Endo Diagnosis Flashcards
Reversible Pulpitis
Symptomatic
Cause= pulp irritant
- reversed by removal of irritant
- no removal = may progress to irreversible pulpits
Positive Cold Test = hypersensitivity + transient, sharp pain
NO spontaneous pain
Asymptomatic Irreversible Pulpitis
Asymptomatic
Physiologically and microscopically comparable to symptomatic irreversible pulpits, but without symptoms
Symptomatic Irreversible Pulpitis
Symptomatic = spontaneous pain (intermittent or constant)
irreversible damage to pulp, will not fully heal with irritant removal
Cold Test= lingering pain
EPT not useful
Radiographs usually insufficient
Posture changes (bending, lying down) may exacerbate pain due to increased blood pressure
Necrotic Pulp
Rarely symptomatic
Often occurs from long term lack of blood supply to the pulp
includes partial or total necrosis
Anterior teeth may appear with crown discoloration
Untreated leads to PDL thickening, sensitivity to percussion and Periapical disease
Cold Test
Application of cold substance on tooth to cause stimulation
Uses Endo-ice (dichlorodifluromethane, -30 degrees C) sprayed onto a cotton pellet and applied onto the dried mid-facial surface of the tooth for 5 seconds
Pulpal diagnosis based on intesity and duration of response`
Electric Pulp Test
Determines presence of vital sensory fibers in the pulp
Can only indicate if the tooth is vital or nonvital– it can not indicate severity
Least reliable pulp vitality test
- False results
- no indication of vascular supply of pulp
- cardiac pacemaker CONTRAINDICATED
Asymptomatic Apical Periodontitis
Asymptomatic
Radiographs are useful = visualization of apical radiolucency
- confirms necrotic pulp
Symptomatic Apical Periodontitis
Symptomatic = pain on percussion (intense and throbbing)
Inflammation around tooth apex
PDL contains localized inflammatory infiltrate
Tooth is vital –> occlusal adjustment
Tooth is necrotic –> Endodontic therapy
Acute Apical Abscess
Acute = rapid swelling + severe pain
Apex contains purulent exudate/liquefactive necrosis of tissue
Chronic Apical Abscess
No/less swelling or discomfort than acute due to presence of draining sinus tract
- path and source of sinus tract can be located by inserting gutta percha cone into the tract until resistance is felt, then you take a Periapical radiograph to “trace back” to which tooth is the problem
Percussion Test
Done by tapping the tooth along its long axis using the end of the mirror handle
Normal response should NOT have pain
Apical Palpation
Palpation of gums/vestibular area around the area of the root apex of tooth
Normal response should not have pain or feel swollen or bumpy
Pain from Pulpitis
Pain conduced from C-FIBERS
- afferent
- small diameter
- unmyelinated
Dull, throbbing, lingering pain
Sensitive to heat
Travel centrally through pulp
Pain conduced from Dentin
Pain conducted from Aẟ FIBERS
- afferent nerve
- large diameter
- myelinated
Sensitive to cold
Sharp, transient pain
Travel coronally in the pulp
- more easily provoked for pain sensation than central C- fibers
