The diseases of the pulp and periodontium - watch video Flashcards
pulp hyperaemia - clinical features
pain lasting for seconds
pain stimulated by hot/cold or sweet foods
pain resolves after stimulus removed
caries approaching pulp
- but tooth can still be restored without treating pulp
acute pulpitis - clinical features
constant severe pain
reacts to thermal stimuli
poorly localised pain
referral of pain
no or minimal response to analgesia
diagnosing acute pulpitis - steps
history
visual exam
usually negative tenderness to percussion
radiographs
diagnostic local anaesthetic
removal of restorations
cute periodontitis diagnosis
easy to make
TTP
tooth non vital - unless traumatic
slight increase in mobility
radiographically:
- loss of clarities of Lamina Dura
Radiolucent shadow - may indicate an ‘old;’ lesion such as apical granuloma
delay in changes at the apex of the tooth - widening of PDL space
Traumatic periodontitis - cause and diagnosis
caused by parafunction - tooth grinding or clenching
diagnosis
clinical examination of the occlusion
- functional positioning
- posturing
TTP
Normal vitality
Radiographs may show generalised widening of periodontal space
traumatic periodontitis - treatment
occlusal adjustment
therapy for parafunction
The acute apical abscess is the most common pus producing infection - what are the other possible causes besides tooth decay?
periodontal abscess
pericoronitis
sialadenitis
Organisms responsible for dental abscesses
polymicrobial
anaerobes play important part
unusual infections causing dental abscess
staphylococcal lymphadenitis of childhood
cervico-facial actinomycosis
clinical features of acute apical abscess
initially almost identical to acute apical periodontitis:
- severe unremitting pain
- acute tenderness in function
- acute tenderness on percussion
BUT
no swelling, redness or heat (yet)
5 cardinal signs of inflammation
pain
heat
redness
swelling
loss of function
once an acute apical abscess perforates through bone…
pain often remits (unless in the palate)
swelling redness and heat in soft tissues becomes increasingly apparent
- as swelling increases pain returns
initial reduction in tip as pus escapes into the soft tissues
acute apical abscess - treatment
soft tissue incision intra orally
soft tissue incision extra orally
remove source/cause
- extraction
- extirpation of pulp
- periradicular surgery
need for antibiotics determined by
- severity
- absence of adequate drainage
- patients medical condition
What does the site of the swelling of a dental abscess depend on?
position of tooth in the arch
root length
muscle attachments
potential spaces in proximity to lesion
- submental
- sublingual
- submandibular
- buccal
- infraorbital
- lateral pharyngeal
- palate
assessing the need for antibiotics - local factors
toxicity
airway compromisation
dysphagia
trismus
lymphadenitis
location e.g. floor of mouth
