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Year 4, Sem 2 > Week 7 Rodrigo- Endo Diagnosis > Flashcards

Week 7 Rodrigo- Endo Diagnosis Flashcards

1
Q

What are the 5 stages of making a diagnosis?

A
  1. Pt tells clinician reasons for seeking advice
  2. Clinician questions pt about symptoms and hx that led to visit
  3. Clinician performs objectives clinical tests
  4. Clinician correlates finding with details and creates tentative list of DD
  5. Clinician formulates definitive diagnosis
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2
Q

How to palpate soft tissue swellings or bony expansion?

A

Light pressure from gloved index finger applied to suspect area with a rolling motion

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3
Q

What does TTP indicate?

A

Inflammation of PDL (does not indicate tooth is non-vital)

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4
Q

What can cause tooth mobility?

A
  • Trauma (physical or occlusal)
  • Parafunctional habits
  • Perio disease
  • Root fractures
  • Rapid ortho movement
  • Extension of pulpal disease into PDL space
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5
Q

What may a localised narrow perio pocket that extends deep down root surface indicate?

A

Vertical root fracture

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6
Q

What is a normal response to hot and cold tests?

A

Pt reports that sensation is felt but disappears immediately upon removal of thermal stimulus

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7
Q

What is electric pulp testing?

A

Response by the pulp to electric current only denotes that some viable nerve fibres are present in pulp and are capable of responding. Numeric readings only have significance if the numbers differ significantly from readings obtained from control tooth tested on same pt.

  • Start with normal tooth and don’t tell pt it is an electric test
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8
Q

What are reasons for false positive readings from EPT?

A
  • Partial pulp necrosis
  • High anxiety
  • Ineffective tooth isolation
  • Contact with metal restorations
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9
Q

What can be used to perform hot test?

A

Heated gutta percha

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10
Q

What are reasons for false-negative responses from EPT?

A
  • Obliterations in root canals
  • Recently traumatised tooth
  • Immature apex
  • Drugs that inc pts threshold for pain
  • Poor contact of pulp tester to tooth
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11
Q

What do vitality vs sensibility tests measure?

A
  • Vitality- blood flow, oxygen presence
  • Sensibility: nerves
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12
Q

What are examples of vitality tests?

A

Laser doppler flowmetry

Pulse oximetry

*not really used in clinic

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13
Q

What is laser doppler flowmetry?

A

Method used to assess blood flow in microvascular systems. Attempts are being made to adapt this technology to assess pulpal blood flow

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14
Q

What is pulse oximetry?

A
  • Designed to measure O2 concentration in blood and pulse rate
  • Transmission of light to sensor requires that there be no obstruction from restorations
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15
Q

When may a person be sensitive to bite test?

A
  • Pulpal pathosis has extended into the periodontal ligament space, creating symptomatic apical periodontitis
  • Sensitivity may be present secondary to a crack in the tooth
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16
Q

What special test method can be used when all other test methods are deemed impossible or other results from tests are inconclusive?

A

Drill a test cavity

17
Q

What is staining and transillumination

A
  • To determine presence of crack in tooth surface, the application of stain to area is often of great assistance
  • Transillumination using a bight fibreoptic light probe to surface of tooth may be helpful
18
Q

When is selective anaesthesia used as special test?

A
  • When symptoms are not localized or referred, the diagnosis may be challenging.
  • When pulp testing is inconclusive, selective anesthesia may be helpful.
19
Q

Should diagnosis be based on radiograph?

A

No, it is only one sign providing clues in diagnosis. Need proper hx, exam and testing.

20
Q

What is CBCT?

A

“Slice imaging” in which thin slices of anatomy of interest are captured in 3-D

21
Q

What is this CBCT indicating?

A

Dens invaginatus

22
Q

What are the 4 pulpal diseases?

A
  • Reversible pulpitis
  • Irreversible pulpitis
  • Asymptomatic irreversible pulpitis
  • Pulp necrosis
23
Q

What is reversible pulpitis?

A
  • This clinical diagnosis is based on subjective and objective findings indicating that the inflammation should resolve and the pulp return to normal.
    Pulp stimulation is uncomfortable to the patient but reverses quickly after irritation
  • Conservative removal of the irritant will resolve the symptoms.
24
Q

What is dentin sensitivity?

A

Presence of exposed dentin, without evidence of pulp pathosis, which can sometimes respond with sharp, quickly reversible pain when subjected to thermal, evaporative, tactile, mechanical, osmotic, or chemical stimuli. Can be confused with reversible pulpitis

25
Q

What is symptomatic irreversible pulpitis?

A
  • Intermittent or spontaneous pain.
  • Rapid exposure to dramatic temperature changes (especially to cold stimuli) will elicit prolonged episodes of pain even after the thermal stimulus has been removed.
  • The pain in these cases may be sharp or dull, localized, diffuse, or referred.
26
Q

What are the radiographic features of symptomatic irreversible pulpitis?

A
  • Deep caries
  • Minimal or no changes in the radiographic appearance of the periradicular bone.
  • With advanced irreversible pulpitis, a thickening of the periodontal ligament may become apparent on the radiograph.
27
Q

What are symptoms of asymptomatic irreversible pulpitis?

A
  • Clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing.
  • The patient does not complain of any symptoms
  • Deep caries will not produce any symptoms even though clinically or radiographically caries may extend well into the pulp.
28
Q

What is pulp necrosis?

A
  • This is a clinical diagnostic category indicating death of the dental pulp.
  • Pulp is usually nonresponsive to pulp testing. If heat is applied for extended period, tooth may response to this stimulus
  • The pulpal blood supply is non-existent and the pulpal nerves are non-functional.
  • This condition is subsequent to symptomatic or asymptomatic irreversible pulpitis.
  • May be partial or complete and may not involve all canals in multirooted teeth.
29
Q

What are radiographic changes of pulp necrosis?

A

Thickening of PDL space or periapical radiolucent lesion

30
Q

What are 4 apical diseases?

A
  • Symptomatic apical periodontitis
  • Asymptomatic apical periodontitis
  • Acute apical abscess
  • Chronic apical abscess
31
Q

What is symptomatic apical periodontitis?

A

Inflammation of the apical periodontium, producing clinical symptoms,
including a painful response to biting or percussion or palpation.

32
Q

What are radiographic features of symptomatic apical periodontitis?

A

The radiograph or image of the tooth will typically exhibit at least a widened periodontal ligament space and may or may not show an apical radiolucency
associated with one or all of the roots.

33
Q

What is asymptomatic apical periodontitis and radiographic findings?

A
  • Inflammation and destruction of the apical periodontium that is of
    pulpal origin and does not produce clinical symptoms
  • The radiograph of the tooth will exhibit an apical radiolucency.
  • The tooth is generally not sensitive to biting pressure but may “feel different” to the patient on percussion.
34
Q

What is acute apical abscess?

A
  • Inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation, and swelling of associated tissues.
  • Acutely painful to biting pressure, percussion, and palpation, varying degrees of mobility.
  • Swelling will be present intraorally and the facial tissues adjacent to the tooth will almost always present with some degree of swelling.
  • The patient will frequently be febrile, and the cervical and submandibular lymph nodes may exhibit tenderness to palpation.
35
Q

What are radiographic features of acute apical abcsess?

A

The radiograph or image can exhibit anything from a widened periodontal ligament space to an apical radiolucency.

36
Q

What are features of chronic apical abscess and radiographic appearance?

A
  • Inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little or no discomfort, and the intermittent discharge of pus through an associated sinus tract.
  • The radiograph will exhibit an apical radiolucency.
  • The tooth is not sensitive to biting pressure but can “feel different” to the patient on percussion.
  • This entity is distinguished from asymptomatic apical periodontitis because it will exhibit intermittent drainage through an associated sinus tract.
37
Q

Before clinician considers performing endo tx, what q’s need to be answered?

A
  • Is the existing problem of dental origin?
  • Are the pulpal tissues within the tooth pathologically involved?
  • Why is the pulpal pathosis present?
  • What is the prognosis?
  • What is the appropriate form of treatment?
38
Q

What is phoenix abscess?

A

Acute exacerbation of a chronic periapical lesion

39
Q

Why does asymptomatic irreversible pulpitis have no pain?

A

Pulp is exposed to oral cavity so there is no pressure build up (expands like polyp)

Year 4, Sem 2 (38 decks)

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