CHAPTER 3 HIGH YIELD

What type of fibers present in the periodontal ligament are responsible for localized pain?

Proprioceptive A-beta fibers

Why is pulpal pain typically diffuse?

Lack of proprioceptive fibers in the pulp

Which nerve fibers are stimulated by movement of dentinal fluid?

A-delta fibers

What type of pain results from A-delta fiber stimulation?

Momentary pain

What diagnoses are associated with momentary pain on stimulation?

Dentinal pain and reversible pulpitis

What causes momentary pain on stimulation (dentinal pain / reversible pulpitis)?

Stimulation of A-delta fibers due to dentinal fluid movement in odontoblastic processes

What diagnosis is associated with spontaneous pain of long duration?

Irreversible pulpitis

Tooth fracture

What causes spontaneous pain for a long duration ?

Stimulation of C-fibers

What causes sharp, shooting, momentary pain on provoking?

Irreversible pulpitis

What causes sharp, shooting pain on mastication?

Reversible pulpitis

What causes spontaneous, dull, throbbing pain for a long duration?

Irreversible pulpitis

What causes a response to sweet and sour stimuli?

Stimulation of A-delta fibers present in odontoblastic processes

What causes a pain response to heat?

Vasodilatation caused by heat stimulates C fibers of the pulp

What causes a pain response to cold (dentin hypersensitivity)?

Stimulation of A-delta fibers due to fluid movement in odontoblastic processes

What condition is indicated when pain is stimulated by heat and relieved by cold?

Acute irreversible pulpitis

What type of pain do A-delta fibers produce?

Sharp, lancinating pain

What type of pain do C-fibers produce?

Dull, throbbing, lingering pain

What sensory nerve response does the Electric Pulp Test (EPT) measure?

A-delta fibers

What does a positive EPT result indicate?

Presence of sensory fibers (not necessarily pulp health)

What are the absolute contraindications for using an EPT?

Cardiac pacemaker

What sensation should a patient normally feel during an EPT?

Tingly, warm, slight pain (not shock-like)

What are the field requirements for an accurate EPT?

Dry field plus good probe contact with natural tooth

What are potential causes of a false positive on an EPT?

Pus-filled canal, partial necrosis, patient anxiety, moisture contamination, contact with metal, or analgesics

What are potential causes of a false negative on an EPT?

Recently traumatized teeth, immature/open apex, calcific obliteration, poor probe contact, or full coverage crown

What factors can cause inconsistent or erratic EPT results?

Failure to isolate tooth properly, poor electrode contact, severe pulpal calcification, multiple canals

What is the most reliable thermal cold test method?

CO2 ice (dry ice) or ethyl chloride spray (Endo Ice)

What cold test method is least effective?

Ice stick

What does a sharp, short pain response to a cold test indicate?

Vital pulp (normal, reversible pulpitis, or sometimes irreversible)

What does an intense, prolonged pain response to a cold test indicate?

Irreversible pulpitis

What does no response to a cold test indicate?

Pulp necrosis

What causes a false-negative cold test result?

Calcific metamorphosis

What causes a false-positive cold test result?

Stimulus touches gingiva or adjacent teeth

Is the cold test more effective on anterior or posterior teeth?

Anterior teeth

What is the most reliable cold test method for full ceramic crowns?

Cold test with ethyl chloride

When is a heat test indicated?

When a patient reports heat sensitivity but cannot localize the tooth

What is the best technique for a heat test?

Dry rubber prophy cup for frictional heat

What other material can be used for heat testing?

Compound stick

Heated gutta-percha

Hot water

What do prolonged responses to heat or cold indicate?

Irreversible pulpitis

What does no response across multiple diagnostic tests indicate?

Necrotic pulp

What is considered the clinical gold standard for assessing pulp vitality?

Blood flow (not neural response)

What are clinical techniques used to measure pulpal blood flow?

Laser Doppler Flowmetry (LDF) and Pulse Oximetry

What are the clinical limitations of blood flow testing tools?

Expensive and not widely used clinically

What two conditions can blood-flow testing help differentiate according to the notes?

Acute periradicular abscess and acute periodontal abscess

What does pain on occlusal tapping only indicate?

Periapical inflammation

What does pain on palpation over the apex indicate?

Spread of inflammation to the periodontium

What does pain on facial tapping only indicate?

More likely periodontal origin

What type of pain on percussion is typically periapical versus periodontal?

Sharp pain = periapical; dull/mild-to-moderate pain = periodontal

What defines Mobility Grade +1?

Slight movement greater than normal

What defines Mobility Grade +2?

Horizontal movement less than 1 mm

What defines Mobility Grade +3?

Horizontal movement greater than 1 mm + / - rotation or vertical movement

When is a tooth a poor RCT candidate based on mobility?

When mobility is caused by periodontal disease

What instruments are used during a biting test to reproduce pain during chewing?

Tooth Slooth or cotton swab

What conditions are indicated by a positive biting test?

Symptomatic apical periodontitis or a cracked tooth

What finding may be particularly characteristic of a cracked tooth during biting?

Pain on release

What is the purpose of transillumination?

To detect cracks in crowns

How does transillumination reveal a crown fracture?

Shining light causes the fracture line to block light transmission

When is selective anesthesia used in diagnosis?

When pain is vague or unlocalized (used more for arch identification)

What does a mandibular block injection help identify?

Helps identify the painful arch, not an individual tooth

Can a mandibular block reliably identify an individual tooth?

No

What is a disadvantage of using a periodontal ligament (PDL) injection for selective anesthesia?

It may affect adjacent teeth

What is the purpose of a test cavity?

To confirm pulp necrosis when other diagnostic tests are inconclusive

What is the method and response for a test cavity?

Drill into dentin without anesthesia; pain means vital, no pain means non-vital

What is the likely origin of wide, generalized bone loss on a periodontal exam?

Periodontal disease

What is the likely origin of an isolated, narrow deep probing defect combined with a necrotic tooth?

Endodontic lesion from a non-vital tooth

What condition is suggested by a narrow deep pocket combined with a normal adjacent periodontium and a history of root canal treatment?

Vertical root fracture

What periodontal finding is strongly associated with a vertical root fracture?

Narrow isolated deep pocket

Why are multiple radiographic angles necessary in endodontics?

Because radiographs are 2-dimensional and superimposition can obscure anatomical details

What does the SLOB rule stand for?

Same Lingual, Opposite Buccal

According to the SLOB rule, how does a lingual object move relative to the X-ray cone?

Moves in the same direction as the cone

According to the SLOB rule, how does a buccal object move relative to the X-ray cone?

Moves in the direction opposite to the cone

Why can two root canals appear superimposed on a radiograph?

The X-ray beam passes directly through both canals

What happens to canal images when the X-ray cone is shifted mesially or distally?

The canals separate

What does internal resorption look like radiographically?

Irregular canal or pulp space enlargement

What do pulp calcifications indicate?

Chronic irritation (not necessarily irreversible pulpitis)

Do pulp stones have pathologic significance?

No, they are radiopaque incidental findings

What is rarefying osteitis radiographically?

Periapical radiolucency

What is rarefying osteitis seen on a periapical radiograph?

Bone loss, widened periodontal ligament, and loss of lamina dura

What is condensing osteitis seen on a periapical radiograph?

Radiopacity with Dense bone with diffuse borders

What is an enostosis or sclerotic bone variant?

A normal anatomic variant

What can appear over roots and mimic pathology on radiographs?

Tori (non-pathologic)

Can standard dental radiographs confirm pulp vitality?

No

Can standard radiographs differentiate between an infected and non-infected lesion?

No

What advanced imaging modality is superior for detecting anatomic details, bone loss, root fractures, resorptions, and perforations?

CBCT (Cone Beam Computed Tomography)