Root Camp Lecture 13 - Diagnosis Flashcards
(85 cards)
1
Q
Which part of diagnosis?
What reasons does the patient give for seeking
treatment? (using pts own words)
A
CC
2
Q
Which part of diagnosis?
May find dental pathosis, but it is not the
pathologic condition causing patients chief
complaint
A
CC
3
Q
Patient will judge the outcome of the treatment
by whether the _______ _________ was managed or not
A
chief complaint
4
Q
Identification and localization of offending
tooth is straight forward during ______ phases
of dental pain
A
early
5
Q
Identification of pain source becomes more
complex in ______ phases
A
late
6
Q
What color would a tooth be if it is calcified?
A
Yellow
7
Q
What color would a tooth be if it is necrotic, there is an amalgam filling, or silver points?
A
Gray
8
Q
What color would a tooth be if it has trauma?
A
Pink or red
9
Q
T/F: PA lesions should remain at apex regardless of the angle of the X-Ray
A
True
10
Q
T/F: Lesions in cancellous bone can be detected on X-Rays
A
FALSE
The lesion can only be detected when there is erosion or perforation of cortical bone
11
Q
T/F: The pulp can be necrotic without a PA lesion
A
True
12
Q
What bone must be involved in order for a PA lesion to be visible?
A
Cortical bone
13
Q
Which radiographic diagnosis?
A low-grade inflammatory response that leads to an increase in bone density rather than
resorption and radiolucency
A
Condensing osteitis
14
Q
Which pulp vitality test?
Easiest; reasonably well-accepted by pt
A
Cold
15
Q
Which pulp vitality test?
Used when it is the CC
A
Heat
16
Q
Which pulp vitality test?
Used with calcified pulp chambers in teeth that respond negatively to cold
A
EPT
17
Q
Which pulp vitality test?
Used only if all else fails; rarely used
A
Test cavity
18
Q
Which pulp vitality test?
Not easily available or convenient
A
Laser doppler flowmeter
19
Q
Which diagnosis using the cold test?
Intense, prolonged pain
A
Irreversible pulpitis
20
Q
Which diagnosis using the cold test?
No response
A
Necrotic
21
Q
Which diagnosis using the cold test?
False negative
A
Calcified canals
22
Q
What are the 3 methods of cold testing?
A
Ice
Dry ice
Refrigerant spray
23
Q
Which method of cold testing?
Produces greater temperature decrease than other 2 options
A
Dry ice
24
Q
Which method of cold testing?
More reliable than ice in producing positive
response
A
Dry ice
Refrigerant spray
25
Which method of cold testing?
Equal in producing pulp response regardless of tooth or restoration
Dry ice
Refrigerant spray
26
Which method of cold testing?
Takes longer to elicit response
Dry ice
27
When cold testing, use a ________ ________ wih refrigerant spray. A cotton tip applicator is relatively ineffective
cotton pellet
28
Which pulp vitality test?
Does not measure degree of health or disease in pulp; just measures yes or no response (vital or necrotic)
EPT
29
Which pulp vitality test?
Rough indicator of presence or absence of vital nerve tissue in canals
EPT
30
Which pulp vitality test?
High readings indicate necrosis
Low readings indicate vitality
EPT
31
Which pulp vitality test?
Variables such as enamel thickness, position of probe, calcification, pt anxiety, and presence of open apex can affect response
EPT
32
Which pulp vitality test?
False positives from large metal restoration, wet tooth, or touching gingiva
EPT
33
Which pulp vitality test?
False negatives from dead battery, no lip clip, lips are dry, poor contact w/ tooth
EPT
34
Which pulp vitality test?
Pulpal "A" fibers respond to stimulus
EPT
35
Which pulp vitality test?
Indicates presence of functional neurons but does not indicate pulpal health
EPT
36
Which pulp vitality test?
Uses low-grade current to stimulate peripherally situated myelinated Ad nerve fibers
EPT
37
Which nerve fibers are most sensitive to oxygen deprivation and will stop working before pulp necrosis occurs?
Ad
38
In immature permanent teeth, the developmental ingress of ______ nerve fibers in the periphery of the pulp tissue is relatively late
Ad
39
Which pulp vitality test?
Not the test of choice for immature traumatized teeth
EPT
40
Which pulp vitality test?
Superior to cold testing in older teeth or teeth that have undergone pulp canal obliteration/mineralization because it does not rely on dentinal fluid flow to elicit a pulpal response
EPT
41
Studies have shown that that with age, the dentinal tubules decrease in size, and the amount of dentin fluid is reduced, making teeth less sensitive to ___________ changes
thermal
42
Where is the area of high neural density on anterior teeth?
Incisal edge
43
Where is the area of high neural density on posterior teeth?
Middle third
44
Conduction medium is necessary for proper probe contact with the tooth surface when using EPT. What 2 things could provide optimal conduction?
Toothpaste
KY gel
45
Which pulp vitality test?
Frictional w/ dry rubber cup or apply hot water
Heat
46
Which pulp vitality test?
Results may be similar to cold test
Heat
47
Which pulp vitality test?
Helpful when major symptom is heat sensitivity and pt can't identify which tooth
Heat
48
Which pulp vitality test?
Can be indicative of a degenerating pulp
Heat
49
What is the goal of pulp vitality testing?
Replicate the symptom
50
What order should you test the teeth?
Test suspicious tooth last
(don't forget to test adjacent, contra-lateral, and opposing teeth)
51
If this is present, trace with gutta percha point. If Endo lesion, it should lead to apex of involved tooth.
Sinus tract
52
Which pulp vitality test?
Helps distinguish between maxillary and mandibular arch
Selective anesthesia
53
Where do maxillary molars often refer pain to?
Mandible
54
Which pulp vitality test?
Positive result signifies inflammation in PDL, could be periodontal or occlusal trauma
Percussion
55
Which pulp vitality test?
Identifies vertical fractures - fractured segments do not transmit light similarly
Transillumination
56
Which pulp vitality test?
Used to test individual cusps for sensitivity
Tooth sleuth
57
__________ lesions can mimic endo lesions
Perio
58
Which diagnosis after perio probing?
Perio bone loss begins at crestal level and progresses apically; typical lesion is conical
Chronic lesion
59
Which diagnosis after perio probing?
Tract is usually only 1 mm wide (precipitous drop), occasionally may be 3-6 mm wide; coupled with non-vital response
Lesion w/ sinus tract
60
T/F: If you have an inconclusive or contradictory finding, often waiting one or two days will make a difficult diagnosis an easier one
True
61
A clinical diagnostic category in which the pulp is symptom free and normally responsive to vitality testing. No radiographic signs of pathosis
Normal pulp
62
What is the diagnosis?
A clinical diagnosis based upon subjective and objective findings indicating mild inflammation in the pulp tissue. If the cause is eliminated, the inflammation reverses and the pulp returns to normal
Reversible pulpitis
63
What is the diagnosis?
Patient History: Pain to cold or hot of short duration. No spontaneous pain. Can be asymptomatic.
Thermal: Hot and Cold sensitivity which goes away quickly <5 seconds
Percussion: Negative
Electric Pulp Test: Positive
Palpation: Negative
Radiograph: Normal PDL. Look for cause of
pulpitis: Deep restoration or Caries
Reversible pulpitis
64
What is the diagnosis?
Treatment includes excavation of caries or
restoration
-If no exposure: place pulp protection and
restoration
-If pulp has carious exposure and closed
apices, initiate RCT
-If apices of tooth are open, indirect pulp
therapy, direct pulp therapy, or partial
pulpotomy, pulpotomy may be indicated
Reversible pulpitis
65
What is the diagnosis?
A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing
Irreversible pulpitis
66
What is the diagnosis?
Lingering thermal pain, spontaneous pain, referred pain
Symptomatic irreversible pulpitis
67
What is the diagnosis?
No clinical symptoms, but inflammation produced by caries, caries excavation, trauma, etc. (large pulp exposure)
Asymptomatic irreversible pulpitis
68
What is the diagnosis?
Patient History: Pain which is prolonged from hot or cold stimulus or is spontaneous in nature
Thermal tests: Prolonged response (5-15+) seconds, especially to cold
Electric Pulp Test: Positive
Percussion: May be sensitive or normal
Palpation: Usually normal
Radiograph: May be normal, condensing osteitis, or thickened PDL
Symptomatic irreversible pulpitis
69
What is the diagnosis?
Treatment includes:
Access and locate canals
Pulp extirpation and complete instrumentation
of canals (Pulpectomy)
If sufficient time remains, obturate canals
with gutta percha and sealer
If insufficient time or patient/operator is
fatigued, place cotton pellets over canal orifices
and temporary filling
Irreversible pulpitis
70
What is the diagnosis?
A clinical diagnostic category indicating death of the dental pulp. The pulp is non-responsive to vitality testing
Necrosis
71
What is the diagnosis?
Usually asymptomatic but can be associated with spontaneous pain or pain to pressure (from periapical tissues)
Necrosis
72
What is the diagnosis?
A clinical diagnostic category indicating that the tooth has been endodontically treated and the canals are obturated with various filling materials, other than intracanal medicaments
Previously treated
73
What is the diagnosis?
A clinical diagnostic category indicating that the tooth has been previously treated by partial endodontic therapy (i.e. pulpotomy, pulpectomy).
Previously initiated therapy
74
What is the PA diagnosis?
Teeth with normal periradicular tissues that will not be abnormally sensitive to percussion or palpation testing. The lamina dura surrounding the root is intact and the PDL space is uniform. Pulp may be vital or necrotic
Normal apical tissue
75
What is the PA diagnosis?
Inflammation, usually of the apical periodontium, producing clinical symptoms including painful response to biting and percussion. It may or may not be associated with an apical radiolucent area
Symptomatic apical periodontitis
76
What is the PA diagnosis?
Inflammation and destruction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area and does not produce clinical symptoms
Asymptomatic apical periodontitis
77
What is the PA diagnosis?
Patient History: May complain of intermittent soreness
Thermal: Negative to Cold
Percussion: May be slightly sore or normal
Electric Pulp Test: Negative
Palpation: May have hard swelling over apex or just be sore to touch.
Radiograph: Periapical lesion or widened lamina dura present
Asymptomatic apical periodontitis
78
What is the PA diagnosis?
Treatment includes:
Access and locate canals
Complete Instrumentation
Obturate canals with gutta percha and sealer or place CaOH dressing in canals and cotton pellet + temporary restoration.
Less likely to obturate canals if tooth is symptomatic
Apical periodontitis (symptomatic or asymptomatic)
79
What is the PA diagnosis?
Acute sensitivity to percussion
Pulp may be vital (Irreversible Pulpitis in later stages)
Pulp may be necrotic (Could be acute flareup before abscess formation)
Make sure tooth is out of occlusion after treating
Symptomatic apical periodontitis
80
What is the PA diagnosis?
An inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation and swelling of associated tissues
Acute apical abscess
81
What is the PA diagnosis?
Patient History: Spontaneous pain, pain to pressure, swelling, possible fever, malaise
Thermal: Negative
Electric Pulp Test: Negative
Percussion: Extremely painful
Palpation: Very tender over apex, swelling on gingiva and/or face
Radiograph: Periapical lesion or thickened PDL
Acute apical abscess
82
What is the PA diagnosis?
Treatment includes:
Debride canals and irrigate (complete tx may be difficult due to anesthesia problems)
If copious drainage , let patient sit with rubber dam in place 15 min
When drainage stops, place cotton pellets and temporary filling.
Adjust occlusion
Prescribe antibiotics
Incision and drainage may be indicated
Complete root canal therapy at next appt
Acute apical abscess
83
What is the PA diagnosis?
Treatment includes:
Block anesthesia, if possible
Open tooth, stabilize with finger, vibrations may hurt even if anesthetized
Allow drainage for several min., irrigate, WL and enlarge canal, may leave open if drainage persists
Antibiotics and warm saline rinses
If swelling is fluctuant, incision and drainage where lesion seems to be pointing
Acute apical abscess
84
What is the PA diagnosis?
An inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little or no discomfort and the intermittent discharge of pus through an associated sinus tract.
Chronic apical abscess
85
What is the PA diagnosis?
Tx is same as for apical periodontitis, but more likely to obturate canals at initial appointment because of less chance of flareup after treatment
Chronic apical abscess
