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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
What is pulp canal calcification?
* 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
What is pulp Stones?
* 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
What is Internal Root Resorption?
* 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
What is Pulp Necrosis?
* 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
What is Pulpal necrosis symptoms and treatment?
Symptoms * usually asymptomatic unless inflammation has progressed to periapical tissues * no response to sensibility testing Treatment * root canal treatment * extraction
30
What are the causes periapical peridpotitis?
Inflammation of periradicular/periapical tissues caused by bacteria and their toxins in root canal space exiting the root canal system.
31
What is the pulpal status and Signs & symptoms of Symptomatic periapical periodontitis?
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
What will you see radiographically in Symptomatic periapical periodontitis?
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
What causes Acute periapical abcess and what are the Signs & Symptoms?
_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
What is the treatment of acute periapical abscess?
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
What is Asymptomatic Periapical periodontitis Clinically and Radiographically?
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
What is Chronic Periapical Abscess clinically and radiographically?
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
What causes Condensing osteitis?
* 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
What is Condensing osteitis Radiographic appearance and treatment?
_Radiographic_ Appears as a periapical radiopacity _Treatment_ If asymptomatic treat the cause Root canal treatment if inflamed or necrotic
39
What are the symptoms of Periodontal Abscess?
* Rapid onset * Spontaneous pain * TTP * Pus formation * Swelling * Deep periodontal pocket * Sensibility testing normal response
40
What must you do in the clinical exam?
Facial asymmetry, sinus tract, soft tissue, periodontal status (probing and mobility, caries, restorations ( depth, defective, newly placed?)
41
What can you do for clinical testing?
**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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