Endo - Diagnosis

Question 1

What does SOCRATES stand for?

Answer 1

Site 
Onset 
Character 
Radiate
Associated symptoms 
Time 
Exacerbating factors 
Severity

Question 2

What question might you ask to gain more of an understanding of the site of the pain?

Answer 2

Where is the pain?

Question 3

What question might you ask to gain more of an understanding of the Onset of the pain?

Answer 3

What were you doing when it started? was it spontaneous or not?

Question 4

What question might you ask to gain more of an understanding of the character of the pain?

Answer 4

What does the pain feel like? Sharp? dull?

Question 5

What question might you ask to gain more of an understanding of how the pain Radiates?

Answer 5

Do you feel it anywhere else?

Question 6

What question might you ask to gain more of an understanding of the Associated symptoms of the pain?

Answer 6

Do you have a fever/ feel nauseous or vomit?

Question 7

What question might you ask to gain more of an understanding of the Time/duration of the pain?

Answer 7

How long does the pain last?

Question 8

What question might you ask to gain more of an understanding of the Exacerbating factors of the pain?

Answer 8

Does anything make it worse?

Postural changes etc?

Question 9

What question might you ask to gain more of an understanding of the severity of the pain?

Answer 9

Create and establish a pain scale

Question 10

What is the scientific name for a toothache?

Answer 10

Odontogenic pain (tooth pain)
non-odontogenic pain (from the gingivae)

Question 11

What type of fibres gives sharp shooting pain?

Answer 11

A-delta fibres

Question 12

What type of fibre gives dull, aching and burning pain?

Answer 12

C fibres

Question 13

Which fibres are responsible for referred pain and where does it usually rate to?

Answer 13

C fibres as the radiating pain is dull and achy.

Radiates to the ipsilateral side. (same side)

Question 14

What is involved in a full endodontic examination?

Answer 14

after the C/O, HPC, PMH, PDH, SH
E/O
I/O
Soft tissues and intraoral swellings 
Sinus tracts 
Palpation 
Percussion (TTP)
Mobility 
Periodontal exam BPE

Question 15

What type of fibres is an EPT testing?

Answer 15

A-delta fibres

Question 16

How would you carry out an EPT?

Answer 16

Dry the tooth and isolate.
Test on a healthy tooth first for a baseline feeling.
Then place toothpaste on the tooth and place the wand on the tooth. Ask the patient to hold (completing the circuit).
Slowing increase power till response and then repeat for adjacent teeth.

Question 17

What results are reliable for an EPT?

Answer 17

Negative results are a good indication of dead pulp.

Question 18

When is EPT not reliable?

Answer 18

In open apex teeth

In telling if the pulp condition is irreversible or reversible

Question 19

What is good about sinus tract-tracing?

Answer 19

Common in chronic apical abscesses and allow you to tract straight to the source of infection.

Question 20

Describe how you would identify a normal pulp?

Answer 20

The pulp would be symptom-free
Have no apical pathology or radiolucency
Responses to sensibility tests

Question 21

Describe reversible pulpitis?

Answer 21

There is inflammation of the pulp but it should resolve after appropriate management.

Question 22

What are some possible causes of the symptoms of reversible pulpitis?

Answer 22

Dentine hypersensitivity mimics the symptoms
Caries
Large restorations

Question 23

If a patient came to you, in practice with reversible pulpitis, how would they describe their symptoms?

Answer 23

They would describe to you, pain/sensitivity upon the stimulus of cold or hot drinks.
That pain then wouldn’t last long after

Question 24

What is symptomatic irreversible pulpitis?

Answer 24

This is inflammation of the pulp that cannot be fixed and RCT is needed to prevent spread.

Question 25

If a patient came to you, in practice with irreversible pulpitis, how would they describe their symptoms?

Answer 25

They would have SPAWNTANEOUS PAIN Upon stimulus, the sharp pain would last a lot longer (linger for 30s or more) OTC analgesia wouldn't help Postural changes would make it worse and referred pain is also indicated.

Question 26

What are some common aetiologies of irreversible pulpitis

Answer 26

Deep caries large restorations Pulpal exposures Root fractures

Question 27

What are the two main clinical ways of diagnosing pulpal issues?

Answer 27

Dental history Thermal tests As inflammation hasn't quite reached the apical tissues, therefore, there is no TTP.

Question 28

For asymptomatic irreversible pulpitis, how do you diagnose?

Answer 28

As the pulp responds normally to tests and doesn't display any clinical symptoms this can be difficult. However, the tooth usually has large amounts of caries or a deep restoration which if removed would result in a pulpal exposure.

Question 29

What is pulpal necrosis closely associated with?

Answer 29

Apical periodontitis

Question 30

What is are the symptoms of pulpal necrosis?

Answer 30

As the pulp is now dead it doesn't respond to thermal or EPT tests. As it comes with apical periodontitis, this means its TTP and has radiolucency in the apical region (osseous breakdown)

Question 31

Diagnosis of normal apical tissues?

Answer 31

Healthy bone levels all the apices. Lamina dura intact No TTP No radiolucency

Question 32

Symptoms of Symptomatic apical periodontitis?

Answer 32

Inflammation has spread to the apical region of the tooth. SEVERE pain to TTP, biting and palpation May or may not be associated with radiographic changes (depending on the stage of disease)

Question 33

Symptoms of Asymptomatic apical periodontitis?

Answer 33

Inflammation of the apical tissues but is not TTP or palpation However, can see radiographic changes.

Question 34

Describe how a chronic apical abscess presents?

Answer 34

It has a gradual onset Little to no discomfort with an intermittent discharge of pus through a sinus tract Radiographic signs of osseous destruction

Question 35

What is a chronic apical abscess a result of?

Answer 35

Pulpal necrosis

Question 36

If a patient came into your practice with a swelling containing pus on the gum, extreme tenderness to palpation and percussion. As well as radiographic changes. What would be your initial diagnosis?

Answer 36

acute apical abscess | They have rapid onset and are also spontaneous to pain

Question 37

What are some other systemic symptoms associated with an acute apical abscess?

Answer 37

Fever Malaise Lymphadenopathy

Question 38

What in condensing osteitis?

Answer 38

Inflammation causes the deposition of bone at the apices as a result of infection. Most common on pre-molars

Question 39

What are the treatment options for endodontic cases?

Answer 39

``` RCT Re-RCT Ex leave and monitor Surgical intervention ```