Lec 4 Flashcards
(36 cards)
WNL (normal pulp)
pulp is symptom free w/ normal response to all pulp tests
-hot, cold response WNL, no lingering
-EPT WNL, similar to other teeth
-percussion negative
-no radiographic changes (never seen in vital pulp!)
-no damage or axial cracks
RP (reversible pulpitis)
inflammation of pulp based on findings that resolve and return to normal. Pt CC may be cold sensitive
-cold sensitive, does NOT linger
-percussion negative
-no radiographic changes
SIP (symptomatic irreversible pulpitis)
vital inflamed pulp that is incapable of healing, linger pain to cold, heat sensitivity, spontaneous pain
CC: Cold sensitive
-cold sensitive, LINGERS 15-20 sec
-percussion negative
-no radiographic changes (still vital)
-look for cracks or caries
-may be HOT SENSITIVE if late SIP (normal teeth not hot sensitive)
AIP (asymptomatic irreversible pulpitis)
vital inflamed pulp incapable of healing, no clinical symptoms. Inflamed due to caries, trauma
normal (+) cold response?
pulpal necrosis
death of pulp, no response to tests, can see PA lesion on radiographs
-no response to hot, cold, or EPT
-can see PA lesion on radiographs
-Pt is probs asymptomatic but hx of symptoms
-tooth turns dark colored
PT (previously treated)
tooth has been treated and obturated
-could need retreatment or extraction
PIT (previously initiated treatment)
tooth has had partial endodontic therapy (pulp cap, pulpotomy, pulpectomy) but RCT not complete
-no obturation
5 elements of clinical exams and testing
medical and dental hx
CC + signs/symptoms
clinical exam
clinical testing
radiological indications
each tooth needs how many diagnoses?
2
pulpal
peri-radicular
what are the types of clinical tests (5)
thermal
EPT
percussion
palpation
perio probing & motility
what radiographs are required for endo dx (3)
straight on PA
shift shot PA (20 degrees)
BWX
peri-apical diagnostics:
WNL
teeth not sensitive to percussion
not sensitive to palpation
lamina dura intact
PDL uniform and unbroken
no radiolucency
no symptoms
SAP (symptomatic apical periodontitis)
inflammation of periodontium
painful response to biting, percussion, palpation
may or may not see RL
Pt is in pain
no swelling
AAP (asymptomatic apical periodontitis)
inflammation/destruction of periodontium
pulpal origin, pulp is non vital
-no sensitivity to percussion/palaption
-radiolucency seen w/ no clinical symptoms
-LEO 100% of the time, no pain
AAA (acute apical abscess)
inflammatory rxn to pulpal infection
pulp is necrotic
RAPID onset of pain, swelling, tooth tender to pressure/percussion
pus formation
SWELLING & FEVER
-may or may not see PARL
-NO DST
-can lead to cellulitis
CAA (chronic apical abscess)
gradual onset
little to no discomfort or pain
no sensitivity to percussion/palpation/biting
no swelling or fever, no pain
will see PARL always
DISTAL SINUS TRACT ALWAYS PRESENT
CO (condensing osteitis)
diffuse RADIOPAQUE lesion
local bony rxn to a low grade inflammatory stimulus
-bone formed, not being resorbed
-asymptomatic, no tx (monitor)
craze lines
vertical lines in enamel
not a concern
fractured cusp
may be restorable
variable injury
transilluminate to see
cracked tooth
greenstick fracture
most common site is mand. 2nd or 1st molar, then max premolar
sharp pain upon biting then relief
pulp is usually vital at first
vertical root fracture
J shaped lesion on radiograph
drop off pocket
every tooth needs how many diagnoses?
2!
pulpal
peri-radicular
1st question to ask Pt?
what is your CC
best way to determine is to reproduce CC
can they localize source of pain?
if not, probs pulpal
(diffuse pain = pulpal)
what is the objective of clinical testing?
find and confirm the etiology of Pt CC
