Diagnosis Flashcards
(47 cards)
1
Q
- Symptom free
- Normal response to sensibility testing
- No inflammatory changes
A
Normal pulp
2
Q
- Pain occurs with thermal, chemical + tactile stimuli
- Exaggerated response to stimuli
- Severe and sharp but does not linger on removal of stimulus
- No specific factors such as caries/fractures/recent restorations
A
Dentine hypersensitivity
3
Q
- Pain short and sharp, not spontaneous
- Cold, sweet and occasionally hot stimulus
- No significant radiographic changes
A
Reversible pulpitis
4
Q
- Spontaneous pain
- Exaggerated response to stimulus that lingers after stimulus is removed
- Sensibility testing responsive
- Not TTP
- No periapical changes radiographically
A
- Irreversible pulpitis
5
Q
- Excrutiating pain
- Momentarily relived by cold
- Tooth often TTP
- Reacts violently to heat
- Radiograph shows thickened PDL
A
- Advanced symptomatic irreversible pulpitis
6
Q
- Usually asymptomatic unless inflammation had progressed to periapical tissues
- No response to sensibility testing
A
Pulpal necrosis
7
Q
- TTP
- Discomfort on biting and chewing
- Palpation may or may not be sensitive
- May be widening of the PDL or a distinct radiolucency
A
- Symptomatic periapical periodontitis
8
Q
- Painful
- Very TTP
- Tooth extruded from socket
- Mobility of tooth
- Rapid onset
- May be localised or diffuse swelling
A
- Acute periapical abscess
9
Q
- Not TTP
- No response to sensibility testing
- Radiographically there will be a radiolucency around apex of tooth
A
Asymptomatic periapical periodontitis
10
Q
- Not TTP
- No response to sensibility testing
- Usually asymptomatic
- Radiographically - radiolucent area on bone
A
Chronic periapical abscess
11
Q
- Systemic signs - temp >38 degrees + feeling unwell
- Drainage through tooth not occurring
Infection spread into fascial planes
A
Cellulitis
12
Q
Which nerve supplies the pulp of teeth?
A
Trigeminal
13
Q
What kind of nerves are associated with sharp pain?
A
- Myelinated A delta and A beta axons
14
Q
What kind of nerves are associated with dull throbbing pain?
A
Unmyelinated C fibres
15
Q
What are the inflammatory mediators of pulp irritation?
A
- Histamine
- Bradykinin
- Arachidonic acid
- Neuropeptides
16
Q
What are the treatment options for irreversible pulpitis?
A
- RCT if tooth restorable
- Extraction
17
Q
What are the treatment options for advanced symptomatic irreversible pulpitis?
A
- RCT
- Pulpotomy for temporary measures and adjust occlusion
- Extract
18
Q
What medicament would we use to relive pain until definitive RCT can be carried out?
- What are its active ingredients?
A
- Odontopaste
- Antibiotic = clindamycin hydrochloride
- Anti-inflammatory = triamcinolone
19
Q
How does inflammatory internal resorption occur?
A
- Activation of dentinoclasts within inflamed pulp tissue that is in contact with necrotic, infected coronal pulp tissue
20
Q
What does irreversible pulpitis lead to?
A
Liquefaction necrosis
21
Q
What is the cause of a periapical abscess?
A
- Bacteria have progressed into the periradicular tissues and the patients immune response cannot defend against the invasion
22
Q
What are the treatment options for an acute periapical abscess?
A
- Drainage
THEN - RCT or extraction
23
Q
Where does a periradicular cyst arise from?
A
- Epithelial cells rests of malassez
24
Q
What are the histopathological features of a radicular cyst?
A
- Epithelial lining
- Cholesterol clefts
- Fibrous capsule of collagen fibres
- Inflammatory cells
25
Why do we test control teeth?
- So the patient knows what to expect
- So the dentist can observe the patients response
- So we can determine if the stimulus if capable of evoking a reponse
26
What does a severe response to percussion testing indicate?
- Periradicular inflammation
27
What does a mild - mod response to percussion testing indicate?
- Periodontal inflammation
| - periodontal disease
28
What does a positive response to pulp sensibility testing indicate?
- Only that there is a presence of some nerve fibres carrying sensory impulses
29
What does an intense, prolonged response to a pulp sensibility test indicate?
- Irreversible pulpitis
30
What does no response to pulp sensibility testing indicate?
- Necrotic pulp
| - False negative
31
What may give us a false negative response to sensibility testing?
- Calcified canals
- Immature apex
- Recent trauma
32
What can we use to do cold sensibility testing?
- Ethyl chloride
- Dichlorodifluoromethane
- Ice sticks
33
What can we use to do heat sensibility testing?
- Hot water
- GP heated in a flame
- Rotation of rubber prophy cup
34
Describe the technique for using and electric pulp tester
- Clean, dry and isolate tooth
- Place toothpaste on electrode
- Place on labial/palatal surface avoiding metal restorations
- Increase level of current until a sensation is felt by the patient
35
When might we get false positives from an EPT?
- Electrode makes contact with gingiva or large amalgam restoration
- Patient is anxious
- Liquefaction necrosis
- Tooth is not dry or well isolated
36
When might we get false negatives from an EPT?
- Patient is premedicated
- Inadequate contact with enamel
- Trauma
- Canal is calcified
- Apex is immature
(these teeth contain fewer Adelta fibres than mature teeth)
- Partial necrosis
37
What does a laser doppler do?
Is an objective test of the presence of moving red blood cells within a tissue
38
What are the indications for laser doppler flowmetry?
- Pulp testing in children
- Traumatised teeth
- Monitoring revascularisation of replanted teeth
- Differential diagnosis of periapical radiolucencies
39
When would we do a bite test and what would we use to do it?
- To diagnose a cracked tooth
| Tooth slooth
40
What are the limitations of using radiographs to diagnose?
- Pathological changes in the pulp are not visible
| - Periradicular pathology is not visible in the early stages
41
What is meant by direct pulp capping?
- A medicament is placed directly over the exposed pup in an attempt to maintain pulp vitality and avoid more extensive treatment
42
What are the indications for direct pulp capping?
- Exposure due to caries - the pulp is likely to be inflamed
- Traumatically exposed pulps - pulp is likely to be normal
43
What are the criteria for a successful direct pulp cap?
- No history of pain
- No swelling
- Normal sensibility tests
- Not TTP
- No radiological evidence of periradicular pathology
- Young patient
44
What are the contraindications of direct pulp capping?
- History of previous toothache
- Deciduous teeth
- Elderly patients
- Large carious exposures
Pulp hyperaemiac at site of exposure
Pulp necrotic at site o exposure
45
What is the most commonly used material for pulp capping?
- Calcium hydroxide
| Dycal
46
What other materials can be used for direct pulp capping?
- MTA
- Bio-aggregate
- Biodentine
47
What is the technique of direct pulp capping?
1. LA
2. Rubber dam
3. Remove carious dentine
4. Arrest haemorrhage - rinse with sodium hypochlorite
5. Dress with pulp capping agent
6. Seal with RMGI and place permanent restoration
