Pulpal and Apical Diagnosis Flashcards
Each tooth needs how many diagnoses? What are they?
2
- pulpal
- periradicular
If patient’s pain is purely pulpal, can they localize it? Why?
probably not, because diffuse pain = pulpal
Clinical testing is performed (based on the CC). What are types of tests and what they test for?
- thermal: cold, heat (pulp vitality)
- EPT (only if pulpal status is in doubt)
- percussion: tapping with mirror (PDL sensitivity)
- palpation: digital touching of gingiva (inflammation, redness, swelling, tenderness)
- perio probing & mobility (periodontal health)
What type and how many radiographs are obtained from the suspect area(s)?
three
- straight on PA
- PA shift shot (20 degree change in horizontal angulation either M or D)
- bitewing (to determine restorability and bone level)
3 basic conditions of the pulp
- normal (should remain normal and healthy)
- inflamed (could recover or deteriorate)
a. reversible (no Tx or symptomatic Tx»_space; recovery)
b. irreversible (pain LINGERING and often spontaneous) - infected (will proceed to necrosis)
5 pulpal diagnoses with accronyms
“normal” pulp > WNL
reversible pulpitis > RP
symptomatic irreversible pulpitis > SIP
asymptomatic irreversible pulpitis > AIP
necrotic pulp > N
Is an endo treated tooth ever the cause of pain?
NO
3 outcomes of RP tooth
- if properly treated > may revert to normal
- may remain RP symptomatic for extended period
- may deteriorate to SIP or AIP (even if properly treated)
_____ sensitivity usually indicates a deteriorating pulp = SIP.
HOT
NP clinical testing?
no response to cold, hot, or EPT
Basic characteristics of pulpal diagnosis: WNL
pulp is symptom free with normal response to pulp tests
Basic characteristics of pulpal diagnosis: RP
inflammation of the pulp based on subjective and objective findings that should revolve and return the pulp to normal
Basic characteristics of pulpal diagnosis: SIP
vital inflamed pulp that is incapable of healing… LINGERING pain to cold (early), sensitivity to hot (late), spontaneous pain
Basic characteristics of pulpal diagnosis: AIP
vital inflamed pulp incapable of healing… no clinical symptoms
- inflamed due to caries (chronic hyperplastic pulpitis)
- caries excavation (pulp exposure)
- trauma (fracture with exposed pulp tissue)
Basic characteristics of pulpal diagnosis: NP
death of the dental pulp… no response to clinical pulp tests
Basic characteristics of pulpal diagnosis: PT
previously treated… canals obturated with final root canal fillings other than medicaments
Basic characteristics of pulpal diagnosis: PIT
previously initiated treatment… partial endodontic therapy, RCT NOT COMPLETED (pulp cap, pulpotomy/pulpectomy)
Rarely do we see apical radiographic changes in cases of pure pulpitis (or even early necrotic pulp). Why is this?
advanced pulpal disease or necrosis of the pulp is generally required to allow infection to affect the apical tissues
A visible PARL is only visible when what has been destroyed?
100% of medullary bone and 40% of cortical bone
What clinical test are ALL periradicular inflammation sensitive to?
percussion; this is important because purely pulpal pain is not
Basic characteristics of periapical diagnosis: WNL
teeth no sensitive to percussion or palpation… lamina dura is intact and the PDL is uniform and unbroken
Basic characteristics of periapical diagnosis: SAP
- symptomatic apical periodontitis
- inflammation of the periodontium producing a painful response to biting/percussion/maybe palpation
- ***patient has PAIN
Basic characteristics of periapical diagnosis: AAP
- asymptomatic apical periodontitis
- inflammation and destruction of the periodontium that is of pulpal origin appearing as a radiolucent area with no clinical symptoms
Basic characteristics of periapical diagnosis: AAA
- acute apical abscess
- inflammatory reaction to pulpal infection with rapid onset, spontaneous pain, tooth tender to pressure, pus formation, and SWELLING & FEVER
Basic characteristics of periapical diagnosis: CAA
inflammatory reaction to pulpal infection with gradual onset, little or no discomfort, and DST (draining sinus tract)
Basic characteristics of periapical diagnosis: CO
- condensing osteitis
- diffuse radiopaque lesion representing a localized boney reaction to a low grade inflammatory stimulus
What longitudinal tooth fracture is confined to enamel, generally asymptomatic, and not a concern for endo?
craze lines, only concern that could arise is esthetic
The most common site of cracked tooth is? Followed by?
- mandibular second molar
- maxillary premolars
Common patient complaint when they have a cracked tooth?
acute, sharp, momentary pain upon biting or **release of biting pressure
(an old crack might be stained)
