DENT 420 MAY 2025 Lecture Notes

Endodontic Diagnosis Flashcards

What are the pulpal diagnostic categories?

Normal, Reversible Pulpitis, Symptomatic Irreversible Pulpitis, Asymptomatic Irreversible Pulpitis, Previously treated, Pulp Necrosis, Previously initiated therapy

What are the apical diagnostic categories?

Normal, Symptomatic apical periodontitis, Asymptomatic apical periodontitis, Acute apical abscess, Condensing osteitis, Chronic apical abscess

What does normal apical tissues indicate?

Not sensitive to percussion or palpation testing. Radiographically, the lamina dura surrounding the root is intact and the PDL space is uniform.

What is symptomatic apical periodontitis?

Inflammation, usually of the apical periodontium, producing clinical symptoms involving a painful response to biting and/or percussion or palpation.

Is symptomatic apical periodontitis always accompanied by radiographic changes?

May or may not be accompanied by radiographic changes, depending on the disease stage.

What does severe pain to percussion and/or palpation indicate?

Highly indicative of a degenerating pulp and need for RCT.

What is asymptomatic apical periodontitis?

Inflammation and destruction of the apical periodontium that is of pulpal origin, appearing as an apical radiolucency without clinical symptoms.

What is acute apical abscess?

An inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, extreme tenderness, pus formation, and swelling.

Are there always radiographic signs of destruction with an acute apical abscess?

There may be NO radiographic signs of destruction.

What systemic symptoms might accompany an acute apical abscess?

Malaise, fever, and lymphadenopathy.

What is chronic apical abscess?

An inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little or no discomfort, and intermittent discharge of pus through a sinus tract.

What radiographic signs are typically present with a chronic apical abscess?

Signs of osseous destruction such as a radiolucency.

How can the source of a draining sinus tract be identified?

By carefully placing a guttapercha cone through the stoma until it stops and taking a radiograph (sinogram).

What is condensing osteitis?

A diffuse radiopaque lesion representing a localized bony reaction to a low-grade inflammatory stimulus usually seen at the apex of the tooth.

What is the typical treatment for cysts versus granulomas?

Root canal treatment as usual. If lesion grows it MAY suggest cystic nature; necessary for surgical intervention

What is the rationale for performing vitality tests?

To establish baseline readings of controls and suspect teeth, identify the tooth in need of treatment, and determine the pulpal and periapical status.

What does percussion testing indicate?

Pain to percussion indicates inflammation in the periodontal ligament (i.e., symptomatic apical periodontitis).

Define Tooth Sleuth/Bite test

Sensitivity may be present secondary to a crack in the tooth

What are the possible responses to cold testing?

Lack of response, a lingering painful sensation, or an immediate, excruciatingly painful sensation.

When is heat testing most useful?

When a patient’s chief complaint is intense dental pain on contact with any hot liquid or food, or when a patient is unable to identify which tooth is sensitive.

What does EPT assess?

Pulp neural responses (vitality / Sensibility).

What does a response to EPT indicate?

That some viable nerve fibers are present in the pulp and are capable of responding.

What is LDF?

An accurate, reliable, and reproducible method of assessing pulpal blood flow microvascular systems.

What does increased tooth mobility indicate?

A compromised periodontal attachment apparatus, NOT pulp vitality.

How is a sinus tract tracked for diagnosis?

An adequate size of Gutta-Percha point is pushed into the opening of the sinus tract until resistance is felt, then a radiograph taken (sinogram).