Endo Diagnosis Flashcards
(50 cards)
What is the 5-step process of diagnosis?
1 - why is the patient seeking advice/come in?
2 - History and symptoms of P complaint
3 - Objective clinical tests
4 - Correlation of objective findings and subjective details to create differential diagnosis
5 - Formulation of definitive diagnosis
What nerve fibres are responsible for dental pain?
A-delta and C fibres
What kind of dental pain is associated with A-delta fibres?
Sharp pricking sensation
Early shooting pain
What kind of dental pain is associated with C-fibres?
Dull, aching or burning
Late dull pain
What is the definition of an endodontic emergency?
Pain and/or swelling caused by various stages of inflammation or infection of the pulpal and/or periapical tissues
Why can it be difficult to discriminate the location of pulpal pain?
Can get referred pain
what are some general rules when dealing with referred pain in teeth?
- always radiates to ipsilateral side (same side)
- anterior teeth seldom refer pain to other teeth or opposite arch
- posterior teeth often refer to opposite arch or periauricular area, but seldom anterior teeth
- mandible posterior teeth refer pain to periauricular area (ear) more often than maxillary
What do we use to help decide what we do with a patient?
Clinical reasoning
What things can influence our critical reasoning/decision making?
- mood
- bias
- preconceptions
- previous experience
- time restrictions
What things would you assess/look for in an endodontic examination?
- extra-oral exam
- Intra-oral exam
- soft tissue exam
- any intraoral swelling
- sinus tracts
- palpation
- percussion
- mobility
- periodontal exam
What can be seen here?
- spreading cellulitis
- eye closed due to swelling of a maxillary tooth
(would send to max fax in ambulance)
When you diagnose via radiographs, how can you logically diagnose things?
- look at the crown first
- then middle of the tooth (pulp)
-Finally bottom of the tooth (apex, bone and soft tissue)
What are the 7 pulpal diagnoses?
- normal pulp
- reversible pulpitis
- symptomatic irreversible pulpitis
- asymptomatic irreversible pulpitis
- pulp necrosis
- previously treated
- previously initiated therapy
Describe normal pulp.
Symptom free and normally responsive to pulp testing
Even though pulp can be diagnosed as clinically normal, where might not be classed as normal?
Might not be histologically normal
How will clinically normal pulp respond to thermal testing?
Have a mild or transient response, lasting no more than one or two secs after the stimulus is removed
When testing with a thermal test, what should be tested first?
The adjacent teeth to the tooth in question so the P is familiar with the experience of a normal response to cold
What is reversible pulpitis?
Inflammation of the pulp that is caused by some sort of irritation that should resolve following appropriate management of the aetiology
What things can cause reversible pulpitis?
Exposed dentine (dentine sensitivity), caries, deep restorations
What are the symptoms of reversible pulpitis?
Discomfort when a stimulus such as cold or sweet is applied but only lasting a few seconds after stimulus removal
Note: pain is NOT spontaneous
Describe the radiographic changes seen in reversible pulpitis.
no significant radiographic changes
What is required after treatment of reversible pulpitis?
Follow-up to determine whether the pulp has returned to a normal status
What is irreversible pulpitis?
Vital inflamed pulp that is incapable of healing (RCT indicated)
What are some symptoms/characteristics of symptomatic irreversible pulpitis?
- Sharp pain upon thermal stimulus (hot)
- lingering pain (30 secs or longer after stimulus removal)
- spontaneous, unprovoked pain
- referred pain
- pain accentuates by postural changes such as lying down or bending over
(classic toothache)
