Pulp & Periapical Disease Flashcards
what is the flow chart for caries when it extends to pulpal tissue?
what are the symptoms of a pulp hyperaemia?
- pain lasting for seconds
- pain stimulated by hot/cold or sweet
- pain resolved after stimulus removed
- caries approaching pulp but tooth can still be restored without treating pulp
what are the symptoms of acute pulpitis?
- constant severe pain
- react to thermal stimuli
- poorly localised pain
- referral of pain
- no/minimal response to analgesics
- open symptoms less severe
how can you diagnose acute pulpitis?
- history
- visual exam
- negative to TTP (not had time to spread to periapical region)
- radiographs
- removal of restorations
how do you diagnose acute periodontitis?
- easy to make
- TTP
- tooth is non-vital (unless traumatic)
- slight increase in mobility
Radiographs:
- loss of clarity of lamina dura
- radiolucent shadow
- widening of apical PDL space
what are the causes of TRAUMATIC periodontitis?
parafunction (clenching/grinding)
what is the most common pus production infection?
acute apical abscess
what organisms are involved in dental abscess’?
- polymicrobial
- anaerobes play an important part (S. aureus, P. gingivalis, prevotella species etc)
what are symptoms of an acute apical abscess?
similar to acute apical periodontitis;
- severe unremitting pain
- acute tenderness in function & permission
BUT
no swelling, redness or heat (YET!)
what are the 5 cardinal signs of inflammation?
- Heat
- Swelling
- Tender
- Redness
- Loss of function
where are some areas/spaces that an acute apical abscess could drain to?
- Submental space
- sublingual space
- submandibular space
- buccal space
- infraorbital space
- palate
what is the treatment for an acute apical abscess?
Provide Drainage:
- soft tissue excision intraorally OR extraorally
- remove source/cause (XLA, extirpation, periradicular surgery)
Antibiotic need determined by:
- severity
- absence of adequate drainage
- patient’s medical condition
what are the LOCAL factors when assessing need for antibiotics in an abscess pt?
- toxicity of swelling
- airway compromisation
- dysphagia
- trismus
- location (floor of mouth)
what are the SYSTEMIC factors when assessing need for antibiotics in an abscess pt?
- immunocompromised pts
- diabetes
- elderly
what is reversible pulpitis?
level of inflammation that tooth can return to normal IF the cause is removed
mild-moderate tooth pain when STIMULATED, no pain without stimulus, no mobility, no TTP
what is irreversible pulpitis?
high level inflammation and pulp damaged beyond point of recovery
sharp, throbbing, severe pain upon stimulation, pain persists after stimulation removed
Tx: RCT/XLA
describe periapical granuloma (chronic apical periodontitis)
mass of chronically inflamed granulation tissue at apex of tooth (plasma cells, lymphocytes etc)
etiology of periapical (radicular) cyst?
- caries, trauma, periodontal disease
- death of pulp
- apical bone inflammation
