usual treatment of acute apical abscess?
Establish drainage, then definitive treatment RCT/XLA
How long does it take for a periapical area to appear on a radiograph?
2 weeks
What are the features of history of a chronic apical asbcess?
Not usually painful, small swelling that drains, bad taste
What are the usual clinical findings of a chronic apical abscess?
Sinus/draining sinus on gingivae
What is the usual sensibility testing of a chronic apical abscess?
Negative and non-vital
What is the TTP of a chronic apical abscess?
Negative
What are the radiographic findings of a chronic apical abscess?
Apical radiolucency
What is the usual treatment of a chronic apical abscess?
RCT/extraction
What are GP points used for?
To track through sinus tracts to locate the source of infection and the offending tooth
What are hard palate abscesses most commonly related to?
Maxillary lateral incisors
Why may you get a positive sensibility test in a multi-rooted tooth in acute apical periodontitis?
Mesio-buccal root is vital and distal is non-vital
What other condition has features that are similar to reversible pulpitis?
Dentine hypersensitivity
What is the weight limit for the dental chair?
21 stone
What is pericoronitis?
An inflammation/swelling of your gum tissue
What is orthognathic surgery?
Corrective jaw surgery
What is a coronectomy?
Remove the crown of the tooth and leave the tooth’s roots in your jaw, intact
How is pericoronitis diagnosed?
Clinically with the presence of soft tissue inflammation and swelling
