pulpal diagnosis Flashcards
A. What are the pulpal diagnoses?
The pulpal diagnoses are (American Association of Endodontists (AAE) Consensus Conference Recommended Diagnostic Terminology 2009; Glickman & Schweitzer 2013):
• Normal Pulp:The pulp is vital, has no symptoms and responds normally to pulp testing.
• Reversible Pulpitis:The pulp is vital and has short discomfort/pain with a stimulus such as cold or sweet.
• Symptomatic Irreversible Pulpitis:The pulp is vital and has spontaneous or lingering or referred pain.
• Asymptomatic Irreversible Pulpitis:The pulp is vital and has no symptoms. Pulp exposure may result from trauma, cavity preparation or deep caries.
• Pulp Necrosis:The pulp has no response to pulp testing and is asymptomatic.
• Previously Treated: The root canals are filled with root canal filling materials.
• Previously Initiated Therapy: The tooth has been previously treated by partial endodontic therapy.
B. What are the apical diagnoses?
The apical diagnoses are (AAE Consensus Conference Recommended Diagnostic Terminology 2009; Glickman & Schweitzer 2013):
• Normal Apical Tissues: The tooth has no sensitivity
to percussion or palpation. Radiograph shows
apical normal.
• Symptomatic Apical Periodontitis: The tooth has
pain to percussion and/or palpation. Radiograph
shows apical normal or radiolucency.
• Asymptomatic Apical Periodontitis: The tooth has
no pain to percussion or palpation. Radiograph
shows apical radiolucency due to pulp necrosis.
• Chronic Apical Abscess: The tooth has sinus tract.
Radiograph shows apical radiolucency due to pulp
necrosis.
• Acute Apical Abscess: The tooth has spontaneous
pain, swelling, pus formation and apical radiolucency due to pulp necrosis.
• Condensing Osteitis: Radiograph shows radio- paque lesion.
C. What are the common etiologic factors of endodontic pathosis?
Generally there are etiologic factors in the tooth associated with pulpal and apical pathosis such as caries, crown, restorative filling, cracks, fractures, attrition, abrasion, trauma or developmental abnormalities. If no etiologic factors can be found, it is unlikely the symptoms and/or apical radiolucency are originating from the tooth.
D. What are the common pulp and apical tests?
he common pulpal tests are electric and thermal pulp testing (Peters, Baumgartner & Lorton 1994; Abbott &Yu 2007).They are used to determine whether the pulp is vital or necrotic.The tooth must be isolated and dried.The electric pulp test probe must contact natural tooth structure. Endo Ice® (1,1,1,2-tetrafluoroethane) is the most-used cold test. The carbon dioxide cone is often used on a tooth with crown or open apex. A heat test is usually reserved for patients complaining of pain with heat. All pulpal tests must have control teeth. Electric and thermal pulp testing are often used at the same time to reduce the possibility of false positive and false negative responses.The common apical tests are percussion and palpation (Abbott &Yu 2007). Either neighboring or contralateral teeth are used as controls. Sinus tract, swelling and periodontal pocket should also be examined for apical diagnosis.
E. What are the radiographic characteristics of endodontic lesions?
Apical lesion due to pulp necrosis has the follow- ing characteristics: loss of lamina dura, a hanging drop appearance, and maintenance of the same position on a shifted radiograph. Generally, an etiological factor may be seen on the radiograph. The use of cone beam computed tomography (CBCT) in endodontic treatment should follow the recommendations in the joint position statement of the AAE and the American Academy of Oral and Maxillofacial Radiology (AAOMR) (AAE and AAOMR Joint Position Statement 2015).
