Diagnosis in Endo Flashcards
(23 cards)
dental pain
a delta fibres = sharp pricking sensation & early shooting pain
c fibres = dull, aching, burning pain & late dull pain
referred pain
perception of pain in one b=part of body distant from source of pain
usually provoked by intense stimulation of C fibres leading to intense slow, dull pain
always radiates to ipsilateral side
referred pain in teeth
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
EPT
electric pulp test
no indication of reversibility of inflammation & no correlation between threshold & pulp condition but a negative response is a reliable indicator
EPT of teeth with open apices is unreliable
normal pulp
symptom free
normally responsive to pulp testing
mild / transient response to thermal cold testing lasting no more than 1-2 seconds after stimulus removed
compare with adjacent & contralateral teeth & test other teeth first so pt is familiar with experience of a normal response to cold
reversible pulpitis
inflammation should resolve following appropriate management of aetiology
discomfort experienced when stimulus applied only lasting a few seconds
exposed dentine, caries, deep restorations
no significant radiographic changes in periapical region of the suspect tooth & pain is not spontaneous
symptomatic irreversible pulpitis
vital inflamed pulp incapable of healing, RCT indicated
sharp pain upon thermal stimulus, lingering pain (>30 secs after stimulus removed), spontaneity & referred pain
pain can be accentuated by postural changes i.e. lying down or bending over
OTC analgesics typically ineffective
common aetiologies inc deep caries, extensive restorations or # exposing pulpal tissues
can be difficult to diagnose as inflammation has not yet reached the periapical tissues so no pain on percussion
asymptomatic irreversible pulpitis
vital inflamed pulp incapable of healing
RCT indicated
no clinical symptoms
pulp necrosis
death of pulp
non responsive to pulp testing
asymptomatic
does not by itself cause apical periodontitis
pain to percussion / radiographic evidence of osseous breakdown unless canal is infected
normal apical tissues
not sensitive to percussion or palpation testing & radiographically the lamina dura surrounding the root is intact & pdl space is uniform
comparative testing for percussion & palpation should always begin with normal teeth as a baseline for the pt
symptomatic apical periodontitis
inflammation, usually of the apical periodontium
painful response to biting and/or percussion or palpation
may or may not be accompanied by radiographic changes i.e. depending on stage of disease
severe TTP is highly indicative of a degenerating pulp and RCT is needed
asymptomatic apical periodontitis
inflammation & destruction of apical periodontium that is of pulpal origin
appears as apical radiolucency & does not present clinical symptoms i.e. no pain / TTP
chronic apical abscess
inflammatory reaction to pulpal infection & necrosis
characterised by gradual onset, little or no discomfort & intermittent discharge of pus through an associated sinus tract
radiographically signs of osseous destruction such as a radiolucency
sinus tract tracing possible
acute apical abscess
inflammatory reaction to pulpal infection & necrosis
characterised by rapid onset, spontaneous pain, extreme tenderness of tooth to pressure, pus formation & swelling of associated tissues
may be no radiographic signs of destruction & pt often experiences malaise, fever & lymphadenopathy
condensing osteitis
diffuse radiopaque lesion representing a localised bony reaction to a low grade inflammatory stimulus usually seen at the apex of the tooth
mandibular 1st molar hypersensitive to cold & sweets over the past few months but symptoms subsided. no response to thermal testing, TTP & biting. radiographically there are diffuse radiopacities around the root apices; what is the diagnosis & tx?
pulp necrosis; symptomatic apical periodontitis with condensing osteitis
tx = non surgical endo followed by build up & crown, over time the condensing osteitis should regress partially / totally
following placement of full gold crown on maxillary 2nd molar pt complains of sensitivity to hot & cold liquids, discomfort is now spontaneous. pain on endo-ice application which lingered for 12 secs following removal. percussion & palpation responses normal, radiographically no evidence of osseous change; what is the diagnosis & tx?
symptomatic irreversible pulpitis & normal apical tissues
tx = non surgical endo, permanent rest
maxillary 1st molar has MO caries, pt complaining of sensitivity to sweets & cold liquids, no discomfort on biting / percussion, tooth hypersensitive to endo ice with no lingering pain; what is the diagnosis & tx?
reversible pulpitis & normal apical tissues
tx = excavation of caries, permanent restoration, if pulp exposed tx inc non surgical endo tx followed by permanent restoration i.e. crown
mandibular lateral incisor has apical radiolucency, hx of trauma > 10 yrs ago, tooth slightly discoloured, no response to endo ice / EPT, adjacent teeth responded normally, no tenderness to percussion / palpation; what is diagnosis & tx?
pulp necrosis & asymptomatic periapical periodontitis
tx = non surgical endo, bleaching, permanent rest
mandibular 1st molar has large apical radiolucency encompassing both mesial & distal roots along with furcation involvement
perio probing depths all within normal limits, tooth did not respond to thermal testing & both percussion / palpation normal
draining sinus tract on mid facial of attached gingiva which was traced with GP cone
recurrent caries around distal margin of crown
what is diagnosis & tx
pulp necrosis & chronic apical abscess
mandibular 1st molar has large apical radiolucency encompassing both mesial & distal roots along with furcation involvement
perio probing depths all within normal limits, tooth did not respond to thermal testing & both percussion / palpation normal
draining sinus tract on mid facial of attached gingiva which was traced with GP cone
recurrent caries around distal margin of crown
what is diagnosis & tx
pulp necrosis & chronic apical abscess
tx = crown removal, non surgical endo & placement of new crown
maxillary 1st molar endo tx >10 yrs ago, pt complaining of pain on biting over past 3 months
apical radiolucencies around all 3 roots, tooth TTP and tooth slooth
what is diagnosis & tx
previously treated; symptomatic apical periodontitis
tx = non surgical endo re tx, permanent rest
maxillary lateral incisor has apical radiolucency
no hx of pain & tooth asymptomatic, no response to endo ice / EPT but adjacent teeth respond normally to tests, no TTP / palpation
what is diagnosis & tx
pulp necrosis & asymptomatic apical periodontitis
tx = non surgical endo, permanent rest
