Pulpal and periapical diagnosis Flashcards
what pulpal diagnosis is suitable for endodontic tx
irreversible pulpitis
pulpal necrosis
what periapical diagnosis is suitable for endodontic tx
periapical disease
types of endodontic tx
stepwise
indirect pulp capping
direct pulp capping
pulpotomy
6 pulpal diagnosis
clinically normal
reversible pulpitis
irreversible pulpitis
pulpal necrosis
previously initiated tx
previously tx
reversible pulpitis symptoms
short sharp pain - not spontaneous
reacts to cold, sweet, sometimes hot
no radiographic changes apically
causes of RP
caries into dentine
fractures
restorative procedures
trauma
RP tx
conservative pulp therapy in conjunction with removal of the cause and pathway of irritation
symptoms of symptomatic IP
sharp pain on thermal stimulus with lingers for 30 seconds
spontaneous pain when unprovoked
excruciating pain with may be relieved by cold
referred pain
accentuated by postural changes
symptoms of asymptomatic IP
no clinical symptoms
usually respond normally to sensitivity testing
may have had trauma or deep caries
treatment for IP
RCT/ pulpotomy
xLA
Breakdown of pulpal tissue allowing bacteria to colonise the root canal system
pulpal necrosis
pulpal necrosis symptoms
usually none unless inflammation has progressed to periapical tissues
no response to sensibility testing
what has been done to canals if ‘previously treated therapy’
located, cleaned and shaped
access cavity dressing
5 periapical diagnosis
normal
symptomatic periapical periodontitis
asymptomatic periapical periodontitis
acute periapical abscess
chronic periapical abscess
pulpal status of symptomatic periapical periodontitis
irreversibly inflamed or necrotic
causes of transient periodontitis
chemicals used in RCT
occlusal trauma
RCT over-instrumentation
symptoms of periapical periodontitis
discomfort when biting/ chewing
TTP
palpation may or may not be sensitive
acute periapical abscess cause
bacteria have progressed to the periapical tissues and pt immune system cant defend them
symptoms of acute periapical abscess
rapid onset
pain - tender to tooth
pus
mobile tooth
systemic involvement
swelling
acute periapical abscess radiographic presentation
PDL may be normal
PDL may be slightly widened
may be a distinct radiolucency if acute flare up of chronic lesion
what is a phoenix abscess
acute flare up of a chronic lesion
acute apical abscess tx
emergency - drainage
RCT or xLA
types of drainage for acute apical abscess
through an incision - if swelling is localised and fluctuant
through root canal
Asymptomatic periapical periodontitis cause
bacterial products from a necrotic or pulpless tooth ingress the periapical tissues
asymptomatic periapical periodontitis symptoms
non sensitive response to percussion and palpation
radiolucency around the apex
chronic periapical abscess presentation
gradual onset
little or no discomfort
intermittent discharge through an associated sinus tract
chronic periapical abscess symptoms
non sensitive response to percussion and palpation
non responsive sensibility tests
sinus tract on buccal/ labial sulcus
radiolucency on bone
dentine hypersensitivity symptoms
exaggerated sharp, transient pain
dentine hypersensitivity causes
gingival recession
tooth surface loss
how do you differentiate dentine hypersensitivity and RP
if there is caries, fractures, recent restorations - RP
focal sclerosing osteomyelitis presentation
increased radiodensity and opacity around one or more roots
focal sclerosing osteomyelitis tx
RCT
cracked teeth symptoms
sharp shooting pain on biting
worse on release of pressure
sensitive to thermal changes, sweet and acidic food
difficult to localise
5 types of cracks
craze lines
fractured cusp
cracked tooth
split tooth
vertical root fracture
craze lines presentation
only enamel
cross marginal ridges and buccal, lingual surfaces
how do you diagnose craze lines
transillumination
fractured cusp presentation
complete/ incomplete fracture initiated from crown
cracked tooth presentation
incomplete fracture initiated in crown and extending subgingivally, usually M-D
split tooth presentation
complete fracture from crown to subgingival
central location occlusally
vertical root fracture presentation
complete or incomplete fracture initiated from root
what is the most common cause of vertical root fracture
RCT
symptoms of periodontal abscess
rapid onset
spontaneous pain
TTP
pus
swelling
deep perio pocket
