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M3 Restorative > Pulpal Diagnosis > Flashcards

Pulpal Diagnosis Flashcards

1
Q

What are the 4 possible pulpal diagnosis?

A
  • Reversible Pulpitis
  • Irreversible Pulpitis
  • Periapical Periodontitis
  • Dental Absces
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2
Q

What is inflammation and what can be a describing word for it?

A

A response of living tissue to injury.

Described by the suffix ‘-itis’ (inflammation of… )

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3
Q

What is Acute Inflammation?

A

Initial tissue reaction to a wide range of injurious agents:

  • Physical
  • Chemical
  • Microbiological
  • Immunological

Lasts for hours / few days.

Predominant cell : ➢ Neutrophil

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4
Q

What are the 5 cardinal signs of inflammation?

A
  • Redness
  • Heat
  • Pain
  • Swelling
  • Loss of function
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5
Q

What is Chronic Inflammation?

A

Duration is longer lasting - days, weeks months or years. Predominant cells:

  • lymphocytes
  • plasma cells
  • macrophages
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6
Q

What is the function of What Acute Inflammatory Response?

A

A defence mechanism

  • provides an exudate which brings proteins, fluids and cells to an area of damage
  • destroys and/or eliminates the injurious agent
  • breaks down the damaged tissue and removes the debris.
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7
Q

What are the 4 possible outcomes (sequelae) of acute inflammation?

A

Possible outcomes:

  1. Resolution
  2. Suppuration
  3. Organisation
  4. Chronic inflammation.
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8
Q

What is suppuration?

A

Formation of pus.

Causative agent must be fairly persistent and is virtually always infective pyogenic bacteria Staph Aureus, Strep pyogenes, Neisseria, coliform organisms.

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9
Q

What is an abscess?

A
  • A localised collection of pus (suppurative inflammation)
  • Can appear in an acute or chronic infection
  • Is associated with tissue destruction and swelling
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10
Q

How does a Abscess disappear?

A
  • Points
  • Bursts
  • Abscess cavity collapses
  • Obliterated by ‘organisation’ and fibrosis
  • Scar formation
  • Deep seated abscesses sometimes discharge their pus along a sinus tract, lined by granulation tissue (a fibrous connective tissue found in healing wounds) which leaves an abnormal passage – a sinus tract.
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11
Q

What is Organisation?

A

This is the replacement of tissue by granulation tissue.

  • Large amounts of fibrin are formed.
  • Can become necrotic.
  • Exudate / debris cannot be removed or discharged
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12
Q

How does Chronic Inflammation occur?

A
  • If the agent causing acute inflammation is not removed it may progress onto chronic stages
  • Chronic inflammation is *Characterised by continuing inflammation at the same time as attempts at healing*
  • Attempts at reconstruction of damaged tissue happen simultaneously with inflammation
  • Balance of destruction and healing/repair.
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13
Q

What is the clinical effects and sequelae of chronic Inflammation?

A

Mostly related to the healing and repair process.

Following tissue damage or loss from any cause there may be a number of different sequelae:

  • Resolution
  • Regeneration
  • Repair
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14
Q

What is the normal pulp?

A
  • Symptom free
  • Normally responds to sensibility testing
  • Mild response that subsides immediately when stimulus is removed
  • Histologically - no inflammatory change
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15
Q

What dentine sensitivity?

A

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

When there is a specific factor (caries, fractures, recent restorations etc.) the symptoms may be identical however the diagnosis is REVERSIBLE PULPITIS

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16
Q

What is reversible pulpitis?

A

Symptoms:

  • Pain short and sharp, not spontaneous
  • Stimuli – thermal, sweet – short, sharp pain
  • Lasts no longer than 5-10secs
  • No radiographic changes, other than caries

Causes:

  • Caries into dentine, fractures, restorative procedures, trauma
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17
Q

What is Reversible Pulpitis Treatment?

A

Treatment

Conservative pulp therapy in conjunction with removal of the cause and pathway of irritation

Consider the diagnosis as provisional:

Review status of the pulp, after 3 months:

  • Symptom free, no signs of pulpal and periradicular disease and respond normally to pulp sensibility testing
18
Q

What is Irreversible Pulpitis?

A

Occurs if inflammatory process continues

Spontaneous pain

Exaggerated response to hot/cold that lingers after stimulus is removed (minutes – hours)

Sensibility tests responsive

19
Q

Why is irreversible pulpitis difficult to diagnose?

A

May confuse maxillary and mandibular arches in early stages

Tooth will not be tender to pressure/percussion until the periapical tissues have become involved

No periapical changes radiographically

20
Q

What are symptoms of Irreversible Pulpitis?

A

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

21
Q

What is the treatment for Irreversible Pulpitis?

A
  • Root canal treatment - if the tooth is restorable
  • Exxtraction
22
Q

What is Odontopaste and what can it be used to?

A
  • Antibiotic - clindamycin hydrochloride
  • Anti-inflammatory - triamcinolone (corticosteroid)

Relieves pain until definitive root canal therapy can be carried out

23
Q

What is Ledermix and what is it used for?

A

Antibiotic

  • demeclocycline hydrochloride - to treat infection

Anti-inflammatory

-triamcinolone - to reduce swelling and inflammation

Relieves pain until definitive root canal therapy can be carried out

24
Q

What are some other pulpal conditions?

A
  • Pulp canal calcification
  • Pulp stones
  • Internal resorption
25
Q

What is pulp canal calcification?

A
  • Occurs in response to trauma, irritants - – results in tertiary dentine formation
  • Painless unless necrosis with bacterial infection
  • Causes eventual obliteration of pulp space

RCT not necessary unless clinical signs of pulpal necrosis (pain or radiographic changes)

26
Q

What is pulp Stones?

A
  • Discrete calcifications within the pulp of the tooth
  • May be attached to dentine or free within the pulp
  • Can be found in both the coronal pulp and within the root
  • Can be a frequent finding on radiograph
  • May have multiple pulp stones in a tooth ( 1-12 )
27
Q

What is Internal Root Resorption?

A
  • Inflammatory
  • Occurs at any point within pulp chamber or root canal
  • Activation of dentinoclasts within inflamed pulp tissue that is in contact with necrotic, infected coronal pulp tissue
  • Asymptomatic, pulp will become necrotic
  • CBCT ( cone beam CT) will show if perforation
  • Treatment - RCT depending on extent
28
Q

What is Pulp Necrosis?

A
  • Breakdown of pulpal tissue allowing bacteria to colonise the root canal system
  • Pulp encased in rigid walls
  • No collateral circulation
  • Venules and lymphatics collapse under increased tissue pressure
  • Irreversible pulpitis leads to liquefaction necrosis
  • Traumatic injury causes ischaemic necrosis due to disruption of blood supply
29
Q

What is Pulpal necrosis symptoms and treatment?

A

Symptoms

  • usually asymptomatic unless inflammation has progressed to periapical tissues
  • no response to sensibility testing

Treatment

  • root canal treatment
  • extraction
30
Q

What are the causes periapical peridpotitis?

A

Inflammation of periradicular/periapical tissues caused by bacteria and their toxins in root canal space exiting the root canal system.

31
Q

What is the pulpal status and Signs & symptoms of Symptomatic periapical periodontitis?

A

Pulpal Status:

  • Irreversibly inflamed
  • Necrotic

Signs and symptoms

  • Discomfort to biting or chewing
  • Sensitivity to percussion
  • Palpation may or may not produce a sensitive result
  • Sensibility testing will depend on whether pulp is irreversibly inflamed or necrotic
32
Q

What will you see radiographically in Symptomatic periapical periodontitis?

A

Radiographically

  • the PDL may appear normal with the lamina dura intact; or the PDL can be widened with loss of the lamina dura; or there can be a distinct periapical radiolucency
33
Q

What causes Acute periapical abcess and what are the Signs & Symptoms?

A

Causes

Bacteria have progressed into the periradicular/periapical tissues and the patient’s immune response cannot defend against the invasion

Signs and symptoms

  • Rapid onset
  • PAIN - exquisitely tender tooth
  • Pus formation
  • Increased mobility of tooth and tooth may be in hyper-occlusion
  • Systemic involvement e.g. fever and malaise
  • Swelling I/O and/or E/O
  • Depends on location of apices and muscle attachments
  • Localised or diffuse/ fluctuant or non-fluctuant
34
Q

What is the treatment of acute periapical abscess?

A

Treatment

Drainage - through the root canal - incision and drainage (I&D) of soft tissue if there is a localised fluctuant swelling

RCT or extraction

35
Q

What is Asymptomatic Periapical periodontitis Clinically and Radiographically?

A

Occurs when bacterial products from a necrotic or pulpless tooth slowly infiltrates the periapical /periradicular tissues

Clinically

Mostly asymptomatic

Percussion and palpation tests produce non-sensitive responses

Radiographically

Radiolucency around the apex of the tooth

36
Q

What is Chronic Periapical Abscess clinically and radiographically?

A

An inflammatory reaction to pulpal infection and necrosis characterised by gradual onset, little or no discomfort and intermittent discharge through an associated sinus tract.

Clinically

  • Usually asymptomatic
  • Percussion and palpation tests produce non-sensitive responses
  • Sensibility tests are non-responsive

Radiographically

Radiolucent area on bone

37
Q

What causes Condensing osteitis?

A
  • low-grade, chronic inflammation such as a necrotic pulp, extensive restoration or crack
  • Inflammation causes bone production (rather than bone destruction) = sclerotic reaction
  • Results from good patient immunity and a low grade irritation
38
Q

What is Condensing osteitis Radiographic appearance and treatment?

A

Radiographic

Appears as a periapical radiopacity

Treatment

If asymptomatic treat the cause

Root canal treatment if inflamed or necrotic

39
Q

What are the symptoms of Periodontal Abscess?

A
  • Rapid onset
  • Spontaneous pain
  • TTP
  • Pus formation
  • Swelling
  • Deep periodontal pocket
  • Sensibility testing normal response
40
Q

What must you do in the clinical exam?

A

Facial asymmetry, sinus tract, soft tissue, periodontal status (probing and mobility, caries, restorations ( depth, defective, newly placed?)

41
Q

What can you do for clinical testing?

A

Sensibility testing – cold, electric, heat

Periapical tests – percussion (TTP?) palpation over the apices Tooths slooth (biting)

Radiograpic Analysis

Periapicals

Additional tests

Selective anaesthesia, test cavity

M3 Restorative (14 decks)

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