Endodontics Diagnosis Flashcards
(36 cards)
What type of pain/sensation is associated with A-delta fibres?
- Sharp pricking sensation
2. Early shooting pain
What type of pain/sensation is associated with C fibres?
- Dull aching or burning
2. Late dull pain
What is the term given for the perception of pain in one part of the body distant from the source of pain?
Referred pain
What causes referred pain?
Usually caused by intense stimulation of C- fibres
What are 4 general rules of referred pain?
- Always radiates to the ipsilateral (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 to anterior teeth
- Mandibular posterior teeth refer pain to periauricular area more often than maxillary
List the components that make up an endodontic examination
- Extra oral exam
- Intra oral exam
- Soft tissue exam
- Intra oral swelling
- Sinus tracts
- Palpation
- Percussion
- Mobility
- Periodontal exam
What is a complication of sensibility/vitality testing in a multi rooted tooth?
Tooth may respond positively to test, but there may still be a necrotic or irreversibly damaged root canal
What is a complication of heat tests?
Too much heat can cause irreversible pulpitis
What nerves are primarily stimulated by electric pulp test?
A-delta fast conducting fibres
What is an advantage of an electric pulp test (EPT)?
Negative response is a reliable indicator
What are some drawbacks of EPT?
- No indication of reversibility of inflammation
- No correlation between threshold and pulp condition
- EPT off teeth with open apices is unreliable
List 4 special tests aside from heat, cold and EPT
- Bite test (using frac finder)
- Test cavity (not popular)
- Staining and trans-illumination
- Selective anaesthesia
How should you think in terms of diagnosing features of a radiograph?
- Top of tooth: crown
- Middle of tooth: pulp
- Bottom of tooth: apex, bone and soft tissue
What are the 7 main pulpal diagnoses?
- Normal pulp
- Reversible pulpitis
- Symptomatic irreversible pulpitis
- Asymptomatic irreversible pulpitis
- Pulp necrosis
- Previously treated
- Previously initiated therapy
Describe some features that can help identify irreversible pulpititis
- Inflammation should resolve following appropriate management of the aetiology
- Discomfort is experienced when a stimulus is applied only lasting a few seconds
- Periapical region of the suspect tooth appears normal on radiograph
- Pain experienced is not spontaneous
What are characteristics of symptomatic irreversible pulpitis?
- Sharp pain upon thermal stimulus
- Lingering pain often 30 seconds or longer after stimulus removal
- Spontaneous pain (unprovoked)
- Referred pain
What are common aetiologies of irreversible pulpitis?
- Deep caries
- Extensive restorations
- Fractures exposing pulpal tissues
What can make symptomatic irreversible pulpitis hard to diagnose?
If Inflammation has not yet reached periapical tissues, resulting in no pain or discomfort to percussion
What are the main methods for testing pulpal status?
Dental history
Thermal testing
Describe the normal clinical presentation of asymptomatic irreversible pulpitis
- No clinical symptoms, usually responds normally to thermal testing
- However may have had trauma or deep caries that would likely result in pulp exposure following removal
What does pulp necrosis indicate?
Indicates death of the dental pulp and need for root canal treatment
How does a tooth with necrotic pulp respond to pulp testing?
Non- responsive to pulp testing and is asymptomatic
Does necrotic pulp cause apical periodontitis?
No
Can previously treated teeth respond to thermal or electric pulp testing?
Typically no, however in maxillary molars if there is a 4th root canal, some nerve tissue may cause a response
