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ENDO > Seminar 1: Diagnosis > Flashcards

Seminar 1: Diagnosis Flashcards

1
Q

What is diagnosis?

A

Identification of a disease from its signs and symptoms

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2
Q

What are the sources of pain from a tooth?

A

Dentinal
Pulpal
Periradicular
Non odontogenic

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3
Q

What are the sources of dental inflammation ?

A

Pulpal
Periapical
Periodontal

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4
Q

What is the mobility classification known as?

A

Millers

Class 1/2/3

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5
Q

What direction of movement is there in a Millers class 3 case?

A

Movement in occlusal apical direction

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6
Q

What are the nerve fibres within the pulp

A

A beta
A delta
C Fibres

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7
Q

Where are A beta fibres located within the tooth?

A

Pulp AND PDL

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8
Q

Where are C fibres located?

A

Centrally located

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9
Q

Where are A delta fibres located?

A

Peripherally in the pulp

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10
Q

What type of pulp fibres are unmyelinated?

A

C Fibres

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11
Q

Between A delta and C fibres which respond to hyper-osmotic stimuli e.g sweet

A

A delta

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12
Q

Between A delta and C fibre which respond in hypoxic environments

A

C fibres

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13
Q

Which fibres respond to increase in pressure?

A

A beta and C

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14
Q

Which fibres respond to increases in inflammatory mediators?

A

C fibres

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15
Q

Why does inflamed pulpal tissue respond less readily to LA?

A

Neurogenic inflammation

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16
Q

What is Neurogenic inflammation?

A

-inflammation arising from the local release by afferent neurons of inflammatory mediators such as Substance P

-release of these pro-inflammatory mediators is triggered by the activation of ion channels that are the principal detectors of noxious environmental stimuli

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17
Q

What are the three names for dentine hypersensitivity theories?

A

Hydrodynamic theory
Direct innervation
Odontoblast receptor

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18
Q

What is the pathophysiology behind the hydrodynamic theory?

A

Movement of dentinal fluid within the dentinal tubules stimulates A delta fibres via a method of mechano transduction.

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19
Q

In which direction of fluid movement is there more pain?

A

Outward

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20
Q

What is the pathophysiology behind the odontoblast receptor theory?

A

Odontoblast process acts as a sensory nerve and transmits pain

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21
Q

Why was the odontoblast receptor theory rejected?

A

The odontoblast receptor is not capable of producing neural impulses

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22
Q

What is the pathophysiology behind Direct innervation?

A

Nerve endings penetrate dentine and extend to EDJ allowing them to be directly stimulated - THIS IS NOT TRUE

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23
Q

features of non odontogenic pain include?

A 
No obvious cause
LA does not affect pain
Can cross midline
Difficult to reproduce
Often lasts for long periods of time++
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24
Q

Where are the spaces in the maxilla infection can spread?

A

Buccal space
Canine Space
Infratemporal -> orbit

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25
Q

Where are the spaces in the mandible infection can spread?

A 
Sublingual
Submental
Submandibular
Parotid
Parapharangeal spaces 
Carotid sheath
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26
Q

What is Perisistent Dentoalveolar Pain?

A

Malacarne et al 2017

  • PDAP is when there is pain from a tooth or prev tooth site in the absence of clinical and radiographic signs
  • Diagnosis of exclusion
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27
Q

Risk factors increasing risk of PDAP?

A 
Pain lastig 3 months
Pre op tooth pain
TTP
Hx of painful treatment in head and neck 
female
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28
Q

What are the possible reasons for false positives ?

A

Anxious patient
Liquefaction necrosis
Contact with metal restorations or adjacent teeth
Tooth only partially necrotic

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29
Q

What are the causes of false negative ?

A 
Patel and Ford 2004
Incomplete root development
Recent trauma 
Sclerosed canals
Recent ortho activation
Psychotic patients
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30
Q

What does sensitivity mean in terms of pulp tests ?

A

Probability result will be positive when the disease is present

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31
Q

What does specificity mean in terms of pulp tests ?

A

Probability test is negative and disease is absent

32
Q

What is predicative value ?

A

Ability of the test to foretell what the diagnosis is

33
Q

What methods exist for carrying out assessment on teeth?

A 
Light
Thermal 
Electrical 
Pressure
LA
test cavity
Crown surface Temp
34
Q

In which circumstances is using light as part of the assessment stage helpful?

A

Cracked teerh

35
Q

If the patient is feeling sensation in the PDL on biting/use of tooth sleuth, what may thus indicate ?

A

Non vital Cracked tooth

36
Q

Are pulp tests more accurate in vital or necrotic cases?

A

Necrotic

37
Q

When using pulp tests what are you trying to assess?

A

Assessment of nerve response via thermal and EPT

Assessment of vascularity via Laser Doppler

38
Q

Pulp testing carried out chairside aims to do what?

A

Uses neural response as an indirect way of assessing blood supply

39
Q

A positive pulp tests indicated the pulp is free of inflammation? T/F

A

False

40
Q

What is the mechanism behind the EPT?

A

Delivers a gradual increase in electrical current which causes ionic movement stimulating nerve response

41
Q

The use of hot water creates more outward or inward movement of dentinal fluid?

A

Inward

42
Q

Why does cold testing create a more severe response than hot tests ?

A

Cold tests created outward fluid movement which elicits more pain and than in ward movement

43
Q

What is the limitation of using heat as a pulp test?

A

Left for excessive time can cause pulpal damage

44
Q

What type of neuronal response happens with heat application ?

A

With heat you can get a biphasic response from A delta then C fibres

45
Q

What temp is ethyl chloride ?

A

-41 degrees celcius

46
Q

According to Patel and Ford 2014 if there is NO responses with EPT in what percentage of cases does this indicate necrosis ?

A

70%

47
Q

What are the requirements when using EPT?

A

Tooth must be dry
Separate teeth with Mylar strip
Test the point of tooth nearest pulp horn which is highest density of nerves
Test lingual and buccal separately

48
Q

How does crown surface temp work with pulp testing?

A

Teeth with intact blood supply have higher surface temp than non vital

49
Q

What do you use to assess crown surface temp?

A

Cholesteric Crystals and thermal imaging

50
Q

What pulp testing method according to Patel and Ford 2004 is good for traumatised teeth?

A

Pulse oximetry - use two diodes to calculate percentage of oxygenated vs deoxy blood

51
Q

What are radiographs ?

A

Ionising radiation that is able to detect changes in atomic weight of tissues

52
Q

What is the fastest speed film?

A

F speed

53
Q

What are the types of digital detectors ?

A

Charged couple device (CCD)

Complimentary Metal Oxide semi conductors (CMOS)

54
Q

Between conventional and digital radiographs which have better spatial resolution?

A

Conventional

55
Q

Between conventional and digital which are more sensitive at detecting lesions affecting lamina dura and cancellous bone?

A

Digital

56
Q

Lesions in cortical bone are easier to detect than those in cancellous bone. T/F

A

True. No matter if conventional or digital films

57
Q

What three methods are there for taking intra oral periapicals ?

A

Paralleling
Bisecting angle
Parallax

58
Q

What angle is the X-ray beam directed to the tooth in parallel radiographs ?

A

90 degrees

59
Q

What is the advantage of paralleling technique for X-rays?

A

Less distortion

Easier to compare since uses beam aiming device

60
Q

What is the disadvantage of paralleling ?

A

Difficult for patients with shallow palate / gag reflex and rubber dam

61
Q

How do you take a bisected angle X-ray?

A

Angle between film and tooth is visualised and bisected and beam placed

62
Q

What is the risk of bisecting angle?

A

Distortion

63
Q

In what cases May you consider bisected angle X-ray?

A

Shallow palate

Small mouths

64
Q

What are the limitations of radiographs ?

A

If lesion only in cancellous bone can be difficult to see
Radiation dose
Super imposition of structures

65
Q

What are the benefits of CBCT?

A

38% more lesions picked up

66
Q

How does CBCT work?

A

Cone shaped pulse X-ray projects into an X-ray in three planes

67
Q

Why are CBCTs better posteriorly than anteriorly?

A

Because the bone is thinner posteriorly and easier to eliminate noise

68
Q

What are the disadvantages of CBCT

A

Cost
Higher radiation dose
Need spec training
Less readily available

69
Q

Why are teeth TTP?

A

Occurs only in partial or total necrosis and associated with localised tissue oedema

70
Q

What is apical periodontitis

A

Inflammation of periodontium at the portals of entry of the root canal system

71
Q

What is the pathophysiology behind the lesion forming in chronic apical periodontitis?

A

Bone Tissue adjacent to infection becomes replaced by inflammatory cell infiltrate - bone resorbed over root since bone is less resistant to resorption than root

72
Q

What is the lamina dura?

A

This encases the teeth in cortical bone and is an extension of the jaw bone

73
Q

What are the causes of changes in appearance of the lamina dura?

A 
Infection 
X-ray tube angulation 
Occlusal stress
Systemic disorders eg pagets or parathyroid disease 
Overlying anatomy 
Nutrient canals
74
Q

With regards to traumatised teeth what are the potential fates of the pulp ?

A

Re vascularisation and Reinnervation
Aseptic pulp necrosis
Infected chronic AP

75
Q

When comparing radiographs and CBCT which is more reliable in detecting RCT success?

A

CBCT- identified up to 14 x more failures

Patel et Al 2019

76
Q

In trauma cases what radiographs are ideal?

A

Two PAs and occlusal view

77
Q

Give three features pathognomic of a vertical root fracture

A

Single isolated pocket
Coronally located gingival fistula
Lateral radiolucency on X-ray

ENDO (22 decks)

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