1 - Diseases of the pulp and periodontium

Question 1

What are the clinical symptoms of pulp hyperaemia?

Answer 1

• pain lasting for seconds
• pain stimulated by hot/cold or sweet foods
• pain resolves after stimulus removed
• caries approaching pulp but tooth can be restored without treating pulp

Question 2

What is pulp hyperaemia also known as?

Answer 2

Reversible pulpitis

Question 3

What are the clinical symptoms of acute pulpitis?

Answer 3

• constant severe pain
• reacts to thermal stimuli
• poorly localised pain
• referral of pain
• no response to analgesics
• if tooth is broken down, symptoms are less severe

Question 4

Why are symptoms less severe in a broken down tooth?

Answer 4

The pressure within the pulp chamber has been released so the symptoms are lessened

Question 5

What can be used during diagnosis of acute pulpitis?

Answer 5

• history
• visual exam
• TTP (negative)
• pulpal testing is ambiguous
• radiographs
• diagnostic LA
• removal of restorations

Question 6

What are the clinical symptoms of acute periodontitis?

Answer 6

• TTP (patient can describe tooth as high as they can’t bite on it)
• tooth is non vital
• slight increase in mobility
• radiographs show low of lamina dura and widening of PDL

Question 7

What are the causes of traumatic periodontitis?

Answer 7

• parafunction
• clenching (patient usually aware)
• grinding (patient unaware)

Question 8

How do you treat traumatic periodontitis?

Answer 8

• occlusal adjustment
• therapy for parafunction

Question 9

How do you diagnose traumatic periodontitis?

Answer 9

• exam of occlusion (posturing)
• TTP
• normal vitality
• radiographs (generalised widening of PDL)

Question 10

What are the different types of dental abscess?

Answer 10

• acute apical abscess (most common)
• periodontal abscess
• pericoronitis
• sialdentitis

Question 11

What is a periodontal abscess?

Answer 11

Infection within the pocket or PDL

Question 12

What is pericoronitis?

Answer 12

Abscess surrounding a partially erupted tooth, usually the 8

Question 13

What is sialadenitis?

Answer 13

Infection of a major salivary gland

Question 14

What organisms are usually involved in dental abscesses?

Answer 14

• polymicorbial
• anaerobes play in important role

Question 15

What are the symptoms of acute apical abscess (initial stages)?

Answer 15

• severe unremitting pain
• acute tenderness in function
• acute TTP
• no swelling, redness or heat

Question 16

What are the symptoms of acute apical abscess (that has perforated bone)?

Answer 16

• pain remits (unless palate) as pressure is released
• initial reduction of TTP as pus escapes into soft tissues
• swelling, redness and heat become apparent
• as swelling increases, as does pain

Question 17

What dictates the site of swelling?

Answer 17

• position of tooth in arch
• root length
• muscle attachments
• potential spaces in proximity to lesion

Question 18

What are spaces that infection can spread in to?

Answer 18

• submental space
• sublingual space
• submandibular space
• buccal space
• infraorbital space
• lateral pharyngeal space
• palate

Question 19

How do you treat an acute apical abscess?

Answer 19

• provide drainage intraorally/extraorally
• remove source or cause (XLA, pulp extirpation, periradicular surgery)
• antibiotics (?)

Question 20

What determines the need for antibiotics in the treatment of an acute apical abscess?

Answer 20

• severity
• absence of adequate drainage
• patients medical history

Question 21

What local factors necessitate antibiotics?

Answer 21

• systemic toxicity
• airway compromised
• dysphagia
• trismus
• lymphadenitis
• location (FOM more likely to obstruct airway)

Question 22

What systemic factors necessitate antibiotics?

Answer 22

• immunocompromised patients
• diabetes
• elderly

Question 23

What is the aetiology of a periapical radicular cyst?

Answer 23

• caries/trauma/perio
• death of pulp
• apical bone inflammation
• dental granuloma
• stimulation of epithelial rest of malassez
• epithelial proliferation
• periapical cyst formation

Question 24

What is a periapical granuloma?

Answer 24

• chronic apical periodontitis
• mass of chronically inflamed granulation tissue at apex of tooth