Diagnosis and management of dental pain

Question 1

What is a differential diagnosis

Answer 1

A list of possible diseases we think a patient may have

Question 2

Give examples of dental conditions that are assorted with a vital pulp

Answer 2

1. Dentine hypersensitivity
2. Reversible pulpitits
3. Irreversible pulpitis
4. Cracked tooth syndrome

Question 3

Give examples of conditions that are associated with a dead tooth

Answer 3

1. Symptomatic apical periodontitis
2. Acute apical abscess
3. Chronic apical abscess
4. Asymptotic apical periodontitis

Question 4

Describe the aetiology of dentine hypersensitivity

Answer 4

Hydrodynamic theory of tooth sensitivity
associated with alpha nerve fibre stimulation

Question 5

What do patients usually complain of if they have dentine hypersensitivity

Answer 5

1. Short sharp pain
2. Worse with hot, cold and sweet things
3. Hard to locate
4. Only present when stimulus present

Question 6

Upon examination what might you see in a patient with dentine hypersensitivity

Answer 6

Look for:
1. Exposed dentine
2. Lost restorations
3. Gingival recession
4. Fractured teeth

Question 7

List what the likely outcomes are for a patient with dentine hypersensitivity to:

1. Sensitivity test
2. TTP

Answer 7

1. Sensitivity testing: positive
2. Not TTP

Question 8

How can you manage dentine hypersensitivity

Answer 8

Seal dentinal tubules to prevent fluid flow
Place flouride varnish

Question 9

Describe the aetiology of reversible pulpits

Answer 9

Mild transient inflammation in the pulp
Associated with simulation of alpha nerve fibres

Question 10

What do patients usually complain of if they have reversible pulpitis

Answer 10

1. Short sharp pain (5-10 secs)
2. Pain worse with hot, cold and sweet things
3. Hard to locate
4. Pain only present when stimulus present

Question 11

On examination what might you see in a patient with reversible pulpitis

Answer 11

Look for:
1. Caries
2. Cracks
3. High restorations
4. Deep restorations

Question 12

List what the likely outcomes are for a patient with reversible pulpitis to:

1. Sensitivity test
2. TTP

Answer 12

1. Sensitivity testing: positive
   2 .Not TTP

Question 13

How do we manage reversible pulpitis

Answer 13

1. Removal or irritant
2. Protection of the pulp
3. Temporary dressings

Question 14

Describe the aetiology of irreversible pulpitis

Answer 14

More severe pulpal inflammation from which it cannot recover
C fibres in the pulp are stimulated

Question 15

What do patients usually complain if they have irreversible pulpitis

Answer 15

1. More throbbing severe pain
2. Worse with hot but can be cold/ sweet stimulus
3. Hard to locate

Question 16

Describe the typical history of presenting complaint for a patent with irreversible pulpitis

Answer 16

1. Last a long time after stimulus is removed (mins to hrs)
2. May be spontaneous
3. Mat keep the patient awake at night

Question 17

Upon examination what might you see in a patient with irreversible pulpits

Answer 17

Look for
Caries
Deep restorations

Question 18

List what the likely outcomes are for a patient with irreversible pulpitis to:

1. Sensitivity test
2. TTP

Answer 18

1. Positive response
2. Not TTP

Question 19

How do we manage irreversible pulpit its

Answer 19

1. Temporary reduction of inflammation with pulp steroid dressing
2. RCT
3. Extraction

Question 20

Describe the aetiology of cracked tooth syndrome

Answer 20

Crack extends into dentine when patient bites with tooth and closes after causing pain as fluid is forced into the dentinal tubules

Question 21

What do patients usually complain of if they have cracked tooth syndrome

Answer 21

1. Pain on biting or after releasing bite
2. Usually sensitive to cold
3. Difficult to say which tooth hurts

Question 22

Describe the typical history of presenting complain for a patient with cracked tooth syndrome

Answer 22

1. Can go on for years
2. Regressively gets worse
3. Causes avoidance of eating food on that side

Question 23

Upon examination what might you see in a patient with cracked tooth syndrome

Answer 23

Look for:
1. Occlusal interference
2. Large restorations
3. Visible cracks

Question 24

List what the likely outcomes are for a patient with cracked tooth syndrome to:

1. Sensitivity test
2. TTP

Answer 24

1. Positive response
2. May be TTP

Question 25

Will cracks be visible on a radiograph if a patient has cracked tooth syndrome

Answer 25

no

Question 26

How can we identify which cusp is flexing in a a patient with cracked tooth syndrome

Answer 26

By using tooth sleuth

Question 27

How can we manage cracked tooth syndrome

Answer 27

Remove any restorations and replace with cusp protective restorations

Question 28

Describe the aetiology of a high restoration?

Answer 28

High biting high restorations results in increased pressure on the tooth effectively bring the PDL and can cause the release of pain mediators on the PDL

Question 29

What do patients usually complain of if they have a high restoration

Answer 29

1. Painful to put teeth together 2. Patients may avoid eating on the side with the high restoration

Question 30

Describe the aetiology of food packing

Answer 30

Usually associated with a poor contact point Food collects in inter proximal area and is packed down further for on top Causes inflammation of gingiva

Question 31

How can we manage food packing?

Answer 31

1. Clean out all the food 2. Try to correct poor contacts 3. Instruct the patient to clean inter proximally regular

Question 32

Describe the aetiology of acute lateral periodontal abscess?

Answer 32

1. Pus formation in periodontal pocket 2. Pus may be prevented from escaping by calculus

Question 33

What do patient usually complain of if they ache an acute lateral periodontal abscess

Answer 33

Pain and swelling that may have started following periodontal treatment

Question 34

Upon examination what might you see in a patient who has an acute lateral periodontal abscess

Answer 34

Fluctuant swelling tooth may be mobile

Question 35

What might a radiograph show if a patient has an acute lateral periodontal abscess

Answer 35

Radiographs may show loss of alveolar crest

Question 36

How can we manage an acute lateral periodontal abscess

Answer 36

1. Drainage of pus under LA 2. Clean any pockets 3. May need antibiotics

Question 37

Describe the aetiology of symptomatic acute apical periodontitis?

Answer 37

Acute inflammation in the periodontal ligament at the apex This is due to bacterial toxins coming from infected dead root canal

Question 38

What do patient s usually complain of if they have symptomatic acute apical periodontitis

Answer 38

1. Extremely painful to put teeth together 2. Very well localised 3. Usually a short history

Question 39

Upon examination what might you see in a patient who has symptomatic acute apical periodontitis

Answer 39

Tooth may have caries or be heavily restored

Question 40

List what the likely outcomes are for a patient with symptomatic acute apical periodontitis: 1. Sensitivity test 2. TTP

Answer 40

1. Negative response (unless tooth is multi rooted) 2. Very TTP

Question 41

How can we manage symptomatic acute apical periodontitis

Answer 41

1. Extraction 2. RCT 3. Pain killers/ occlusal adjustment if RCT can't be carried out immediately

Question 42

Describe the aetiology of acute apical abscess

Answer 42

Pus formation in the peri radicular tosses Pus racks through cortical paste and causes accumulation in the soft tissues

Question 43

What do patients usually complain of If they have an acute apical abscess

Answer 43

1. Intense throbbing pain and swelling 2. Patient feels generally unwell 3. Short onset

Question 44

Upon examination what might you see in a patient who has an acute apical abscess

Answer 44

1. Fluctuant swelling intra orally or extra orally 2. Possible lymphadenopathy

Question 45

List what the likely outcomes are for a patient who has an acute apical abscess : 1. Sensitivity test 2. TTP

Answer 45

1. Non responsive 2. Very TTP and touch

Question 46

What might a radiograph show in a patient with an acute apical abscess/

Answer 46

May show area of exacerbation of existing pathology

Question 47

How do we manage an acute apical abscess

Answer 47

Drainage of pus through root canal or soft tissues

Question 48

Describe the aetiology of chronic apical abscess

Answer 48

Pus forms peri radicular tissues May have formed a sinus tract

Question 49

What do patients usually complain of if they have chronic apical abscess

Answer 49

Tooth may be symptom free Possible vague mild symptoms or the occlusal tooth ache

Question 50

When might the history of presenting complain be of patient with chronic apical abscess

Answer 50

Possible previous failed Endodontic treatment Untreated periapical periodontitis

Question 51

Upon examination what might you see in a patient who has a chronic apical abscess?

Answer 51

1. Small localised swelling or sinus tract 2. Mat be able to express pus

Question 52

What might a radiograph show if a patient has a chronic apical abscess

Answer 52

Will show PA area

Question 53

How do we manage chronic apical abscesses

Answer 53

RCT or apical surgery

Question 54

Describe the aetiology of asymptomatic apical periodontitis

Answer 54

Bacteria occupying the dead pulp space causes a defensive reaction in surrounding tissues Can lead to the formation of a granuloma

Question 55

What do patient usually complain of If they have asymptomatic apical periodontitis

Answer 55

Usually symptom free but there may be pas history of pain in the area

Question 56

Upon examination what might you see in a patient who has asymptomatic apical periodontitis?

Answer 56

Heavily restored carious Tooth

Question 57

What might a radiograph show in a patient who has asymptomatic apical periodontitis?

Answer 57

Will show PA areaMay show deep caries, restoration or the reason for pulp dead

Question 58

How can we mage asymptomatic apical periodontitis?

Answer 58

Leave and monitor if asymptomatic Carry out RCT