Pulpal and Apical Diagnosis

Question 1

Each tooth needs how many diagnoses? What are they?

Answer 1

2
- pulpal
- periradicular

Question 2

If patient’s pain is purely pulpal, can they localize it? Why?

Answer 2

probably not, because diffuse pain = pulpal

Question 3

Clinical testing is performed (based on the CC). What are types of tests and what they test for?

Answer 3

• 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)

Question 4

What type and how many radiographs are obtained from the suspect area(s)?

Answer 4

three
- straight on PA
- PA shift shot (20 degree change in horizontal angulation either M or D)
- bitewing (to determine restorability and bone level)

Question 5

3 basic conditions of the pulp

Answer 5

1. normal (should remain normal and healthy)
2. inflamed (could recover or deteriorate)
   a. reversible (no Tx or symptomatic Tx&raquo_space; recovery)
   b. irreversible (pain LINGERING and often spontaneous)
3. infected (will proceed to necrosis)

Question 6

5 pulpal diagnoses with accronyms

Answer 6

“normal” pulp > WNL
reversible pulpitis > RP
symptomatic irreversible pulpitis > SIP
asymptomatic irreversible pulpitis > AIP
necrotic pulp > N

Question 7

Is an endo treated tooth ever the cause of pain?

Answer 7

NO

Question 8

3 outcomes of RP tooth

Answer 8

1. if properly treated > may revert to normal
2. may remain RP symptomatic for extended period
3. may deteriorate to SIP or AIP (even if properly treated)

Question 9

_____ sensitivity usually indicates a deteriorating pulp = SIP.

Answer 9

HOT

Question 10

NP clinical testing?

Answer 10

no response to cold, hot, or EPT

Question 11

Basic characteristics of pulpal diagnosis: WNL

Answer 11

pulp is symptom free with normal response to pulp tests

Question 12

Basic characteristics of pulpal diagnosis: RP

Answer 12

inflammation of the pulp based on subjective and objective findings that should revolve and return the pulp to normal

Question 13

Basic characteristics of pulpal diagnosis: SIP

Answer 13

vital inflamed pulp that is incapable of healing… LINGERING pain to cold (early), sensitivity to hot (late), spontaneous pain

Question 14

Basic characteristics of pulpal diagnosis: AIP

Answer 14

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)

Question 15

Basic characteristics of pulpal diagnosis: NP

Answer 15

death of the dental pulp… no response to clinical pulp tests

Question 16

Basic characteristics of pulpal diagnosis: PT

Answer 16

previously treated… canals obturated with final root canal fillings other than medicaments

Question 17

Basic characteristics of pulpal diagnosis: PIT

Answer 17

previously initiated treatment… partial endodontic therapy, RCT NOT COMPLETED (pulp cap, pulpotomy/pulpectomy)

Question 18

Rarely do we see apical radiographic changes in cases of pure pulpitis (or even early necrotic pulp). Why is this?

Answer 18

advanced pulpal disease or necrosis of the pulp is generally required to allow infection to affect the apical tissues

Question 19

A visible PARL is only visible when what has been destroyed?

Answer 19

100% of medullary bone and 40% of cortical bone

Question 20

What clinical test are ALL periradicular inflammation sensitive to?

Answer 20

percussion; this is important because purely pulpal pain is not

Question 21

Basic characteristics of periapical diagnosis: WNL

Answer 21

teeth no sensitive to percussion or palpation… lamina dura is intact and the PDL is uniform and unbroken

Question 22

Basic characteristics of periapical diagnosis: SAP

Answer 22

• symptomatic apical periodontitis
• inflammation of the periodontium producing a painful response to biting/percussion/maybe palpation
• ***patient has PAIN

Question 23

Basic characteristics of periapical diagnosis: AAP

Answer 23

• asymptomatic apical periodontitis
• inflammation and destruction of the periodontium that is of pulpal origin appearing as a radiolucent area with no clinical symptoms

Question 24

Basic characteristics of periapical diagnosis: AAA

Answer 24

• acute apical abscess
• inflammatory reaction to pulpal infection with rapid onset, spontaneous pain, tooth tender to pressure, pus formation, and SWELLING & FEVER

Question 25

Basic characteristics of periapical diagnosis: CAA

Answer 25

inflammatory reaction to pulpal infection with gradual onset, little or no discomfort, and DST (draining sinus tract)

Question 26

Basic characteristics of periapical diagnosis: CO

Answer 26

• condensing osteitis
• diffuse radiopaque lesion representing a localized boney reaction to a low grade inflammatory stimulus

Question 27

What longitudinal tooth fracture is confined to enamel, generally asymptomatic, and not a concern for endo?

Answer 27

craze lines, only concern that could arise is esthetic

Question 28

The most common site of cracked tooth is? Followed by?

Answer 28

1. mandibular second molar
2. maxillary premolars

Question 29

Common patient complaint when they have a cracked tooth?

Answer 29

acute, sharp, momentary pain upon biting or **release of biting pressure
(an old crack might be stained)