P1-ENDO-CHAPTER 1-Endodontic Diagnosis

tooth sensitivity and osteoradionecrosis

what are the effects of radiation therapy?

Acute maxillary sinusitis

is a common condition that may create diagnostic confusion because it may mimic tooth pain in the maxillary posterior quadrant

acute maxillary sinusitis

In this situation the teeth in the quadrant will be extremely sensitive to cold and percussion

localization

commencement

intensity

provocation

duration

what are the 5 basic directions for questioning when obtaining the patient's dental history?

there is internal dentin resorption and inflammation inside the tooth, perform RCT to prevent fracture

what is indicated by a pink discoloration of a tooth

HYPERALGESIA:

increased response to stimulus that is normally painful

ALLODYNIA

pain from stimulus that does not normally provoke pain

SPONTANEOUS PAIN

pain w/out stimulus

canine space infection

what causes loss of definition of the nasolabial fold on one side of the nose

maxillary central swelling

what causes swelling of the upper lip and base of the nose

swelling of buccal root apices of posterior teeth

what causes swelling of posterior cheek

swelling at apex of palatal root of maxillary molars

what causes swelling of posterior palate

swelling at apex of lateral incisors and palatal root of 1st premolar

what causes swelling of anterior palate

in the submental or submandibular space

where is extraoral swelling associated with mandibular incisors exhibited?

due to any root that exits at the facial aspect of the alveolar bone, and inferior to muscle attachment

what causes swelling of the mucobuccal fold

stoma

opening of the sinus tract

fistula

abnormal passageway between two organs or between an internal organ and the body surface

heat test

what vitality test should be done if the chief complaint is intense pain, and the patient cannot locate which tooth is sensitive

immediate, intense

what is the pain response in a heat test

gutta-percha, heated compound stick, dry prophy cup

what are used for a heat test

necrotic

the tooth responds to heat and is relieved by cold

cold test

the primary pulp testing method

vital pulp

false-positive response to a cold test

calcified canals

false-negative response to a cold test

anterior teeth

for which teeth is the cold test effective for?

electric pulp test

this vitality test is determined by the intactness and health of vascular supply

toothpaste

the most common medium used for EPT

false

EPT cannot reflect the disease status/health of the pulp

true/false

electric testing can reveal/reflect the disease status of the pulp, while cold testing cannot reveal the integrity of the pulp tissue

px with pacemaker

EPT is contraindicated in which patients?

test cavity

used only when all other tests are INCONCLUSIVE

false

true/false

referred pain crosses the midline

laser doppler flowmetry

pulse oximetry

what are the most accurate pulp vitality tests

pulse oximetry

laser doppler flowmetry

pulp vitality tests that assess the pulp blood supply

pulpitis

during cold test, the response is a lingering pain

acute pulpitis (symptomatic irreversible pulpitis)

during cold test, the response is an excruciating pain

contralateral and adjacent teeth

when percussing a tooth, what are the control teeth?

periodontal origin

what will be the interpretation of a periodontal probing where the bone loss is wide and is generalized?

endodontic origin

what will be the interpretation of a periodontal probing it is an isolated vertical bone loss and associated with a non-vital tooth?

+1 mobility

first distinguishable sign of movement greater than normal

+2 mobility

Horizontal movement no greater than 1mm

+3 mobility

horizontal tooth movement greater than 1 mm, with or without the visualization of rotation or vertical depressability

class I furcation defect

the furcation can be probed but not to a significant depth

class II furcation defect

the furcation can be entered into but not completely through to the opposite sied

class III furcation defect

the furcation can be probed completely through

refrigerant spray (most common)

frozen CO2 (must not contact soft tissues because it can burn the tissue)

what are used for a cold test?

sensitivity

The ability of a test to identify teeth that are diseased

specificity

Relates to the ability of a test to identify teeth without disease

Laser Doppler Flowmetry

A method used to assess blood flow in microvascular systems

Pulse oximetry

Designed to measure the oxygen concentration in the blood and the pulse rate

bite test

percussion

used if the patient presents with pain on biting that is unclear

Periradicular periodontitis

Pain to percussion and biting tests regardless of the location of the coronal pressure

Cracked tooth or fractured cusp

Elicit pain only when percussion or bite test is applied to certain coronal location

tooth slooth and FracFinder

what instruments are used for a bite test?

fractured cusp

presence of pain upon release of biting pressure

methylene blue dye

what is used to stain cracked areas?

o Mastication

o Locally applied temperature changes

Majority of initiating factors that cause dental pain

it releases infectious exudates, resulting in relief of pain

therefore, a periapical infection with a sinus tract is not painful!

what is the function of a sinus tract?

1. alveolar mucosa

2. attached gingiva

3. furcation

4. gingival crevice

what are the sites where an intraoral stomata can open into?

it indicates active periradicular inflammation!

but it does not indicate whether it is of endodontic or periodontal origin

what does a positive response to palpation indicate?

true

True/false

any tooth exceeding +1 mobility is abnormal

1,1,1,2-tetrafluoroethane

what is the component of a refrigerant spray?

-26.2 degrees celcius

what is the temperature of a refrigerant spray?

cold test

what is the best test for younger patients with developing apices?

true

true/false

- electric pulp test results are most accurate when no response is obtained to any amount of electric current

diode

it projects an infrared light beam through the crown and pulp chamber of a tooth during LDF test

light beams will shift in frequency when passing through moving red blood cells, and will be unshifted when passing through static tissue

what is the Doppler principle?

laser doppler flowmetry

what is the greatest indicator of pulp vitality in luxation injuries?

#1 or #2 round bur w/ air and water

what instrument is used for a test cavity?

stop testing, and perform class I cavity restoration

patient feels sensitivity during test cavity

perform RCT

patient does not feel sensitivity during test cavity

intraligamentary anesthesia

what injection method is used when doing selective anesthesia?

C fibers

referred pain is provoked by what nociceptors?

maxillary incisors

offending teeth for referred pain in the forehead region

maxillary canines, premolars

offending teeth for referred pain in the nasolabial region

maxillary second premolars

offending teeth for referred pain in the temporal region

mandibular molars

offending teeth for referred pain in the ear (auricles), angle of jaw, or posterior regions of the neck

mandibular anteriors and premolars

offending teeth for referred pain in the mental region of the mandible

maxillary molars

offending teeth for referred pain in the zygomatic, parietal, and occipital regions of the head

maxillary/mandibular molars

offending teeth for referred pain in the opposing quadrant or to other teeth in the same quadrant

pulse oximetry

useful for assessing teeth with traumatic injuries where conventional tests may be unreliable, but has mixed study results on its effectiveness for pulp health diagnosis

a-delta fibers

which nociceptors are stimulated during dentinal fluid movement?

craze lines

Are merely cracks in the enamel that do not extend into the dentin

fractures

Are cracks that extend deeper into the dentin and primarily extend mesially to distally, involving the marginal ridges

split tooth

Occur when a fracture extends from one surface of the tooth to another surface of the tooth, with the tooth separating into two segments

vertical root fracture

one of the more common reasons for recurrent endodontic pathosis and is a severe crack in the tooth that extends longitudinally down the long axis of the root

endodontic treatment

it is the most common dental procedure that contributes to vertical root fractures

when the patient complains of varying pain intensity that occurs on a tooth when they "bite a certain way"

and also correlate it with their dental history if endodontic treatment occurred previously (placement of post and core), and if tooth was later used as an abutment for a bridge

what patient complaint can help a clinician diagnose/determine a vertical root fracture?

direct surgical exposure

what is the best way to diagnose a split tooth/vertical root fracture?

1. cement trail

2. halo-like bone loss

3. isolated bone loss

what are the radiographic signs of a vertical root fracture?

cement trail

- it appears more diffuse that obturated accessory canals!

this radiographic sign of a vertical root fracture typically occurs after endodontic treatment because of the material itself that extrudes out of the fracture site and can be mistaken as obturated accessory canals

halo-like bone loss

this radiographic sign of a vertical root fracture traverses circumferentially around the root, and may also travel completely up one side of the root resulting in a "J-type" lesion

isolated bone loss

this radiographic sign of a vertical root fracture is extensive bone loss that is isolated to just one tooth in the absence of advanced periodontal disease

partial pulp necrosis

tx - RCT

Pulp testing over one root may give no response and another root positively respond

Symptomatic Apical Periodontitis

Clinical symptoms including painful response to biting or percussion or palpation

Asymptomatic Apical Periodontitis

Appears as an apical radiolucent area and does not produce clinical symptoms. Patient is not sensitive to bite pressure but will feel different on percussion

nociceptive fibers (a-delta and c fibers)

what are the nerve fibers in the dental pulp?

A-delta fibers

nerve fibers that give off a fast and sharp pain

C fibers

nerve fibers characterized with slow and dull pain

A-delta fibers - COLD

C fibers - HOT

which nerve fibers respond to (a) cold and (b) hot testing?