The diseases of the pulp and periodontium Flashcards
What can caries result in
Clinical features of pulp hyperaemia
- sharp pain lasting for seconds
- pain stimulated by hot/cold or sweet foods
- pain resolves after stimulus
- caries approaching pulp but tooth can still be restored without treating pulp (reversible pulpitis)
Clinical features of acute pulpitis
- constant severe pain
- reacts to thermal stimuli
- poorly localised pain
- referral of pain
- no/minimal response to analgesics (can’t get into pulp chamber)
- open sumptoms less severe
would acute pulpitis show as positive or negative to TTP and why
Negative (usually) as PDL is not inflamed
How could you diagnose acute pulpitis
- History - constant severe pain, reacts to thermal stimuli, poorly localised pain, referral of pain, no/minimal response to analgesics
- Visual examination
- negative TTP
- pulp testing equivocal
- radiographs - big cavity maybe but that’s all
- ‘Diagnostic LA’ - numb up and see if pain goes away
- removal of restorations
is pulp hyperaemia reversible or irreversible
reversible
Is acute pulpitis reversible or irreversible
irreversible
What is the diagnosis:
- can pinpoint exactly where pain is
- very TTP
- tooth is non-vital
- slight increase in mobility
- radiographs: loss of clarity of lamina dura, possible radioleucent shadow from old lesion, delay in changes at the apex of the tooth
acute periodontits
What causes traumatic periodontitis
parafunction (tooth clenching or grinding)
in traumatic periodontitis would teeth have vitality?
yes
how would you diagnose traumatic periodontitis
- clinical examination of occlusion (functional positioning, posturing)
- TTP
- normal vitality
- radiographs may show generalised widening of PDL space
how would you treat traumatic periodontitis
- occlusal adjustment
- therapy for parafunction
what is the most common pus producing infection
acute apical abscess
what infections produce pus
- acute apical abscess
- periodontal abscess
- peridoronitis
- sialadenitis (infection of glands)
scientific word for pus
suppuration
what orgainisms are in a dental abscess
- polymicrobial
- anaerobes play a part
unusual infections:
- staphylococcal lymphadenitis of childhood
- cervico-facial actinomycosis
initial symptoms of acute apical abscess
- severe unremitting pain
- acute tenderness in function
- acute tenderness on percussion
before it perforates through bone
what are the differences between acute apical periodontitis and acute apical abscess
get answer
what are the 5 cardinal signs of inflammation
- heat
- redness
- swelling
- pain
- loss of function
what are the symptoms once an acute apical abscess perforates through bone
- pain often remits (unless it’s in the palate) (release of pressure)
- swelling, redness and heat (in the soft tissues) become increasingly apparent
- as swelling increases, pain returns
- there is an initial reduction in TTP of the tooth as pus escapes into the soft tissues
when do 3rd molars erupt into the mouth
18-24yrs
when does crown calcification begin in a 3rd molar
7-10 years old
Upper: 7-9yrs; Lower: 8-10yrs
when is root calcification complete for 3rd molars
18-25yrs
what is it called when an organ (tooth) fails to erupt
agenesis
What does impacted mean
blocked (partial or full)
incidence of impacted lower 3rd molars
36-59%
nerves at risk during 3rd molar surgery
- inferior alveolar nerve
- lingual nerve
- nerve to mylohyoid
- long buccal nerve
anatomy of where the lingual and inferior alveolar nerve lies at 3rd molar
what does the IAN supply and what is it a branch of
- mandibular division of trigeminal nerve
- supplies all mandibular teeth on that side, skin of lower lip and chin on that side
what is the lingual nerve a branch of and what does it supply
- mandibular division of the trigeminal nerve
- supplies anterior 2/3 dorsal and ventral mucosa of tongue
- also gives off a branch which supplies lingual gingiva of mouth
where does the lingual nerve lie
- superior attachment of mylohyoid muscle and mean vertical distance from the crest of the lingual plate is 8.32mm while mean horizontal distance is 3.45mm
what is the location of the lingual nerve
close relationship to the lingual plate in mandibular and retromolar area
What are the NICE guidelines on whether or not to extract wisdom teeth
Discouraged removal unless there is pathology
What are the FDS, RCS 2020 guidelines on whether to extract wisdom teeth
- by not removing we’re just postponing inevitable surgery which can make tx more difficult at the time
- could affect 7
- complicaitons if older pt
more holistic and agreed by pt
Indications for extraction
- infections
- cysts
- tumours
- external resorption of 7 or 8
