Pain History and Diagnosis

Question 1

What are the Causes of Pulpal Inflammation (4)

Answer 1

caries
trauma
tooth wear
restorative processes

Question 2

What is the Initial Pulpal Response?

Answer 2

• deposit reactionary and reparative dentine
• tubular sclerosis
• reduce dentine permeability

Question 3

What is the Pulpal Response when the Stimulus is Removed?

Answer 3

pulp begins repairing
= reversible pulpitis

Question 4

What is the Pulp Response if Inflammation Persists? What’s the Treatment?

Answer 4

= irreversible pulpitis
- pulp necrosis
extraction or RCT

Question 5

Describe Pain History Taking

Answer 5

Site - generalised/localised
Onset - spontaneous/constant
Character - sharp/dull
Radition - spread
Association - unwell in any other way
Time - how long
Exacerbation - anything that enhances or relieves
Severity

Question 6

Describe Symptoms of Reversible Pulpitis, What an Examination, Pulp Test and Radiograph may Look like.

Answer 6

Site = poorly localised
Onset = **not spontaneous **
Character = sharp
Radiation
Association
Time = short
Exaccerbation = worse with cold and sweets
Severity

examination - caries, tooth wear, heavily restored
pulp test = high response
radiograph - no periapical change, maybe secondary caries

Question 7

Describe Symptoms of Irreversible Pulpitis, What an Examination, Pulp Test and Radiograph may Look like.

Answer 7

S = poorly localised
O = spontaneous
C = dull
R
A
T = constant
E = worse with hot temperature
S = very severe

Examination - caries, tooth wear, heavily restored
Pulp Test - exaggerated response
Radiograph - PDL space widening

Question 8

Describe Symptoms of Acute Periapical Periodontitis, What an Examination, Percussion and Radiograph may Look like.

Answer 8

S - localised
O - not spontaneous
C - sharp
R
A
T - short
E - worse on biting
S

Examination - occlusal trauma, cracks, wear, overloaded teeth
Percussion - tender
Pulp Test - may be exaggerated
Radiograph - PDL space widening

Question 9

Describe Symptoms of Chronic Periapical Periodontitis, What an Examination, Percussion and Radiograph may Look like.

Answer 9

S
O
C - dull ache
R
A
T
E - worse on biting
S

= patient may be asymptomatic
examination - discoloured, heavily restored, tenderness in buccal sullcus
percussion - slight tender
radiograph - PDL space widening

Question 10

Describe Symptoms of Acute Periapical Abscess, What an Examination, Percussion, Pulp Test and Radiograph may Look like.

Answer 10

S - localised
O - spontaneous
C - throbbing, dull
R
A
T - long duration
E - worse on biting
S - very severe

Examination - swelling, tender, mobile tooth
Percussion - tender
Pulp Test - non-vital
Radiograph - periapical radiolucency

Question 11

Describe Symptoms of Chronic Periapical Abscess, What an Examination, Percussion, Pulp Test and Radiograph may Look like.

Answer 11

S
O
C - low grade, dull ache
R
A - repeating swelling on gum, yields pus
T
E
S

= may be asymptomatic

Examination - sinus papilla on alveolar, pus
Percussion - tender
Pulp-Test - non-vital
Radiograph - periapical radiolucency

Question 12

What are 3 Ways to Test Pulp Vitality?

Answer 12

1. thermal stimuli
   - cold = ethyl chloride
   - hot - hot gutta percha
2. EPT
   - dry the tooth as saliva may conduct
   - higher the reading = more unresponsive
   - low reading - pulpal inflammation
3. test cavity without LA