Lecture 4 (9/12) Flashcards
(208 cards)
1
Q
Can cold testing be done with crowns?
A
yes
2
Q
It is ____ to often present as PURELY pulpal
A
unlikely
3
Q
What diseases go hand-in-hand?
A
Pulpal disease & periradicular disease
4
Q
How many diagnoses does each tooth need?
A
2 diagnoses
5
Q
What are the two diagnoses that each tooth need?
A
- pulpal diagnosis
- periradicular diagnosis
(maybe perio & restorative also)
6
Q
What is the first question to ask your in pain patient?
A
What is you chief complaint?
7
Q
When you ask the patient to “point to the tooth that hurts” you are asking them if they can:
A
Localize the source of pain
8
Q
If the source of pain is purely pulpal your patient will likely:
A
Be unable to localize the source of pain
9
Q
Why might the patient be unable to localize the source of pain that is purely pulpal?
A
Pulpal pain = diffuse pain
10
Q
How might we describe purely pulpal pain?
A
Diffuse pain
11
Q
It is important to understand the ____ before proceeding
A
Chief complaint
12
Q
The _____ is what brought the patient here
A
Chief complaint
13
Q
The objective of clinical testing is to:
A
Find and confirm the etiology of the patients CCs
14
Q
Conclusions in the study “associations between pain severity, clinical findings, and endodontic disease: a cross-sectional study” reveals that percussion hypersensitivity on healthy adjacent tooth may reveal a:
A
Lowered pain threshold and heightened pain sensitization
15
Q
Conclusions in the study “associations between pain severity, clinical findings, and endodontic disease: a cross-sectional study” reveals that a lowered pain threshold and heightened pain sensitization. It is also possible that the two commonly performed mechanical sensory tests, percussion and palpation hypersensitivity may detect:
A
Different aspects of endodontic pathophysiology and pain processing
16
Q
Performed based on chief complaint:
A
Clinical testing
17
Q
Some examples of clinical testing include: (5)
A
- thermal
- EPT
- Percussion
- Palpation
- Periodontal probing and mobility
18
Q
The thermal test (cold, heat) is testing he:
A
Pulp vitality
19
Q
An EPT is only done _______. This test is _____.
A
Only done if pulpal status is in doubt; NOT done routinely
20
Q
Clinical test performed by tapping with mirror to detect PDL sensitivity:
A
Percussion test
21
Q
Clinical test performed by digital touching of gingiva, detecting for inflammation, redness, swelling and tenderness:
A
Palpation
22
Q
Periodontal probing and mobility is testing for:
A
Periodontal health
23
Q
Following clinical testing what is the next step?
A
Obtain radiographs of the suspect areas
24
Q
When obtaining radiographs of the suspect areas, what is the minimum three diagnostic films that must be taken:
A
- straight-on PA film
- PA shift shot (20 degree change in horizontal angulation) M or D
- Bite-wing (to determine restorability and bone level)
25
After obtaining chief complaint, clinical testing and obtaining radiographs of suspect areas, you next:
Examine the collected data
26
What should you ask yourself when examining the collected data?
1. have you interpreted the test results correctly
2. have you identified the radiographic results correctly
3. do results support the CC
4. is there a reason for the pulpal condition noted
27
What might be some possible reasons for the noted pulpal condition?
-deep caries
-deep restoration especially composite
-evidence of trauma
-if virgin tooth- crack
28
Answering the question of "why?" usually leads to a _____ and more _____
Accurate diagnosis; successful treatment outcome
29
How many diagnoses do you need for a tooth in endodontics?
two
30
It is uncommon to have a PA lesion on a radiograph for a tooth with inflamed pulp and early necrosis: (T/F)
True
31
Reversible pulpitis would exhibit ______?
Cold sensitivity (non-lingering)
32
What is the diagnosis you would make for the following findings:
a) No PARL
b) Sensitive to cold (non-lingering)
c) Normal PDL
d) No heat sensitivity
e) No swelling
f) No response to percussion tests
- Reversible pulpitis
- Symptomatic irreversible pulpitis
- Asymptomatic irreversible pulpitis
- Necrotic pulp
Reversible pulpitis
33
You always test the suspected tooth first when doing sensitivity tests: (T/F)
False
34
When evaluating pulpal status, it may be helpful to think of the pulp existing in only three basic conditions, including:
1. normal
2. inflamed
3. infected
35
The outcome of "normal" pulp should:
Remains normal and healthy
36
What are the two categories of inflamed pulp?
1. Reversible
2. Irreversible
37
The outcome of "inflamed" pulp could:
recover or deteriorate
38
If someone presents with reversible inflamed pulp, what are your options? What is the outcome?
No treatment (if asymptomatic) or treatment (if symptomatic)
Recovery
39
If someone presents with irreversible inflamed pulp, it is most likely _____ but can be ____ (rare)
symptomatic; asymptomatic (rare)
40
Describe the pain associated with irreversible inflamed pulp:
Pain is lingering and often spontaneous
41
Lingering and often spontaneous pain describes:
Irreversible inflamed pulp
42
What is the outcome of infected pulp?
Will proceed to necrosis
43
If we think of pulp as a separate entity, we end up with a total of five pulpal diagnostic "boxes" including:
1. WNL (normal pulp)
2. RP (reversible pulpitis)
3. SIP (symptomatic irreversible pulpitis)
4. AIP (asymptomatic irreversible pulpitis)
5. N (Necrotic pulp)
44
What are two additional "diagnostic boxes" pertaining to the pulp that are easily seen on the X-ray and reported in recent dental history of the area?
PT & PIT
45
Normal pulp =
WNL
46
What would the CC of normal pulp likely be?
CC: None (asymptomatic currently & historically)
47
What would the results of the following clinical tests for a normal pulp be?
1. Thermal testing
2. EPT
3. Percussion
4. Radiographically
1. Hot-cold WNL
2. EPT responsive (similar to other WNL teeth)
3. Negative (WNL)
4. No radiographic changes
48
If clinical testing is all normal, minimal or no apparent damage, and no axial cracks in tooth:
LEAVE IT ALONE
49
Always test 2-3 adjacent teeth _____ to the tooth in question.
Why?
prior; establish a standard base-line
50
What would the diagnosis be for the following case:
CC: Cold sensitive
Clinical testing:
-Cold sensitivity #6 and #8 - pain relieved almost immediately once stimulus remove (NO LINGERING)
-Patient was referred for retreatment of #7 but only #6 and #8 symptomatic (with cold stimulus, not lingering, no spontaneous pain)
-Percussion negative (all three teeth)
-Unsure of radiographic changes
Reversible pulpitis
51
For the following case, what did the referring DDS miss? (3)
CC: Cold sensitive
Clinical testing:
-Cold sensitivity #6 and #8 - pain relieved almost immediately once stimulus remove (NO LINGERING)
-Patient was referred for retreatment of #7 but only #6 and #8 symptomatic (with cold stimulus, not lingering, no spontaneous pain)
-Percussion negative (all three teeth)
-Unsure of radiographic changes
1. failure to listen to patient's CC
2. Improper diagnosis due to failure to perform clinical testing
3. No need to do hot (CC was COLD)
52
Reversible pulpitis may follow 1 if 3 outcomes including:
1. if properly treated - may revert to normal
2. may remain reversible pulpitis symptomatic for extended period
3. May deteriorate to SIP or AIP (even if properly treated)
53
RP:
Reversible pulpitis
54
What would the diagnosis be for the following case:
CC: cold sensitive
Clinical testing:
-cold sensitivity #6 only that lingers 15-20 seconds after stimulus is removed
-percussion: negative
-radiographic changes: none at apex
-etiology present on radiograph (large cavity on #6)
Irreversible pulpitis (symptomatic)
55
SIP:
Symptomatic irreversible pulpitis
56
1. In early SIP _____ hurts > 10 and ____
2. In late SIP ____ hurts - ____ helps
3. &/or pain might be ______ or ______
1. cold; lingers
2. hot; cold
3. spontaneous; awakes patient from sleep
57
What stage of SIP is being described below?
-Cold hurts > 10 and lingers
Early SIP
58
What stage of SIP is being described below?
-Hot hurts - cold helps
Late SIP
59
What stage of SIP is being described below?
-Pain is spontaneous or awakes the patient from sleep
Late SIP
60
Normal teeth are NOT sensitive to ____
Hot
61
Gingiva are _____ sensitive to hot than teeth
More
62
Hot sensitivity usually indicates _____ = ____
Deteriorating pulp = SIP
63
AIP:
Asymptomatic irreversible pulpitis
64
Rarely, deep caries will _____ produce any symptoms, though clinically or radiographically, caries may extend well into the pulp
This is indicative of:
not; asymptomatic irreversible pulpitis
65
Rarely, deep caries will not produce any symptoms, though clinically or radiographically, caries may extend well into the pulp. This is indicative of asymptomatic irreversible pulpitis.
In such cases ______ is definitely indicated in order to prevent _____
RCT; a later exacerbation
66
NP:
Necrotic pulp
67
What would the diagnosis be for the following case:
CC: May be currently asymptomatic - usual history of symptomatic previously
Clinical testing:
-No response to cold, hot or electric pulp tester
Necrotic pulp
68
Describe the results to cold, hot and electric pulp testing with a necrotic pulp:
No response to any
69
PT:
Previously treated
70
PIT:
Previously initiated treatment
71
How would you label this tooth:
Obturated with final RC filling materials other than medicaments which is not healing or requires remedial treatment of some type.
PT
72
For a previously treated tooth:
Obturated with final RC materials other than medicaments which is not healing or requires remedial treatment of some type. This becomes a ____ or a ____ or simply ____ & replacement
Non-surgical retreatment; surgical RETX; extraction
73
In a previously initiated treatment, the tooth has been previously treated by:
Partial endodontic therapy
74
How would you label this tooth:
A failed pulp cap pr pulpotomy, or even a pulpectomy
Previously initiated treatment
75
Label with the correct pulpal diagnostic "box"
-Pulp is symptom free with normal response to pulp tests
WNL (normal pulp)
76
Label with the correct pulpal diagnostic "box"
-Inflammation of the pulp based on subjective and objective findings that should resolve and return the pulp to normal
RP (Reversible pulpitis)
77
Label with the correct pulpal diagnostic "box"
-Vital inflamed pulp that is incapable of healing i.e. lingering pain to cold, sensitivity to heat, spontaneous pain
SIP (Symptomatic irreversible pulpitis)
78
Label with the correct pulpal diagnostic "box"
-Vital inflamed pulp incapable of healing. No clinical symptoms. Inflamed due to caries (chronic hyperplastic pulpitis) caries excavation (pulp exposure), trauma (fracture with exposed pulp tissue)
AAP (Asymptomatic irreversible pulpitis)
79
Label with the correct pulpal diagnostic "box"
-Death of the dental pulp. (No response to pulp tests)
NP (Pulpal necrosis)
80
Label with the correct pulpal diagnostic "box"
-Tooth has been endodontically treated with canals obturated with final root canal filling materials other than medicaments
PT (Previously treated)
81
Label with the correct pulpal diagnostic "box"
-Tooth has been previously treated by partial endodontic therapy, i.e. pulp cap, pulpotomy/pulpectomy (RCT is NOT completed)
PIT (Previously initiated treatment)
82
Always remember, everything in diagnosis is:
Continually changing
83
-a pain which is diffuse today may be localized tomorrow
-a severe cold sensitivity may abate overnight
-the same tooth may become newly sensitive to bite nest day as pulp vitality succumbs to challenge
these are all example of:
The diagnosis continually changing
84
If left untreated long enough, both seriously inflamed and infected pulpits cases will ultimately:
lead to a necrotic pulp
85
Both seriously inflamed and infected pulpits cases will ultimately lead to a necrotic pulp if:
Left untreated long enough
86
Our diagnostic findings are simply a ______ during this continuum
snapshot in time
87
if you cannot arrive at a supportable diagnosis:
you CANNOT do any treatment
88
What should occur if you are unable to arrive at a supportable diagnosis?
No treatment, re-examine the tooth daily, if necessary, to monitor and diagnose
89
RARELY do we see _______ in cases of of pure pulpits or even early necrotic pulp
apical radiograph changes
90
Why do we rarely see apical radiograph changes in cases of pure pulpits or even early necrotic pulp?
Advanced pulpal disease or necrosis of the pulp is generally required to allow infection to affect the apical tissues
91
What is generally required to see apical radiographic changes?
Advanced pulpal disease or pulpal necrosis
92
Diagnose after reviewing all clinical tests:
Symptoms: None
Pulp testing:
-hot: N/A
-cold: WNL
-EPT: N/A or WNL
Percussion: WNL
Palpation: WNL
Probing: WNL
Mobility: WNL
Swelling:
-intraoral: None
-extraoral: None
-DST: None
Radiographic: No changes
Normal pulp (NP)
93
Diagnose after reviewing all clinical tests:
Symptoms: Pain to cold
Pulp testing:
-hot: N/A or +
-cold: + (not lingering)
-EPT: + (not lingering)
Percussion: WNL
Palpation: WNL
Probing: WNL
Mobility: WNL
Swelling:
-intraoral: None
-extraoral: None
-DST: None
Radiographic: No changes
Reversible pulpits (RP)
94
Diagnose after reviewing all clinical tests:
Symptoms: Pain to cold - possibly hot
Pulp testing:
-hot: N/A or +
-cold: + (lingers)
-EPT: + (lingers)
Percussion: WNL
Palpation: WNL
Probing: WNL
Mobility: WNL
Swelling:
-intraoral: None
-extraoral: None
-DST: None
Radiographic: No changes
Symptomatic irreversible pulpitis (SIP)
95
Diagnose after reviewing all clinical tests:
Symptoms: No symptoms
Pulp testing:
-hot: N/A or NR
-cold: N/A or NR
-EPT: N/A or NR
Percussion: WNL
Palpation: WNL
Probing: WNL
Mobility: WNL
Swelling:
-intraoral: None
-extraoral: None
-DST: None
Radiographic: No changes
Asymptomatic irreversible pulpits (AIP)
96
Diagnose after reviewing all clinical tests:
Symptoms: No symptoms - unless extends to per-radicular area
Pulp testing:
-hot: NR
-cold: NR
-EPT: NR
Percussion: WNL
Palpation: WNL
Probing: WNL
Mobility: WNL
Swelling:
-intraoral: None
-extraoral: None
-DST: None
Radiographic: No changes
Necrosis (NE)
97
(True/False): There is very little correlation between clinical symptoms and histo/pathological reality
True
98
(True/False): We can do histology without destroying the principle tissue we are trying to preserve
False
99
A periapical diagnosis must be supported & documented by ____ & _____ before any treatment planning can be done
clinical examination & testing
100
How do we support our peri-apical diagnosis?
Using evidence from clinical exam and testing (along with knowledge & experience)
101
The 5 elements of clinical examination & testing include:
1. medical & dental history
2. CC + signs & symptoms
3. Clinical examination
4. Clinical testing
5. Radiological indications
102
Radiographs which are generally of limited use in diagnosis of purely pulpal disease, may become of some value in _____ diagnoses
apical
103
Although radiographs may become of some value in apical diagnoses NEVER attempt to:
Make a diagnosis from radiographs alone
104
Why must you NEVER attempt to make a diagnosis based on a radiograph alone?
Many unrelated, non-odontogentic entitites can mimic LEOs radiographically (but in fact be something entirely different)
105
It is important to _____ all testing & examination done
Document
106
Following pulpal necrosis, the disease process rapidly extends:
Peri-apically
107
Following pulpal necrosis, the disease process rapidly extends peri-apically & the tooth will often become percussion + &/or spontaneous pain may appear:
BEFORE radiographic evidence is clear
108
Following pulpal necrosis (though it takes time), ______ % of medullary bone can be destroyed and no PARL
100%
109
Pulpal necrosis is only visible in _____% of cortical bone
40%
110
Progression of RC system infections:
1. _______ or ______ opens tubules to bacterial invasion
2. bacteria inflame the pulp _____
3. Inflammation may overcome pulpal defenses and _____ may form in _____
4. Infection increases in pulp and _____ begins
5. Necrosis involves ______
6. Infection uses ________ (apical foramen & lateral canals) to invade _____ (apical periodontitis)
7. Peri-radicular infection occurs beyond the apex (_______)
1. carious lesion or trauma
2. locally
3. localized abscess; coronal pulp
4. necrosis
5. the entire RC system
6. portals of exit; peri-radicular tissues
7. apical abscess
111
All peri-radicular inflammation is sensitive to:
(What does this differ from?)
Percussion
This differs from purely pulpal pain as it is NOT sensitive to percussion
112
Why can the patient likely point to the tooth that hurts when peri-radicular inflammation comes into play?
Mechanoreceptors (Proprioceptors) are present in the PDL (not in the pulp)
113
When the patient is able to point to the tooth that hurts, this means that the inflammation/infection from the pulp has already:
Reached the peri-apical tissues
(we are dealing with an apical diagnosis of some type)
114
If inflammation/infection from the pulp has already reached the peri-apical tissues, the offending tooth will now be:
Sensitive to percussion (however a lesion may not yet show on XR)
115
Apical diagnostic boxes include (6):
1. WNL (within normal limits)
2. SAP (symptomatic apical periodontitis)
3. AAP (asymptomatic apical periodontitis)
4. AAA (acute apical abscess)
5. CAA (chronic apical abscess)
6. CO (condensing osteoitis)
116
AAA = ________ and may be accompanied by _____
acute apical abscess (swelling & fever)
117
CAA= _______ and is typically accompanied by _____
Chronic apical abscess (PAR + DST)
118
Whenever a DST is present this signifies:
CAA
119
CO= _______ and typically has a _____ appearance on the XR and treatment is determined by _____
Condensing osteitis; radiopaque appearance; symptoms
120
Peri-apical diagnostic "boxes"
Teeth NOT sensitive to percussion or palpation. Lamina dura is intact and the PDL is uniform and unbroken:
WNL (normal)
121
Peri-apical diagnostic "boxes"
For WNL:
-Percussion test:
-Palpation test:
-Lamina dura:
-PDL:
1. not sensitive to percussion
2. not sensitive to palpation
3. lamina dura is intact
4. PDL is not broken
122
Peri-apical diagnostic "boxes"
Inflammation of the periodontium producing a painful response to biting/percussion/maybe palpation:
SAP (symptomatic apical periodontitis)
123
Peri-apical diagnostic "boxes"
For SAP:
-Inflammation of ______
-Percussion test:
-Biting:
-Palpation test:
1. inflammation of the periodontium
2. painful response to percussion
3. painful response to biting
4. possible painful response to palpation
124
Peri-apical diagnostic "boxes"
Inflammation and destruction of the periodontium that is of pulpal origin appearing as a radiolucent area with no clinical symptoms:
AAP (asymptomatic apical periodontitis)
125
Peri-apical diagnostic "boxes"
For AAP:
-Inflammation & destruction of _____ that is of _____ origin, appearing as a ______ with _____
periodontium; pulpal origin; radiolucent area; no clincial symptoms
126
Peri-apical diagnostic "boxes"
"Destruction of the periodontium"
Asymptomatic apical periodontitis (AAP)
127
Peri-apical diagnostic "boxes"
Inflammatory reaction to pulpal infection with rapid onset, spontaneous pain, tooth tender to pressure, pus formation and swelling and fever:
AAA (Acute apical abscess)
128
Peri-apical diagnostic "boxes"
For AAA:
-Inflammatory reaction to pulpal infection with _____ and _____
-The tooth is tender to ____
- _____ formation and _____ & _____
-rapid onset; spontaneous pain
-pressure
-pus formation, swelling & fever
129
Peri-apical diagnostic "boxes"
"SWELLING AND FEVER"
AAA (acute apical abscess)
130
Peri-apical diagnostic "boxes"
Inflammatory reaction to pulpal infection with gradual onset, little or no discomfort and draining sinus tract:
CAA (chronical apical abscess)
131
Peri-apical diagnostic "boxes"
"DRAINING SINUS TRACT"
CAA (Chronic apical abscess)
132
Describe the onset of chronic apical abscess:
Gradual onset
133
Describe the onset of acute apical abscess:
Rapid onset
134
Peri-apical diagnostic "boxes"
Diffuse radiopaque lesion representing a localized bony reaction to a low-grade inflammatory stimulis:
CO (condensing osteitis)
135
Peri-apical diagnostic "boxes"
"Localized bony reaction to a low-grade inflammatory stimulis"
(CO) condensing osteitis
136
Fill in the blanks:
1. Normal (WNL)
2. SAP (symptomatic apical periodontitis)
3. AAP (asymptomatic apical periodontitis)
4. AAA (Acute apical abscess)
5. CAA (Chronic apical abscess)
6. CO (condensing osteitis)
137
Fill in the blanks:
1. NO radiolucency
2. YES/NO radiolucency
3. YES radiolucency
4. YES/NO radiolucency
5. YES radiolucency
6. Radiopaque lesion
138
Fill in the blanks:
1. NO PAIN
2. PAIN
3. NO PAIN
4. PAIN
5. NO PAIN
6. N/A
139
Fill in the blanks for normal pulp (NP here but dont confuse this with necrotic pulp):
SYMPTOMS: none
PULP TESTING:
hot- N/A
cold- WNL
EPT- N/A or WNL
Percussion- WNL
Palpation- WNL
Probing- WNL
Mobility- WNL
SWELLING:
Intraoral- None
Extraoral- None
DST- None
Radiographic: No changes
140
Fill in the blanks for reversible pulpitis (RP):
SYMPTOMS: Pain to cold
PULP TESTING:
hot- N/A or +
cold- + (not lingering)
EPT- + (not lingering)
Percussion- WNL
Palpation- WNL
Probing- WNL
Mobility- WNL
SWELLING:
Intraoral- None
Extraoral- None
DST- None
Radiographic: No changes
141
Fill in the blanks for symptomatic irreversible pulpitis (SIP):
SYMPTOMS: Pain to cold - possibly hot
PULP TESTING:
hot- N/A or +
cold- + (lingering)
EPT- + (lingering)
Percussion- WNL
Palpation- WNL
Probing- WNL
Mobility- WNL
SWELLING:
Intraoral- None
Extraoral- None
DST- None
Radiographic: No changes
142
Fill in the blanks for asymptomatic irreversible pulpitis (AIP):
SYMPTOMS: No symptoms
PULP TESTING:
hot- N/A or NR
cold- N/A or NR
EPT- N/A or NR
Percussion- WNL
Palpation- WNL
Probing- WNL
Mobility- WNL
SWELLING:
Intraoral- None
Extraoral- None
DST- None
Radiographic: No changes
143
Fill in the blanks for necrotic pulp (NE):
SYMPTOMS: No symptoms unless extends to peri-radicular area
PULP TESTING:
hot- NR
cold- NR
EPT- NR
Percussion- WNL
Palpation- WNL
Probing- WNL
Mobility- WNL
SWELLING:
Intraoral- None
Extraoral- None
DST- None
Radiographic: No changes
144
What is the apical diagnosis for the following:
1. Tooth NOT SENSITIVE to percussion or palpation
2. Lamina dura IS INTACT
3. PDL IS UNIFORM- No radiolucency
4. NO SYMPTOMS- No CC
5. All pulp TEST WNL
6. NO APPARENT INJURY to the tooth
WNL
145
What other situations may result in similar symptoms to symptomatic apical periodontitis (SIP):
1. Recent high restoration
2. Occlusal habits (bruxism)
3. Trauma, etc.
146
A thickened PDL can be caused by:
1. occlusal trauma
2. PARL
147
Why is it important to check the occlusion when you see a thickened PDL?
A high restoration/occlusal trauma may caused a thickened PDL
148
What is the apical diagnosis for the following:
1. NO SENSITIVITY to percussion/palpation/biting
2. PULP NON-VITAL (apical destruction of pulpal origin)
3. THICKENED PDL space of P/A radiolucency
4. NO SWELLING - no DST
Asymptomatic apical periodontitis
149
With an apical diagnosis of AAA (acute apical abscess) describe the pulp:
necrotic
150
With an apical diagnosis of AAA (acute apical abscess), describe the response to biting, percussion or palpation:
SEVERE pain
151
With an apical diagnosis of AAA (acute apical abscess) describe the apical radiographic changes:
-thickened PDL space or P/A radiolucency
152
With an apical diagnosis of AAA (acute apical abscess), often mobile due to:
active infection in apical tissues
153
With an apical diagnosis of AAA (acute apical abscess) often _______ due to active infection in apical tissues
mobile
154
With an apical diagnosis of AAA (acute apical abscess) this is a rapidly developing infection so it presents with:
1. intraoral swelling
2. extraoral swelling
3. fever
(No DST)
155
With apical diagnosis of AAA (acute apical abscess), if the patient has rapid development of swelling (often severe), elevated temp/fever this is considered:
AAA with severe cellulitis
156
If a patient presents with AAA with severe cellulitis the treatment involves:
I&D - oral surgeon if extra-oral & patient often needs to be admitted
157
With an apical diagnosis of CAA (chronic apical abscess) this is considered:
NOT an emergency
158
What is the following apical diagnosis:
1. pulp necrotic
2. pain minimal or none
3. sensitivity to percussion, minimal or none
4. sensitive to palpation, minimal or none
5. swelling generally minimal or none
6. no fever
7. may have been present for extended periods of time
8. usually drainage via DST or gingival sulcus via narrow periodontal pocket
CAA (Chronic apical abscess) - not an emergency
159
Describe the pain that associated with a chronic apical abscess:
Usually no/minimal pain
160
What is associated with an intraoral draining sinus tract?
CAA
161
Are antibiotics required for CAA?
No (also no Rx analgesic)
162
______ is pathognomic for CAA
DST
163
Always trace out a draining sinus tract (DST) with:
Gutta percha cone & radiograph
164
What conditions may appear the same radiographically- which further emphasizes the need to diagnose based on the sum of patient history & symptoms, clinical exam, signs & symptoms and + radiographic interpretation:
SAP, AAP, AAA
165
Radiopaque formative or reactive bone:
CO (Condensing osteitis)
166
Treatment of CO (Condensing osteitis) is based on:
symptoms
167
CO develops in response to a mild or ______ where bone is actually formed instead of being resorbed or destroyed
"Sub-clinical" inflammation or infection
168
If CO is asymptomatic and no aparent pathology is present, how would you treat?
No treatment- continue to monitor
169
Differential diagnosis for CO:
Sclerotic bone (which is a non-pathology & requires no treatment)
170
You cannot do ANY TREATMENT for the patient until you have a:
supported diagnosis
171
If you cannot make a definitive diagnosis today, support the patient with appropriate _____ and follow up
supportive medications
172
Peri-radicular diagnosis: SAP
1. Symptoms:
2. Pulp testing:
-hot:
-cold:
-EPT:
3.
Percussion:
Palpation:
Probing:
Mobility:
4. Swelling:
-intraoral:
-extraoral:
-DST:
5. Radiographic:
1. sensitive to percussion & biting pressure
2. Variable (all three)
3.
Percussion: +
Palpation: Variable
Probing: Variable
Mobility: Variable
4. None
5. Thickened PDL or none
173
Peri-radicular diagnosis: AAP
1. Symptoms:
2. Pulp testing:
-hot:
-cold:
-EPT:
3.
Percussion:
Palpation:
Probing:
Mobility:
4. Swelling:
-intraoral:
-extraoral:
-DST:
5. Radiographic:
1. Not sensitive
2. No response to any
3. WNL (all)
4. None
5. Radiographic: Thickened PDL or none
174
Peri-radicular diagnosis: AAA
1. Symptoms:
2. Pulp testing:
-hot:
-cold:
-EPT:
3.
Percussion:
Palpation:
Probing:
Mobility:
4. Swelling:
-intraoral:
-extraoral:
-DST:
5. Radiographic:
1. Very sensitive to percussion & biting pressure
2. No response to any
3.
Percussion +++
Palpation: +++
Probing: Variable
Mobility: Variable
4. Rapid & extensive swelling with no DST
5. Thickened PDL or P/A area
175
Peri-radicular diagnosis: CAA
1. Symptoms:
2. Pulp testing:
-hot:
-cold:
-EPT:
3.
Percussion:
Palpation:
Probing:
Mobility:
4. Swelling:
-intraoral:
-extraoral:
-DST:
5. Radiographic:
1. May or may not be symptomatic
2. No response to any
3.
Percussion: + or none
Palpation: + or none
Probing: variable
Mobility: variable
4. minimal or no swelling and DST present
5. Definite PA area
176
Longitudinal tooth fractures are ______ and also called _____ tooth fractures
Important; vertical
177
-Longitudinal tooth fracture that is confined to the enamel
-common & generally unimportant
-don't stop light
Craze lines
178
-Longitudinal tooth fracture
-facial to lingual
-often involves undermined cusps & may be restorable
Fractured cusp (oblique shearing fracture)
179
-Longitudinal tooth fracture
- M-D fracture involving one or both marginal ridges
- may or may not involve the pulp
- may be confined to crown or extend to root
Cracked tooth (incomplete "greenstick" fracture)
180
A longitudinal fracture- cracked tooth, may also be called:
Incomplete "greenstick" fracture
181
A longitudinal fracture cusp, may also be called:
Oblique shearing fracture
182
-Longitudinal tooth fracture
-fracture extends to a surface in all areas
-involves crown, root & generally pulp
-must remove fractured segment & determine restorability
Split tooth
183
What is the treatment for a split tooth?
must remove fractured segment & determine restorability
184
-Longitudinal tooth fracture
-begins internally (at root apex or from crown)
-primarily in axial plane (may be F-L or M-D)
Vertical root fracture (VRF)
185
What is the most severe type of longitudinal tooth fracture?
Vertical root fracture (VRF) followed by split tooth
186
Horizontal fractures are also important but are generally ______ and usually associated with _____
easily seen; known traumatic events
187
Vertical lines in the enamel of teeth:
Craze lines
188
Craze lines are common and generally _____ and ______
asymptomatic; not a concern for endo
189
A fractured cusp is a HIGHLY VARIABLE injury meaning: (treatment)
Treatment can vary from a simple intracoronal restoration, to endodontic intervention to extraction
190
For a fracture cusp, if the pulp tested WNL, the normal procedure is to:
Remove the fractured cusp and see if the remaining tooth structure will support a restoration
191
A cracked tooth may also be called:
"greenstick" fracture
192
The most common site for a cracked tooth (greenstick fracture) is:
mandibular 2nd molar or 1st molar followed by maxillary premolars
192
Cracked tooth (greenstick fractures) are often seen in teeth:
without caries or restorations
192
A cracked tooth (greenstick fracture) is most often discovered following patient complaint of:
acute, sharp, momentary pain upon biting or release of biting pressuer
193
Describe the pulp in a cracked tooth (greenstick fracture):
Generally pulps is vital in early stages & may remain so for some time
193
A cracked tooth will continue to cause pain, as long as:
Pulp remains vital
194
What syndrome is associated with a greenstick fracture?
Cracked tooth syndrome
195
A ______ in an otherwise healthy periodontal mouth may be a tip-off that a longitudinal (axial) crack may extend into the root and therefore create a guarded or hopeless prognosis
Drop-off periodontal pocket
196
Whats it called when your perio measuring looks something like 3-3-3-3-8-3:
Drop-off periodontal pocket
197
A NARROW pocket that often indicates the extension of a crown fracture into the root:
Drop-off periodontal poclet
198
A drop-off periodontal pocket may signal a _____ tooth
Nonrestorable
199
What does a drop-off periodontal pocket indicate?
extension of a crown fracture into the root
200
When looking for a vertical root fracture, look for:
J-shaped (halo) apical bony lesion
201
When searching for a vertical root fracture, probe for:
Drop-off pocket
202
VRFs are difficult to confirm ______ unless ______ occurs
Radiographically; separation of segments
203
The only ABSOLUTE CERTAIN WAY to determine a vertical root fracture is to:
expose it surgically & stain (possibly microscope use)
204
Label the following fracture types:
A) fractured cusp
B) Incomplete crown fracture
C) Incomplete crown-root fracture
D) split tooth
E) Vertical root fracture
205
