Tooth pain, Diagnosis and Management Flashcards
(32 cards)
What 6 things can cause pulpal/periapical disease?
- Dental caries (bacteria)
- Dental trauma>cracks, fractures>bacteria.
- Cavity preparation
- Dental materials
- Bacterial leakage at the interface between tooth and restorations
- Exposure of dentine>leads to bacteria seeping in.
What 3 theories have been associated with dentine hypersensitivity?
- Direct Innervation (DI) theory
- Odontoblast Receptor (OR) theory
- Fluid Movement/Hydrodynamic theory
Which theory is most accepted for dentine hypersensitivity and describe it.
Hydrodynamic theory
There are changes in the direction of the flux of dentinal fluid within the dentinal tubules due to:
Heat and mechanical factors causing inward movements
Cold, evaporation, osmotic factors causing outward movements
The movement of dentinal fluid leads to mechancial deformation and activation of the sensory nerve terminals of alphadelta fibres located in close contact with odontoblasts.
What are the symptoms of dentine hypersensitivity?
Short sharp pain provoked by Hot and cold (mostly cold), acidic foods and drinks, sweet foods
starts as soon as the stimulus is applied
And disappears as soon as the stimulus is removed (may last a couple of seconds)
Give 7 causes of dentine hypersensitivity.
- Periodontal disease
- Periodontal treatment
- Excessive brushing or flossing
- Leaking restorations and crown preparations
- Cracked teeth
- Abfractions
- Erosions
What teeth are mainly affected by cracks?
Teeth with:
- Big amalgam/composite/GIC fillings
- Unsupported cusps
What is a tooth slooth used for?
To test bite and see if a tooth is cracked
What symptoms are seen with cracked teeth?
- Similar to dentine sensitivity AND:
- Pain on biting
How are cracked teeth treated?
- Use a microscope to see them.
- Warn the patients regarding prognosis of the tooth.
- Check their depth.
- Remove them if possible
- Prevent extension of the crack by placing an orthodontic band
- Make an composite onlay or filling
- Monitor the tooth for 6 months-one year (including periapical radiographs)
- Place a crown if needed.
What 6 tests can be used to test the vitality of the pulp?
- Thermal test
Cold test: ethylchloride, dichlorodiluoromethane (DDM)
Heat test: (heated gutta-percha)
2. Electric pulp test
3. Periapical radiograph
4. CBCT radiographic images
5. LDF and Pulse Oximetry:
Assessment of pulpal blood flow (unavailable in most surgeries and more often used only for scientific purposes)
6. Cavity test
Cavity preparation without anaesthesia.
Drill till beyond CEJ and see if patient responds.
When doing percussion and hot and cold tests what must always be done?
You must test on unsuspecting teeth first.
Test on teeth adjacent and opposite.
What can affect the response to hot and cold tests that is not to do with the pulp?
If the patient is taking pain killers
What are the symptoms for reversible pulpitis?
- Pain
- Pain is caused by cold, hot food or drinks, sweet food, fresh air.
- Pain lasts for a few seconds.
- Pain been there for a few weeks maybe months.
- Patient is able to identify the exact tooth/teeth that are cause of the pain.
What are the special test results for reversible pulpitis?
- Hot and cold test
Pain appears as soon as the stimulus is applied and disappears as soon as the stimulus is removed. - Electric test
Lower levels of electric current elicit the response compared to contra lateral teeth. - Percussion and palpation
No tenderness - Examination of radiograph
Caries or big filling close to the pulp - Cavity preparation without anaesthesia
The patient feels pain as soon as you reach dentine and the pain disappears as soon as you stop drilling.
What is the treatment for reversible pulpitis?
- Filling
- Dentine protection
- Pulp capping.
what is the symptoms for irrevsible pulpitits?
- Pain caused by cold, hot food, sweet food, fresh air and lasts for a longer time
- Cold drinks may relieve the pain
- Pain is often not provoked by a stimulus
- Pain lasts minutes, sometimes hours.
- Patient took pain killers for this and they somewhat work.
- Pain has been there for a few days.
- Patient is often not capable of identifying the tooth/teeth that are cause of the pain.
- Patient awake at night with pain
- Pain starts with some delay from the stimulus.
What is the treatment for irreversible pulpitis?
RCT
What are the special test results for irreversible pulpitis?
- Hot and cold test
Pain appears often with some delay and stays there for 2-3 mins or longer. Hot test very painful so have anaesthetic ready. - Electric test
Lower levels of electric current elicit the response compared to contra lateral teeth.
- Percussion and palpation
Little tenderness sometimes.
- Examination of radiograph
Caries or big filling close to the pulp, but also widening of PDL and periapical radiolucency sometimes.
- Cavity preparation without anaesthesia
The patient feels pain as soon as you reach dentine and the pain continues after stopping drilling (2-3 mins or more)
What are the symptoms for acute periapical abscess?
- Pain
- Pain caused by biting, swallowing, touching the tooth with the tongue
- Cold drinks and hot drinks do not affect the pain.
- Pain is often not provoked by a stimulus
- Pain lasts hours.
- Patient took pain killers for this and they were not effective.
- Pain has been there for a few days.
- Patient perfectly capable of identifying the tooth that is the cause of the pain.
- Patient awake at night with pain
What are the special test results for acute periapical abcess ?
1 Hot and cold test
No response as pulp is necrotic.
- Electric test
No response or response with very high levels. - Percussion and palpation
Very tender - Examination of radiograph
Caries or big filling close to the pulp plus periapical radiolucency (but not always). - Cavity preparation without anaesthesia
Not needed as tooth is already tender.
What are the 4 different variations of pulp necrosis?
- Necrosis of the pulp with normal periapical tissues- TTP sometimes
- Chronic apical periodontitis - TTP sometimes
- Chronic apical periodontitis with associated sinus (happens as abscess drains through area of least resistance) - TTP sometimes
- Acute periapical abscess - TTP sometimes
What are the 4 steps for clincial examination of the pulp?
- Inspection
- Palpation- check for pain and swelling w attached buccal mucosa.
- Percussion- start with using your finger.
- Periodontal probing- to assess the presence of pockets and root fractures- a deep pocket indicates this.
How can a root fracture be indicated with periodontal probing and what does this mean?
- A deep probing in one single point is indicative of root fracture.
- This means the tooth isn’t saveable and root canal treatment is futile.
Apart from pulpal problems what are 5 other causes of tenderness to percussion of a tooth?
- Periodontal disease (abscess)
- Trauma from occlusion (radiographic aspect)
- Sinusitis
- First or second molar may be tender when the third molar is erupting
- Food impaction
