Pulpal Diagnosis Flashcards
Describe reversible pulpitis.
- localised sharp pain, lasting a few seconds
- painful stimuli include hot/cold/sweet
- no change to pulpal blood flow
- responds to sensibility testing
How do you treat reversible pulpitis?
- caused by caries progressing towards the pulp
- treat caries with a filling, pulp should return to normal state
Describe symptomatic irreversible pulpitis.
- spontaneous dull pain
- disturbance to sleep
- increased blood flow
- cold drinks can alleviate the pain
What are some questions that you can ask the patient to help with a differential diagnosis for reversible or irreversible pulpitis?
Pain at night = irreversible
Painkillers help = reversible
Cold drinks help = irreversible
Describe asymptomatic pulpitis.
- pulp necrosis
- often have a history of pulpotic symptoms
- can progress to apical periodontitis
Describe acute apical periodontitis.
- localised pain to biting (inflamed PDLs)
- bone resorption (can be seen as a radiolucency on a radiograph)
- often presents with the symptoms of irreversible pulpitis
Describe chronic apical periodontitis.
- visible on a radiograph as a much larger radiolucency
- asymptomatic but can progress to become symptomatic again
Describe an acute apical abscess.
- infection has passed through the apex
- puss filled swelling, lots of pressure
- severe spontaneous pain
- extreme tenderness to touch
Describe a chronic apical abscess.
- infection has passed through the apex
- the swelling has developed a sinus tract which relieves the pressure, and therefore the pain
How do you diagnose which tooth is causing the apical abscess?
- put a GP point into the sinus tract
- take a radiograph
When is RCT indicated?
- infection and inflammation of the pulp
What is pulpal necrosis?
- non vital, partial or total necrosis
What is the hydrodynamic mechanism?
- activates intradental sensory fibres
- increased dentinal fluid flow see the intradental nerves being activated
- action potential is generated
- brain receives this AP as pain
