P1-ENDO-CHAPTER 1-Clinical Classification of Pulpal and Periapical Diseases

Pulpal diagnosis

Periapical diagnosis

what are the 2 diagnosis?

pulp vitality tests

what are the tests needed for pulpal diagnosis?

-percussion test

-palpation

-bite test

-mobility

what are the tests needed for periapical diagnosis?

normal pulp

symptom-free pulp, responds to pulp tests

mild, do mot cause distress, transient sensation that disappears in seconds

response of normal pulp to pulp tests

normal pulp

in radiograph, there is varying degrees of pulpal calcification, no resorption or mechanical pulp exposure therefore there is no need of endo tx

Pulpitis

inflammation of the dental pulp

pulp polyp

pulpitis is also known as?

true

true or falsies

a pulp with pulpitis is still VITAL, it is just inflammed

non-vital

if pulp is necrotic, it is?

dedz na dedZ

if pulp is swelling, it is?

reversible pulpitis

when the pain within the tooth is irritated so that the stimulation is uncomfortable to the patient, but reverses quickly after irritation

caries, exposed dentin, recent dental treatment, defective resto

what are the possible causes of reversible pulpitis?

conservative removal of the irritant

what is the treatment for reversible pulpitis?

dentinal hypersensitivity

reversible pulpitis may be confused with?

dentinal hypersensitivity

it is an exposed dentin but without pulp pathosis

removal of the diseased tissue

what is the treatment for the irreversible pulpitis?

symptomatic

asymptomatic

irreversible pulpitis is divided into

symptomatic irreversible pulpitis

there is an intermittent or spontaneous pain, pulp is incapable of healing

symptomatic irreversible pulpitis

when rapid exposure of teeth to dramatic temperature changes (esp. cold), there is hightened and prolonged episodes of pain even after the thermal stimulus has been removed

symptomatic irreversible pulpitis

based on the radiograph, there is minimal or no changes of periradicular bone, thickening of PDL, pulpal irritation

extensive pulp chamber

root canal space calcification

the pulpal irritation in symptomatic irreversible pulpitis seen in radiograph is because of this two:

asymptomatic irreversible pulpitis

similar to symptomatic, but px reports NO PAIN

asymptomatic irreversible pulpitis

deep caries will not produce any symptoms, even though clinically or radiographically the caries may extend well into the pulp

true

true or falsies

In cases of asymptomatic irreversible pulpitis, endodontic treatment should be

performed as soon as possible so that symptomatic irreversible

pulpitis does not take place and result in severe pain and

patient distress.

Pulp necrosis

death of dental pulp which gradually happens

pulpal blood supply is non-existent

pulpal nerves are non functional

what happens to the pulpal blood supply and pulpal nerves during pulp necrosis?

Pulp necrosis

not respond to EPT or cold test, may respond to prolonged heat

remnants of fluid/gases in the pulp canal space expands and extends into the periapical tissues when exposed to heat

why do necrotic pulp may still respond to prolonged heat?

tooth injury

it mimics pulpal necrosis in the same way that it also do not respond to tests, therefore dental history is imperative

Pulp necrosis

it may be partial or complete because it may not involve all of canals in a multirooted tooth

necrotic pulp--> bacterial growth sustained within canal--> bacterial toxins from this infection extends into the PDL space--> tooth becomes symptomatic to percussion/spontaneous pain

how can the pulp necrosis become symptomatic to percussion or exhibit spontaneous pain?

pulp necrosis

tooth may become hypersensitive to heat, even to the warmth of the oral cavity

application of cold

how can the hypersensitivity to heat during pulp necrosis be relieved?

previously treated

tooth has already had nonsurgical root canal therapy and it may or may not present with signs/symptoms

previously initiated therapy

those cases that present with partial endodontic therapy, either pulpotomy or pulpectomy

pulpotomy

Removal of the coronal portion of a vital pulp from a tooth

pulpectomy

Complete removal of vital pulp from a tooth

previously initiated therapy

when presented for RCT, it would not be possible to make an accurate pulpal diagnosis since all or part of the pulpal tissue has already been removed

normal

sharp pain goes away

reversible

hypersensitivity/pain goes away quickly

irreversible

hypersensitivity/pain lingers

necrotic

no response

normal apical tissues

standard against which all of the other apical disease processes

normal apical tissues

px is asymptomatic and the tooth responds normally to percussion and palpation testing

intact lamina dura

PDL space around all the root apices

what is seen in the radiograph for normal apical tissues

symptomatic apical periodontitis

acutely painful response to biting pressure or percussion, tooth may or may not respond to pulp vitality tests

symptomatic apical periodontitis

in radiograph, there is widened PDL space and may or may nor have an apical radiolucency

symptomatic apical periodontitis

it is positive to percussion test but without swelling

asymptomatic apical periodontitis

generally presents with no clinical symptoms, does not respond to pulp vitality tests

acute apical abscess

acutely painful to biting pressure, percussion, and palpation, do not respond to any pulp vitality tests and will exhibit varying degrees of mobility

acute apical abscess

it has swelling intraorally, facial tissues almost adjacent to the tooth will almost always present with some degree of swelling

acute apical abscess

px will be frequently febrile, cervical and submandibular lymph nodes will exhibit tenderness to palpation

acute apical abscess

it is fluctuant, rapid onset & severe pain

chronic apical abscess

not present clinical symptoms, not respond to pulp vitality tests, has apical radiolucency, but with swelling and intermittent drainage through sinus tract

orofacial pain clinic

where would you refer your patient if after all the testing procedures are completed and pain is not an odontogenic origin?

symptomatic apical periodontitis

if there is pain

asymptomatic apical periodontitis

no pain

acute apical abscess

swelling with pain

chronic apical abscess

swelling without pain, with sinus tract & opening (stoma)

extreme grand mal seizures

petit mal seizures

seizures can be exhibited as?