Endodontics - Types of Pulpal Diagnoses

Question 1

Describe the process of endodontic disease.

Answer 1

Caries reaches the pulp/sometimes caries doesn’t reach the pulp but there is still leaching of bacterial/fungal products into the pulp.

This creates slow inflammatory changes.

There is a formation of a biofilm.

(If caries is removed and the cause is addressed = reversible inflammatory changes.)

If disease is persistent and progressive = irreversible changes to the pulp which leads to tissue necrosis.

Necrosis of the pulp leads to abscess formation (periapical or lateral)

Question 2

Endodontic disease is an example of what kind of disease?

Answer 2

Biofilm disease

Question 3

What fibres are responsible fr referred pain?

Answer 3

C fibres

Question 4

What are the general rules for referred pain?

Answer 4

Pain always radiates to the ipsilateral side

Anterior teeth rarely refer pain to other teeth in the opposite arch.

Posterior teeth refer pain to the opposite arch or periauricular areas.
- periauricular pain most commonly caused by mandibular posterior teeth.

Question 5

Describe the response to sensibility testing in a tooth with REVERSIBLE PULPITIS.

Answer 5

Discomfort experienced when stimulus is applied but only lasts a few seconds.

Question 6

Describe the radiographic examination of a tooth with REVERSIBLE PULPITIS.

Answer 6

No significant changed at periapical regions

Question 7

What is SYMPTOMATIC IRREVERSIBLE PULPITIS described as?

Answer 7

Classic toothache

Question 8

What are the options for a tooth with SYMPTOMATIC IRREVERSIBLE PULPITIS?

Answer 8

Root canal treatment or extraction.

Question 9

Describe the radiographic examination of a tooth with SYMPTOMATIC IRREVERSIBLE PULPITIS.

Answer 9

Recession can be seen on a radiograph

Question 10

Describe the response to sensibility testing in a tooth with SYMPTOMATIC IRREVERSIBLE PULPITIS.

Answer 10

Sharp pain with thermal stimuli

Pain lingers after stimuli is removed for > 30 seconds.

Question 11

Describe the other characteristics of SYMPTOMATIC IRREVERSIBLE PULPITIS.

Answer 11

Unprovoked pain

Referred pain

Pain accentuated by postural changes - bending over/lying down

Over the counter analgesics = ineffective

Question 12

Describe the response to sensibility testing in a tooth with ASYMPTOMATIC IRREVERSIBLE PULPITIS.

Answer 12

Normal response

Question 13

Describe the symptoms of ASYMPTOMATIC IRREVERSIBLE PULPITIS.

Answer 13

None

Question 14

What are the options for a tooth with ASYMPTOMATIC IRREVERSIBLE PULPITIS?

Answer 14

Root canal treatment or extraction

Question 15

Since there are no clinical symptoms of asymptomatic irreversible pulpitits, what are the indications?

Answer 15

Deep cavities that likely involve the pulp chamber / pulpal exposure

Question 16

Describe the response to sensibility testing in a tooth with a NECROTIC PULP.

Answer 16

No response

Question 17

Describe the symptoms associated with a NECROTIC PULP.

Answer 17

None

Question 18

What are the options for a tooth with a NECROTIC PULP?

Answer 18

Root canal treatment or extraction.

Question 19

Describe the response to sensibility testing in a tooth that has been previously treated/partially treated.

Answer 19

Tooth typically wont respond but it can be possible to have a response. (depends on the level of therapy)