W7 - Endodontic Diagnosis - Amaral

Question 1

5 stages of making a diagnosis

Answer 1

1. Pt reasoning for visiting clinician
2. Symptoms and history
3. Objective clinical tests
4. Clnician correlates objective findings with subjective details and creates a list of Diff dx
5. Definitive diagnosis formed

Question 2

Why must intraoral swellings be palpated?

Answer 2

Want to determine whether they are diffuse or localised, and firm or fluctuant

Question 3

What does percussion test indicate

Answer 3

Pain to percussion does not indicate that the tooth is vital
or nonvital but is rather an indication of inflammation in
the PDL

Question 4

What may a localised narrow perio pocket that extends deep down while adjacent periodontium is WNL indicate?

Answer 4

Vertical root fracture

Question 5

Sensibility vs vitality

Answer 5

Vitality - blood flow, oxygen presence

Sensibility - nerve intact

Question 6

3 ways of testing pulp sensibility

Answer 6

Application of:

Mechanical

Electrical

Thermal Stimuli

Question 7

What are abnormal responses to cold test

Answer 7

Lack of response

Lingering pain

Immediate, excruciating pain

Question 8

What does EPT look for?

Answer 8

Presence of viable nerve fibers in pulp that are capable of responding

Question 9

What can a false positive EPT response mean? (4)

Answer 9

False positive responses

• could be partial pulp necrosis
• could be due to high anxiety
• Ineffective tooth isolation
• Contact with metal restorations

Question 10

What may false negative responses of EPT indicate? (4)

Answer 10

obliteration

recently traumatized tooth

Immature apex

Drugs that increase pain threshold (antidepressant)

Question 11

2 vitality tests

Answer 11

Laser doppler flowmetry

Pulse oximetry

**not really used in clinics*

Question 12

Test used for suspected fracture

Answer 12

Bite test / frac finder

Question 13

What special test to be done IF ALL OTHER TESTS FAIL to assess sensibility of tooth

Answer 13

Test cavity

• No anethesia
• Want to see if pt has any sensation during drilling

Question 14

What test to do when symptoms are not localized or are referred and pulp testing is inconclusive

Answer 14

Selective anesthesia

Question 15

Should diagnosis be made with radiograph only?

Answer 15

No

Image should be used only as one sign, providing important clues in the diagnostic investigation.

When history, clinical examination and testing not assessed with the radiograph, it can lead to misdiagnosis

Question 16

Answer 16

Dens invaginatus

Question 17

What should be requested if treated tooth is flaring up or if PA radiograph unable to see all detail

Answer 17

CBCT

Question 18

4 diseases of the pulp

Answer 18

Reversible pulpitis

Irrev pulp

Asymptomatic Irrev pulp

Necrosis

Question 19

What is dentin sensitivity

Answer 19

Exposed dentin wihout signs of pulp pathosis

• Sharp, quickly reversible pain
• In response to thermal, tactile, mechanical osmotic or chemical stimuli

Question 20

subcategories of irrev pulp

Answer 20

Symptomatic - exposure to cold will elicit prolonged pain

Pain can be sharp or dull, localised, diffuse or reffered

Asymptomatic

Question 21

What happens in pulp necrosis

Answer 21

Pulpal blood supply is non existent and the pulpal nerves are nonfunctional

• This condition is preceded by irrev pulp
• Asymptomatic until disease extends periapically

necrosis may be partial or complete, and may not involve all canals in a multirooted tooth

Question 22

How does necrotic pulp respond to special tests

Answer 22

Unresponsive to EPT and cold

If heat is applied for extended period of time, it may respond (will be relieved by cold)

*

Question 23

4 apical diseases

Answer 23

Symptomatic apical periodontitis

Asymptomatic apical periodontitis

Acute apical abscess

Chronic apical abscess

Question 24

Features of asymptomatic apical periodontitis (3)

Answer 24

“Feels different” on percussion, but not painful

Apical radiolucency

No clinical symptoms (pain)

Question 25

Features of symptomatic apical periodontitis (3)

Answer 25

Painful clinical symptoms

Painful response to TTP

MAY or MAY NOT have apical radiolucency

Question 26

Features of acute apical abscess (3)

Answer 26

Radiograph can exhibit anything from widened PDL up to apical radiolucency

Swelling present intraorally or facially

Pt frequently febrile, lymph nodes will be tender to palpation

Question 27

What is phoenix abscess?

Answer 27

Acute exacerbation of a chronic periapical lesion

Abscess that can occur immediately following RCT

Due to untreated necrotic pulp (chronic apical periodontitis). Or inadequate debridement during the procedure

Question 28

Features of chronic apical abscess (4)

Answer 28

Minimal or no pain

Sinus tract

Apical radiolucency

Tooth not sensitive to biting pressure but “feels different” to TTP

• “This entity is distinguished from asymptomatic apical periodontitis because it will exhibit intermittent drainage*
• through an associated sinus tract.”*

Question 29

What must be considered before performing endo tx? (5)

Answer 29

Is the problem of dental origin?

Is the pulp pathologically involved?

Why is the pulpal pathogen present?

Prognosis?

What is the appropriate form of treatment?

Question 30

Radiographic changes in pulpal necrosis

Answer 30

Thickening of PDL space or PARL

Question 31

For your own knowledge

Why is asymptomatic irrev pulp painless?

Answer 31

Bc the pulp is exposed to the oral cavity

• It’s inflamed and swells up, however since it is exposed, there is no pressure build up (expands like polyp)
• Symptomatic irrev pulp is painful because the pulp is still bound to chamber (dentine above) → no room for swelling = no pain relief