Pulpal Diagnoses

Question 1

normal pulp

Answer 1

symptom free
normally responsive to pulp testing

Question 2

reversible pulpitis

Answer 2

pain on stimulus e.g. cold / sweet
lasts a few seconds
typical aetiologies = exposed dentine/caries/deep restorations
pain not spontaneous
no radiographic changes to periapical region
should return to normal post management of aetiology

Question 3

symptomatic irreversible pulpitis

Answer 3

sharp pain on thermal stimulus
lingering pain (>30 secs post stimulus removal)
spontaneous & referred pain
aetiology = deep caries, extensive restorations, # with pulp exposure
pain can be increased with postural changes
difficult to diagnose as inflammation has not reached periapical tissues so not TTP

Question 4

asymptomatic irreversible pulpitis

Answer 4

pulp incapable of healing
RCT indicated
no clinical symptoms
usually respond to normal thermal testing
may have had trauma/deep caries that would likely result in exposure following removal

Question 5

pulp necrosis

Answer 5

death of dental pulp
non responsive to pulp testing
asymptomatic
pulp necrosis itself does not cause apical periodontitis unless canal is infected

Question 6

why test contralateral teeth

Answer 6

some teeth may be unresponsive due to calcification, recent history of trauma or simply does not respond on any teeth so all testing must be of a comparative nature

Question 7

previously treated

Answer 7

endodontically treated tooth that has been obturated with various filling materials / medicaments
typically does not respond to thermal or EP testing

Question 8

previously initiated therapy

Answer 8

tooth previously treated by partial endo therapy e.g. pulpotomy / pulpectomy
depending on level of therapy tooth may or may not respond to testing

Question 9

normal apical tissues

Answer 9

not sensitive to percussion or palpation testing
radiographically, lamina dura intact & periodontal ligament space is uniform

Question 10

symptomatic apical periodontitis

Answer 10

pain on biting and/or percussion or palpation
may or may not have radiographic changes also

Question 11

asymptomatic apical periodontitis

Answer 11

inflammation & destruction of apical periodontium of pulpal origin
appears as apical radiolucency
no clinical symptoms i.e. no TTP

Question 12

chronic apical abscess

Answer 12

inflammatory reaction to pulpal infection & necrosis characterised by gradual onset, little to no discomfort & intermittent discharge of pus through associated sinus tract
typically signs of osseous destruction on radiograph

Question 13

acute apical abscess

Answer 13

inflammatory reaction to pulpal infection & necrosis characterised by rapid onset, spontaneous pain, extreme TTP, pus formation, swelling of associated tissues
may be no radiographic signs & ptx often suffers malaise, fever, lymphadenopathy

Question 14

condensing osteitis

Answer 14

diffuse radiopaque lesion representing localised bone reaction to low grade inflammatory stimulus usually seen at apex of tooth