Pulpal Diagnosis

Question 1

What does SOCRATES stand for?

Answer 1

Site - location of pain
Onset - when did pain begin
Character - how would you describe pain
Radiation - is the pain spreading elsewhere
Associated features - is there anything else
Time - has pain changed over time in severity of character
Exacerbating/alleviating factors - what makes pain better/worse
Severity - how severe on a scale of 1-10

Question 2

What are the cardinal features of inflammation?

Answer 2

• rubor: redness
• calor: heat
• dolor: pain
• tumor: swelling
• functio laesa: loss of function

Question 3

What symptoms present with dentine sensitivity?

Answer 3

• pain occurs with thermal, chemical, tactile or osmotic stimuli and is associated with exposed dentine
• an exaggerated response of normal pulpo-dentinal complex
• severe and sharp but does not linger on removal of stimulus

Question 4

What are symptoms, causes and treatment of reversible pulpitis?

Answer 4

• pain, short and sharp, not spontaneous
• stimuli: thermal, sweet
• lasts no longer than 5-10 seconds
• no radiographic changes other than caries
  Causes: caries into dentine, fractures, restorative procedures, trauma
  Treatment: conservative pulp therapy with removal of the cause and pathway of irritation, review after 3 months?

Question 5

What are the symptoms of irreversible pulpitis?

Answer 5

• excruciating pain
• momentarily relieved by cold
• pulp allodynia (painful response to a normally innocuous stimulus)
• hyperalgesia (increased exaggerated response to painful stimulus)
• tooth often TTP
• reacts violently to heat

Question 6

What are some factors of irreversible pulpitis? How is it treated?

Answer 6

• spontaneous pain
• exaggerated response to hot/cold stimulus that lingers for minutes-hours
• sensibility tests responsive
• difficult to diagnose, upper and lower arch can be confused for pain
• no PA changes radiographically
  Treatment: RCT or Extraction

Question 7

What is odontopaste?
Ledermix?

Answer 7

Odontopaste
Antibiotic: clindamycin hydrochloride
Anti-inflammatory: triamcinolone
Ledermix
Antibiotic: demeclocycline hydrochloride
Anti-inflammatory: triamcinolone

Question 8

What is pulp canal calcification?

Answer 8

• occurs in response to trauma, results in tertiary dentine formation
• painless unless necrosis with bacterial infection
• RCT not necessary unless clinical signs of pulpal necrosis

Question 9

What is symptomatic periapical periodontitis?

Answer 9

• inflammation of periapical tissues caused by bacteria and toxins in root canal space exiting root canal system
• pulp irreversibly inflamed, necrotic
• pain on biting/chewing, TTP
• PDL may be normal, widened or distinct radiolucency
  Treatment: RCT or XLA

Question 10

What is a periodontal abscess?

Answer 10

• rapid onset, spontaneous pain
• TTP
• pus formation
• swelling
• deep periodontal pocket
• sensibility testing normal response