Patient presents with pain specifically when eating sweets and drinking cold water. The pain is non-spontaneous and the patient has a short sharp response to thermal testing. Pulpal diagnosis?
Reversible pulpitis - VITAL
Patient presents with spontaneous pain often waking the patient up at night. There is a prolonged response to cold testing. Pulpal diagnosis?
Symptomatic Irreversible pulpitis (IRP) - VITAL
While excavating carries you discover that the carries extends all the way to the pulp. The pulp is still pink/red, but is incapable of healing. Pulpal diagnosis?
Asymptomatic irreversible pulpitis (IRP)
Radiograph shows a radiopaque lesion at the apex of the tooth. What could be a periapical diagnosis?
Condensing osteitis
Patient presents with a small discharge of pus through the mucosa near the apex of her mandibular molars. She is in little to no discomfort. Periapical diagnosis?
Chronic apical abscess (CAA) - pulp most likely necrotic and infected
*Only diagnosis with sinus tract
Patient presents with a large, painful swelling in the buccal mucosa near the maxillary molars. Tooth number 3 is tender to pressure and non-responsive to pulp testing. Periapical and pulpal diagnosis?
Acute apical abscess (AAA) - necrotic and infected pulp
What is the major difference between a chronic and acute abscess?
Chronic abscess has drainage so there is less pain and swelling
Patient presents with spontaneous pain waking her up at night in the upper right region. Upon cold testing there is a prolonged response to tooth #4. The tooth also has a painful response to percussion testing. Pulpal/PA diagnosis?
Symptomatic irreversible pulpitis (VITAL) and symptomatic apical periodontitis
SIP/SAP
If a patient is diagnosed with SIP/SAP would you expect to see a radiolucency in the periapical region?
No. Radiolucency could be seen with necrotic pulp and SAP
Radiograph of a tooth shows a “hanging drop” radiolucency at the apex of #5. The tooth is not painful to percussion of biting. PA diagnosis? Expected pulpal diagnosis?
Asymptomatic apical periodontitis (AAP)
Necrotic
T/F: A pulpectomy involves only removing the coronal pulp.
False
Pulpotomy - only coronal
Pulpectomy - all pulp
T/F: Antibiotics are always necessary for patients with necrotic pulp/abscess.
False
Only if systemic symptoms are present
T/F: Pulpectomy can be performed on necrotic teeth.
False
Debridement is the term if the tooth is necrotic
T/F: Antibiotics should be given for a patient with symptomatic irreversible pulpitis.
False