Pulp and periapical diagnosis

Question 1

Pulp conditions
Periapical conditions

1. Symptoms from patient
2. Clinical signs, diagnostic tests.
3. What is the condition
4. Treatment

Answer 1

Pulp conditions
Normal pulp: mild, 1-2s cold test

Reversible pulpitis: Presents like dentine hypersensitivity; sensitivity to cold drinks/food. Sharper discomfort that lingers for a couple seconds on cold test. It’s pulpal inflammation/irritation. Tx: removal of caries and restoration. May require indirect resto.

Irreversible pulpitis (symptomatic): Presents as severe, throbbing dull pain that keeps one up at night; sensitivity to hot drinks/food. Severe pain that lingers for >30s on cold test. Inflamed, infected pulp that cannot be healed. Tx: RCT

Pulpal necrosis: Prev Hx of irreversible pulpitis that appeared to resolve. No response to cold or hot.

—Once pulp canals are infected, following conditions can develop in the apical tissues:

Symptomatic apical periodontitis: Throbbing, severe pain on biting/pressure. Potential apical radiolucency and PDL space widening.

Asymptomatic apical periodontitis: No pain. Potential apical radiolucency and PDL widening.
——Condensing osteitis - variant of AsAP. Diffuse R/O lesion at apex - localised bony reaction to low inflamm; shd regress w Tx

Acute apical abscess: Severe pain on biting/pressure. Swelling, extremely tender gingival tissues on palpation. Sinus draining tract may be present; pus seen. Potential apical radiolucency and slight PDL space widening.

Chronic apical abscess: Prev history of swelling, no pain or tenderness currently. May be aware of sinus tract; bad taste and smell of the pus discharge. Apical radiolucency typical, PDL space widened.