special investigations relating pulpal and periodical disease

Question 1

what can mobility indicate

Answer 1

periodontal bone loss

presence of apical bone loss resulting in bone loss

Question 2

checking for mobility

Answer 2

lateral pressure on tooth to see if there is any movement

grade 1-3

Question 3

tooth discoloration types

Answer 3

yellow/cream

black/grey

Question 4

yellow/cream discolouration

Answer 4

• due to depositon of tertiary dentine resulting in thicker dentine tissue and reduced light transmission
• tooth may be vital or non vital
• deposition may be due to trauma, previous caries ect
• had to be vital to lay down the additional dentine, but may have lost vitality after
• fracture line down the tooth, may be due to trauma
• harder to return to normal colour , internal bleaching can take a long time

Question 5

grey/black discoulation

Answer 5

• due to pulpal blood products straining dentine
• tooth will generally be non vital
• should be thinking about root treatment
• generally respond well to internal bleaching to return to a normal colour

Question 6

pulp tests

Answer 6

sensibility testing

vitality testing

Question 7

sensibility testing

Answer 7

• tests the ability to respond to a stimulus
• assessment of the pulps nerve supply
• testing if the nerve can feel a stimulus

cold
hot
electric pulp testing

Question 8

vitality testing

Answer 8

tests if pulp is vital i.e. functioning blood supply
pulse oximetry
laser doppler flowmerty

Question 9

which nerve fibres are in the more central aspect of th epulp

Answer 9

C

respond to more noxious inflammatory/thermal

Question 10

sensibility tests

Answer 10

Cold
-	ethyl chloride
-	ice
-	Frozen CO2
-	Propane/butane spray
Heat
-	heated wax
-	heated gutta percha
-	hot liquid
EPT (electric pulp testing)

Question 11

ethyl chloride results

Answer 11

Theoretically

• only sensation from a tooth can be pain. (sensory nerves are only nociceptors)
• sensation may be mild or severe pain
• intensity of sensation gives an indication of the level of pulpal inflammation
• a positive response is likely to indicate functioning nerve tissue, although false positives are possible
• a negative repsonce is likely to indicate no functioning nerve tissue, false negative is possible eg if there is lots of sclerosis may not reach the nerves

Question 12

general principles of pain

Answer 12

pain can refer from one arch to the other
due to nerve fibres going back to the same trunk
but never crosses midline

Question 13

factors which can affect reliablity of sensibility testing

Answer 13

1) Varying thickness of enamel/dentine
2) restorations, notably crowns -difficult to transmit stimulus through the tooth
3) teeth with open apices
4) patient repose factors eg nervous patient

Question 14

periapical tests

Answer 14

percussion
palpation
tooth sloth

Question 15

percussion

Answer 15

not true vitality tests, indicate presence of inflammation in periodontium
tender to palpation more frequent where there is necrosis
percussion
- tap from vertical/horiontal perspectives
see if tender

Question 16

tooth slouth and result indications

Answer 16

pressure testing on individual cusps

• pain on biting is usually an indication of periapical inflammation
• pain on release of pressure is usually an indication of a crack on the tooth

Question 17

what can a gutta percha be used for

Answer 17

• if a sinus is present inset a gutta percha point into the sinus tract
• the GP point will appear on the radiograph and point to the source of infection
• useful to select the tooth