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2ND YR- CSA- Treatment planning > Pain history and diagnosis > Flashcards

Pain history and diagnosis Flashcards

1
Q

Describe the dental tissues and surrounding periodontium

A

They are richly innervated

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2
Q

Why can do we feel frequent pain when we have a dental problem?

A

As dental tissues are deeply innervated

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3
Q

Name the3 sources of dental pain

A
  1. Dentinal tubular fluid flow
  2. Raised pulpal pressure
  3. Periodontal inflammation
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4
Q

Why is the pulp-dentine complex sensitive?

A

As dentine contains tubules

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5
Q

What do tubules contain?

A
  1. Odontoblast processes

2. Tubular fluid

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6
Q

What causes tubular fluid movement according to the hydrodynamic theory

A
  1. Heat
  2. Cold
  3. Desiccation
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7
Q

What happens to tubular fluid when it is exposed to a hot stimulus?

A

Fluid expands

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8
Q

What happens to tubular fluid when it is exposed to a cold stimulus?

A

Fluid contracts

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9
Q

What happens to tubular fluid when it is exposed to a desiccation stimulus?

A

Fluid is drawn out of the tubules

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10
Q

Describe the hydrodynamic theory

A
  1. Fluid movement due to a stimulus leads to stimulation of nerves associated with the odontoblasts
  2. Th nerve impulses generated give rise to the sensation of pain
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11
Q

What can cause sensitivity?

A

Anything which results in the exposure of dentinal tubules

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12
Q

Give example of what can cause exposure of dentinal tubules

A
  1. Gingival Recession
  2. Caries
  3. Trauma
  4. Erosion, abrasion and attrition
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13
Q

How does an inflamed pulp response to offending stimuli ?

A

Depositing reactionary and reparative secondary dentine

Tis leafs to tubular sclerosis permeability

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14
Q

What is reversible pulpitis?

A

When an inflamed pulp ha the capacity to repair itself

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15
Q

What happens if the stimulus inflaming the pup isn’t removed?

A

The pup may become irreversibly damaged developing irreversible pulpitis

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16
Q

What will eventually happen to a tooth with irreversible pulpitis?

A

It will die

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17
Q

What are the treatment option for a tooth with irreversible pulpitis?

A
  1. Extraction

2. Root canal

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18
Q

What are the treatment option for a tooth with reversible pulpitis?

A

Caries removal and restoration placement

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19
Q

List some causes o pulpal inflammation?

A
  1. Caries
  2. . Trauma
  3. Abrasion, erosion, attrition
  4. Restorative procedure
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20
Q

What are the symptoms of reversible pulpitis?

A
  1. Short sharp poorly localised pain
  2. Sensitive to hot, cold and sweet stuff
  3. No spontaneous onset
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21
Q

What are we looking for when checking fro reversible pulpitis?

A

Caries
Tooth wear
Heavily restored tooth

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22
Q

What result would you get from a pulp yes for a tooth with reversible pulpitis?

A

Exaggerated response

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23
Q

What are the symptoms of irreversible pulpitis?

A
  1. Constant dull ache
  2. Throbbing poorly localised pain that radiated widely
  3. Worsens with heat
  4. Pain lasts or a lng duration
  5. Spontaneous onset
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24
Q

What are we looking for when checking for irreversible pulpitis?

A

Caries
Tooth wear
Heavily restored tooth

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25
Q

What result would you get from a pulp yes for a tooth with irreversible pulpitis?

A

Exaggerated response

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26
Q

What might you see on a radiograph of a tooth with irreversible pulpitis

A

May be slight PDL space widening e

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27
Q

What are the symptoms of acute periapical periodontitis?

A
  1. Short shooting pain that is well localised
  2. Pain worsens when biting
  3. Short duration
  4. No spontaneous onset
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28
Q

What are we looking for when checking for acute periapical periodontitis?

A
  1. Occlusal trauma
  2. Cracks
  3. Wear facets
  4. Overload teeth
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29
Q

If you tap on a tooth with acute periapical periodontitis what would you expect?

A

Tenderness to percussion

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30
Q

What might you see on a radiograph of a tooth with acute periapical periodontitis?

A

Expect PDL space widening

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31
Q

What are the symptoms of acute periapical abscess ?

A
  1. Severe throbbing pain the I well localised
  2. Worsens on biting and lasts for along duration
  3. Spontaneous onset
32
Q

What are we looking for when checking for acute periapical abscess?

A
  1. May be swelling intra or extra orally
  2. Exquisitely tender
  3. Mobile tooth
33
Q

If you tap on a tooth with an acute periapical abscess what would you expect?

A

Will b very tender to percussion

34
Q

What results would you expect from a pulp vitality test for a tooth with an acute periapical abscess?

A

Will show the tooth is non vital

35
Q

What would you se on a radiograph of a tooth with an acute periapical abscess?

A

Periapical radiolucency

36
Q

What are the symptoms of chronic periapical periodontitis?

A
  1. May be asymptomatic

2. Constant lo grades ache that worsens on biting

37
Q

What would you expect to see when checking for a chronic periapical periodontitis?

A
  1. Discoloured
  2. Heavily restored tooth
  3. Slight tenderness in buccal sulcus
38
Q

If you tap on a tooth with chronic periapical periodontitis what would you expect?

A

Slight tender to percussion

39
Q

What result would you get from a pulp test for a tooth with chronic periapical periodontitis?

A

All show the tooth is non vital

40
Q

What would you expect to see on a radiograph of a tooth with chronic periapical periodontitis ?

A

Expect PDL space widening

41
Q

What are the symptoms of chronic periapical abscess?

A
  1. May be asymptomatic
  2. Repeated swelling on gums that can burst to yield pus
  3. Low grade dull ache
42
Q

What would you expect to see when checking for a chronic periapical abscess?

A

Sinus papilla on alveolus (pus maybe presented)

Slight tenderness on palpation

43
Q

What results would you expect from a pulp vitality test for a tooth with a chronic periapical abscess?

A

The tooth will be non vital

44
Q

What would you expect to see from a radiograph of a tooth with a chronic periapical abscess

A

Periapical radiolucency

45
Q

What must you do before reaching a diagnosis?

A
  1. History including a detailed pain history
  2. Clinical examination
  3. special investigations
46
Q

Why is it important to tale a thorough pain history?

A
  1. To be able to determine nature and organ of pain
  2. Establish an accurate diagnosis
  3. To be able to provide the appropriate treatment
47
Q

What should a good pain history help you be able to determine?

A

Determine the likely cause of the patients pain

48
Q

What acronym do we use to make sure we have asked all the appropriate questions in regard to pain history |

A

SOCRATES

49
Q

What does SOCRATES stand for|

A 
Site
Onset
Character
Radiation
Association
Timing 
Exacerbating/ relieving factors
Severity
50
Q

Once you have taken a detailed history what should you do

/

A

Perform a thorough clinical examination

51
Q

What does a clinical examination compose of?

A

1 Extra oral examination

2. Intra oral examination

52
Q

What should we look for when we are taking an extra oral exam?

A
  1. Assessment of symmetry
  2. Palpation of lymph nodes
  3. Palpation of muscles of mastication
  4. Assessment of TMJs
53
Q

What should we look for when we are taking an intra oral exam in relation to soft tissues?

A
  1. Mucosal lesions
  2. Soft tissue swelling
  3. Suppuration
  4. Tenderness of alveolus
  5. Periodontal exam
54
Q

What should we look for when we are taking an intra oral exam in relation to hard tissues?

A
  1. Caries
  2. Heavily restored teeth
  3. Cracks
  4. Wear facets on teeth
55
Q

Name some special tests we might do?

A
  1. Sensibility testing
  2. Tenderness to percussion
  3. Check for occlusal trauma
  4. Radiographs
  5. tooth slooth
56
Q

What can we use to carry out a pulp sensibility (vitality) east?

A
  1. Thermal stimuli
  2. Electric pulp test
  3. Test cavity without LA
57
Q

What are some thermal stimuli we can us to check for pulp vitality

A

Cold:
1. Ethyl chloride
2, Ice stiks

Hot:
Hot Gutta percha
Hot water

58
Q

What are we looking for when using thermal stimuli to check tooth vitality?

A
  1. hypersensitive teeth (may indicate pulpal inflammation)

2. Non responsive tooth (May indicate pulp necrosis)

59
Q

What response would a sound tooth have to thermal stimuli?

A

Sound tooth will be sensitive to hot and cold

60
Q

How does an electric pulp test work?

A

It passes an electric current through the tooth

61
Q

What must you remember before carrying out an electric pulp test?

A
  1. Always dry the teeth first
  2. High reading means LESS responsive tooth
  3. Low reading may indicate pulpal inflammation
62
Q

Which teeth do we usually carry out n electric pulp test on|

A

Tooth we are interested in and the contralateral tooth

63
Q

How is a normal thermal stimulus charted?

A

+

64
Q

How is no response from thermal stimuli test charted?

A

-

65
Q

How is a hypersensitive result from a thermal stimuli test charted?

A

++

66
Q

What are the problems with sensibility tests?

A

They are highly variable

67
Q

What do sensibility tests depend on?

A
  1. Restorations present
  2. Patients pain threshold
  3. Degree of pulp chamber necrosis
68
Q

What type of tooth might provide conflicting results from a sensibility test?

A

Multi-rooted teeth as their may be necrosis of part of the pulp whilst the remainder maybe inflamed but the nth still maintains its vitality

69
Q

IF a patient complains of pain on biting what can you do?

A

Gently tap the teeth to identify the cause

70
Q

What does tenderness on percussion indicate?

A

Indicates periradicular inflammation

71
Q

What can periradicular inflammation be due to?

A
  1. Abscess
  2. Occulusal trauma
  3. Root fracture
72
Q

What symptoms will a tooth that receives excessive occlusal trauma display?

A
  1. Tender to bite

2. Sensitive to hot/cold

73
Q

What are some signs of occlusal trauma?

A
  1. Tooth TTP/ mobility
  2. Wear facets (shiny spots of amalgam
  3. Heavy contacts identified with articulating paper
74
Q

What do you need to look out for when taking radiographs?

A
  1. Caries
  2. Periodontal support
  3. Bony defects
  4. Periapical pathology
75
Q

Give examples of piratical pathology

A
  1. PDL widening
  2. Loss of lamina dura
  3. Periapical radiolucency

2ND YR- CSA- Treatment planning (5 decks)

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