Diagnosis

Question 1

What should the clinical notes include?

Answer 1

Date
Socrates
Exam
Special investigations
Diagnoses
Treatment options and risks / prognosis
Agreed treatment
Signed /dated

Question 2

What are the two types of pain?

fibres

Answer 2

A-delta fibres
* Sharp pricking sensation
* Early shooting pain

C fibres
* Dull, aching or burning
* Late dull pain

Question 3

What is an endodontic emergency?

Answer 3

• Pain and or swelling caused by various stages of inflammation or infection of the pulpal and /or periapical tissues

Question 4

SOCRATES

Answer 4

• Site
• Onset
• Character
• Radiation
• Association
• Time course
• Exacerbating/Relieving factors
• Severity

Question 5

What is referred pain?

Answer 5

• Perception of pain in one part of body distant from source of pain
• Difficult to discriminate location of pulpal pain
• Referred pain usually provoked by intense stimulation of C- fibres leading to intense slow, dull pain

Question 6

What are the characteristics of referred pain?

Answer 6

• Always radiates to ipsilateral side
• Anterior teeth seldom refer pain to other teeth or opposite arch
• Posterior teeth often refer to opposite arch or periauricular area, but seldom to anterior teeth
• Mandibular posterior teeth refer pain to periauricular area more often than maxillary

Question 7

What medical condition can be the cause of bone pain?

Answer 7

sickle cell anemia

Question 8

What medical condition can be the cause of tooth mobility?

Answer 8

multiple myeloma

Question 9

What medical conditions can be the cause of lymph node involvement?

Answer 9

TB
lymphoma

Question 10

What medical conditions can be the cause of paraesthesia?

Answer 10

leukaemia
anaemia

Question 11

What medical conditions can be the cause of tooth pain?

Answer 11

Multiple sclerosis
Acute maxillary sinusitis
Trigeminal neuralgia

Question 12

What does the endodontic examination include?

Answer 12

• Extra oral exam
• Intra oral exam
• Soft tissue exam
• Intra oral swelling
• Sinus tracts
• Palpation
• Percussion
• Mobility
• Periodontal exam

Question 13

What are sensibility tests?

Answer 13

thermal
electric

Question 14

What is a vital test?

Answer 14

laser doppler flowmetry

Question 15

What is used for cold tests?

Answer 15

frozen CO2
endo-frost
endo-ice

Question 16

What is used for heat tests?

Answer 16

hot gutta percha

Question 17

What are EPTs testing?

Answer 17

• Electric current used to stimulate sensory nerves
• Primarily A-delta fast conducting fibres
• Unmyelinated C-fibres may or may not respond

Question 18

Why are EPTs not reliable?

why are they sometimes?

Answer 18

• No indication of reversibility of inflammation
• No correlation between threshold and pulp condition
• EPT of teeth with open apices unreliable

* Negative response reliable indicator

Question 19

What is a bite test used for?

Answer 19

to find fractures or tooth sleuth

Question 20

What are the pulpal diagnoses?

Answer 20

• Normal Pulp
• Reversible Pulpitis
• Irreversible Pulpitis
• Pulp Necrosis
• Previously Treated
• Previously Initiated Therapy

Question 21

What is normal pulp?

Answer 21

• Pulp is symptom-free and normally responsive to pulp testing (normal means response is mild or transisent and lasts no more than 1-2 secs after stimulus is removed)
• Pulp may not be histologically normal

Question 22

What are qualities of reversible pulpitis?

Answer 22

• Inflammation should resolve following appropriate management of the aetiology
• Discomfort is experienced when a stimulus applied only lasting a few seconds
• Exposed dentin (dentinal sensitivity), caries or deep restorations
• No significant radiographic changes in the periapical region of the suspect tooth and the pain experienced is not spontaneous

Question 23

What are characteristics of irreversible pulpitis?

Answer 23

• Vital inflamed pulp is incapable of healing and that root canal treatment is indicated
• Characteristics may include sharp pain upon thermal stimulus, lingering pain (often 30 seconds or longer after stimulus removal), spontaneity (unprovoked pain) and referred pain
• Pain may be accentuated by postural changes such as lying down or bending over
• OTC analgesics typically ineffective
• May have no clinical symptoms (asymptomatic)

Question 24

What is pulp necrosis?

Answer 24

• Diagnostic category indicating death of the dental pulp, necessitating root canal treatment
• Non responsive to pulp testing and is asymptomatic
• Does not by itself cause apical periodontitis
• (pain to percussion or radiographic evidence of osseous breakdown) unless the canal is infected

Question 25

What is previously treated?

Answer 25

* Clinical diagnostic category indicating that the tooth has been endodontically treated * Canals are obturated with various filling materials other than intracanal medicaments * The tooth typically does not respond to thermal or electric pulp testing

Question 26

What is previously initiated?

Answer 26

* Clinical diagnostic category indicating that the tooth has been previously treated by partial endodontic therapy such as pulpotomy or pulpectomy * Depending on the level of therapy, the tooth may or may not respond to pulp testing modalities

Question 27

What are the apical diagnoses?

Answer 27

* Normal Apical Tissues * Symptomatic Apical Periodontitis * Asymptomatic Apical Periodontitis * Chronic Apical Abscess * Acute Apical Abscess * Condensing Osteitis

Question 28

What are normal apical tissues?

Answer 28

* Not sensitive to percussion or palpation testing and radiographically, the lamina dura surrounding the root is intact and the periodontal ligament space is uniform * Comparative testing for percussion and palpation should always begin with normal teeth as a baseline for the patient

Question 29

What is symptomatic apical periodontitis?

Answer 29

* Represents inflammation, usually of the apical periodontium * Painful response to biting and/or percussion or palpation * May or may not be accompanied by radiographic changes (there may be a periapical radiolucency) * Severe pain to percussion and/or palpation is highly indicative of a degenerating pulp and root canal treatment is needed.

Question 30

What is asymptomatic apical periodontitis?

Answer 30

* Inflammation and destruction of the apical periodontium that is of pulpal origin * Appears as an apical radiolucency and does not present clinical symptoms (no pain on percussion or palpation)

Question 31

What is a chronic apical abscess?

Answer 31

* Inflammatory reaction to pulpal infection and necrosis * Characterized by gradual onset, little or no discomfort and an intermittent discharge of pus through an associated sinus tract * Radiographically, signs of osseous destruction such as a radiolucency * Sinus tract tracing possible

Question 32

What is a acute apical abscess?

Answer 32

* Inflammatory reaction to pulpal infection and necrosis * Characterized by rapid onset, spontaneous pain, extreme tenderness of the tooth to pressure, pus formation and swelling of associated tissues * May be no radiographic signs of destruction and the patient often experiences malaise, fever and lymphadenopathy

Question 33

What is condesing osteitis?

Answer 33

Diffuse radiopaque lesion representing a localized bony reaction to a low-grade inflammatory stimulus usually seen at the apex of the tooth