Pain Diagnosis and Indications for Extractions

Question 1

What does Tx mean?

Answer 1

Treatment

Question 2

What is normal mouth opening?

Answer 2

35mm (3 fingers)

Question 3

What should you describe about a swelling?

Answer 3

Size, site, and firm/soft

Question 4

What are the common special tests?

Answer 4

Tender to Tap Test, Millers Mobility Index, sensitivity testing (ethyl chloride, EPT), periodontal pocketing, radiographs (usually IOPA/OPG)

Question 5

What is grade 0 of Millers Mobility Index?

Answer 5

No mobility

Question 6

What is grade 1 of Millers Mobility Index?

Answer 6

<1mm mobility in buccolingual direction

Question 7

What is grade 2 of Millers Mobility Index?

Answer 7

> 1mm and <2mm mobility

Question 8

What is grade 3 of Millers Mobility Index?

Answer 8

> 2mm mobility/depressibility in socket

Question 9

What does one deep pocket often indicate?

Answer 9

Root fracture

Question 10

What is the general rule of radiographs for extractions?

Answer 10

> 12 months old take a new radiograph

Question 11

What is the radiograph of choice prior to extractions for third molars?

Answer 11

OPG (ID canal)

Question 12

What is the radiograph of choice prior to extractions with the exception of third molars?

Answer 12

Periapical

Question 13

What structures are adjacent to the upper 6’s?

Answer 13

Maxillary sinus

Question 14

What structures are adjacent to the lower third molars?

Answer 14

ID canal

Question 15

When can a treatment plan be formulated?

Answer 15

Only once a diagnosis has been made

Question 16

What are the types of dental pain?

Answer 16

Reversible pulpitis, irreversible pulpitis, acute apical periodontitis, chronic apical periodontitis, acute apical abscess, and chronic apical abscess

Question 17

What are the features of history of reversible pulpitis?

Answer 17

Provoked, pain with stimulus (cold/ sweet), short lived, and sharp pain

Question 18

What are the usual clinical findings of reversible pulpitis?

Answer 18

Caries and tooth usually restorable

Question 19

What is the usual sensibility testing for reversible pulpitis?

Answer 19

Hypersensitive to cold test and vital

Question 20

What is the TTP for reversible pulpitis?

Answer 20

Negative

Question 21

What are the usual radiographic findings for reversible pulpitis?

Answer 21

Caries in tooth, not into pulp and normal apical tissues

Question 22

What is the usual treatment of reversible pulpitits?

Answer 22

Removal of caries and restoration

Question 23

What are the features of history of irreversible pulpitis?

Answer 23

Spontaneous intense pain, pain lasts much longer than stimulus, and some patients find cold water helps pain

Question 24

What are the usual clinical findings of irreversible pulpitis?

Answer 24

Deep caries, usually into/very close to pulp

Question 25

What is the sensibility testing for irreversible pulpitis?

Answer 25

May be positive/no response

Question 26

What is the TTP for reversible pulpitis?

Answer 26

Usually, negative

Question 27

What are the radiographic findings for irreversible pulpitis?

Answer 27

Caries in tooth, usually into pulp, and normal apical tissues

Question 28

What is the usual treatment for irreversible pulpitits?

Answer 28

RCT/extraction

Question 29

What are the features of history of acute apical periodontitis?

Answer 29

Severe aching pain, keeping patient awake at night, analgesia may not be helping

Question 30

What are the usual clinical findings of acute apical periodontitis?

Answer 30

Deep caries, involving pulp/severe periodontal disease (perio-endo lesion)

Question 31

What is the sensibility testing for acute apical periodontitis?

Answer 31

Negative and non-vital

Question 32

What is the TTP for acute apical periodontitis?

Answer 32

Positive

Question 33

What are the radiographic findings for acute apical periodontitis?

Answer 33

PDL widening, may/may not be an apical area If an apical area also known as ‘acute exacerbation of a chronic apical periodontitis’

Question 34

What is the usual treatment for acute apical periodontitis?

Answer 34

RCT/extraction

Question 35

What are the features of history of chronic apical periodontitis?

Answer 35

Tooth not painful, may be an incidental finding, and may be a history of previous pain which has settled

Question 36

What are the usual clinical findings for chronic apical periodontitis?

Answer 36

Deep caries, involving pulp and tooth broken down/severe periodontal disease (perio-endo lesion)

Question 37

What is the sensibility testing for chronic apical periodontitis?

Answer 37

Negative and non-vital

Question 38

What is the TTP for chronic apical periodontitis?

Answer 38

Negative

Question 39

What are the radiographic findings for chronic apical periodontitis?

Answer 39

Apical radiolucency

Question 40

What is the usual treatment for chronic apical periodontitis?

Answer 40

RCT/extraction

Question 41

What are the features of history of acute apical abscess?

Answer 41

Severe pain, swelling, and may be feeling unwell with a fever

Question 42

What are the usual clinical findings of acute apical abscess?

Answer 42

Swelling (intra oral +/- extra oral swelling) pus collection, and may be perio/endo in origin

Question 43

What is the sensibility testing of acute apical abscess?

Answer 43

Negative and non-vital

Question 44

What is the TTP of acute apical abscess?

Answer 44

Positive

Question 45

What are the radiographic findings of acute apical abscess?

Answer 45

PDL widening, may/may not be an apical area

Question 46

What is acute apical abscess known as if radiographic findings of an apical area?

Answer 46

Acute exacerbation of a chronic apical abscess

Question 47

What is the usual treatment of acute apical abscess?

Answer 47

Establish drainage, then definitive treatment RCT/XLA

Question 48

How long does it take for a periapical area to appear on a radiograph?

Answer 48

2 weeks

Question 49

What are the features of history of a chronic apical asbcess?

Answer 49

Not usually painful, small swelling that drains, bad taste

Question 50

What are the usual clinical findings of a chronic apical abscess?

Answer 50

Sinus/draining sinus on gingivae

Question 51

What is the usual sensibility testing of a chronic apical abscess?

Answer 51

Negative and non-vital

Question 52

What is the TTP of a chronic apical abscess?

Answer 52

Negative

Question 53

What are the radiographic findings of a chronic apical abscess?

Answer 53

Apical radiolucency

Question 54

What is the usual treatment of a chronic apical abscess?

Answer 54

RCT/extraction

Question 55

What are GP points used for?

Answer 55

To track through sinus tracts to locate the source of infection and the offending tooth

Question 56

What are hard palate abscesses most commonly related to?

Answer 56

Maxillary lateral incisors

Question 57

Why may you get a positive sensibility test in a multi-rooted tooth in acute apical periodontitis?

Answer 57

Mesio-buccal root is vital and distal is non-vital

Question 58

What other condition has features that are similar to reversible pulpitis?

Answer 58

Dentine hypersensitivity

Question 59

What is the weight limit for the dental chair?

Answer 59

21 stone

Question 60

What is pericoronitis?

Answer 60

An inflammation/swelling of your gum tissue

Question 61

What is orthognathic surgery?

Answer 61

Corrective jaw surgery

Question 62

What is a coronectomy?

Answer 62

Remove the crown of the tooth and leave the tooth's roots in your jaw, intact

Question 63

How is pericoronitis diagnosed?

Answer 63

Clinically with the presence of soft tissue inflammation and swelling