3BDS: Endodontics 2

when is RCT required, for what teeth

for teeth where the dental pulp is irreversibly damaged (irreversible pulpitis, pulpal necrosis) and periapical disease

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talk about: pulpal diagnosis
clinically normal pulp

• Symptom free
• Normally responds to sensibility testing (mild response that subsides immediately when stimulus is removed)
• Histologically- no inflammatory change

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talk about: pulpal diagnosis: reversible pulpitis.
what is it, what are the symptoms/ causes/ treatment

• Symptoms:
Pain short and sharp, non-spontaneous
Stimulus- cold, sweet, sometimes hot
No significant radiographic changes apically
• Causes:
Caries into dentine, fractures, restorative procedures, trauma
• Treatment:
Conservative pulp therapy in conjun

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talk about pulpal diagnosis:
irreversible pulpitis

It’s a follow on. Occurs if inflammatory process continues
• Asymptomatic or symptomatic- based on subjective and objective findings that the vital inflamed pulp is incapable of healing (if you were to replace the restoration or remove the caries the pul

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what are the symptoms of symptomatic irreversible pulpitis

sharp pain on thermal stimulus which lingers (30 secs)
pulp allodynia, spontaneous pain, excruciating pain may be momentarily relieved by cold, referred pain, accentuated by postural changes

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what are the symptoms of asymptomatic irreversible pulpitis

no clinical symptoms, usually respond normally to sensitivity testing. may have had trauma or deep caries that would likely result in exposure following removal

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where does referred pain not happen

does not happen across the midline

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why would a tooth not be tender to pressure/percussion in irreversible pulpitis

inflammation has not yet reached the periapical tissues

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talk about pulpal diagnosis: pulpal necrosis - symptom

Usually asymptomatic unless inflammation has progressed to periapical tissues
No response to sensibility testing

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what is previously initiated treatment

A clinical diagnostic category indicating the tooth has been endodontically treated by partial endodontic therapy (pulpotomy (for example as an emergency procedure), pulpectomy) opening the tooth to find the canals
Canals may have been located, cleaned an

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what is previously treated

A clinical diagnostic category indicating the tooth has been endodontically treated and the canals obturated with root canal filling material

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what is normal periapical tissues

- Teeth will be non-sensitive to percussion and palpation testing

- Radiographically the tissues are normal with intact lamina dura and a uniform periodontal ligament space

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what pulpal conditions would have normal periapical tissues

A vital pulp with reversible and irreversible pulpitis

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what causes symptomatic periapical periodontitis and what is the pulpal status in this situation

Inflammation of periapical tissues due to microbial toxins
Pulpal status: end stage of irreversibly inflamed or have become necrotic

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what are the signs and symptoms of symptomatic periapical periodontitis

Discomfort to biting or chewing
Sensitivity to percussion
Palpation may or may not produce a sensitive result (depending on the degree of inflammation present)
Sensibility testing will depend on whether pulp is irreversibly inflamed or necrotic

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what periapical changes will be seen radiographically

 Loss of lamina dura, widening of PDL (if the periapical periodontitis has not been present for a long period of time)
 Periapical radiolucency (if it is an acute flare up of an existing chronic lesion)

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what causes acute periapical abscess

Bacteria have progressed into the periapical tissues and the patient’s immune response cannot defend against the invasion. This results in a facial swelling and the formation of pus

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what are the signs and symptoms of acute periapical abscess

Rapid onset
PAIN- exquisitely tender to tooth to touch
Pus formation
Mobility of tooth
Systemic involvement (could have a fever and feel generally unwell)
Swelling
 Depends on location of apices and muscles attachments. Anatomy of tooth in relation to

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how would an acute periapical abscess radiographically

The PDL space may be normal, slightly widened or demonstrate a distinct radiolucency if an acute flare up of a chronic lesion (known as a phoenix abscess)

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how is an acute periapical abscess treated

drainage
RCT
Extraction

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when does asymptomatic perioapial periodontitis occur

Occurs when bacterial products from a necrotic or pulpless tooth slowly ingress the periapical tissues resulting in bone resorption

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how is an asymptomatic periapical periodontitis seen radiographically

radiolucency around the apex of the tooth (may have a tooth that has caries, has not had previous RCT or you may have a tooth with a previous and a chronic lesion present)

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what is chronic periapical abscess

An inflammatory reaction to pulpal infection and necrosis characterised by gradual onset, little or no discomfort and intermittent discharge through an associated sinus tract (can be located intra-orally or in some young people occasionally drain extra-or

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what causes dentine hypersensitivity

Gingival recession, tooth surface loss (leaving the dentinal tubules exposed
Cannot be attributed to any other dental cause such as caries, defective restoration
Stimuli- thermal, chemical, osmotic, tactile or physical which causes fluid movement in tubul

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what if there is exaggerated sharp, transient pain with a specific factor like caries, fractures, recent restorations. what is the diagnosis

reversible pulpitis

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how is focal sclerosing osteomyelitis (condensing osteitis ) seen radiographically

- Increased radiodensity and opacity around one or more roots

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what are the symptoms of cracked teeth

sharp shooting pain on biting hard objects
may be worse on release of pressure
sensitivity to thermal changes, sweet, acidic food
often difficult to localise

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what is the cause of cracked teeth

occlusal forces, abnormal chewing habits, accidental trauma, structural fatigue

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if cracked teeth are left unrecognised and untreated it may lead to...

vertical root fracture and extraction of tooth

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what is the definition of cracked teeth

Incomplete fracture of a posterior tooth with a vital pulp, which includes dentine and possibly the pulp.

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what are the symptoms of periodontal abscess

Rapid onset
Spontaneous pain
TTP
Pus formation
Swelling

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where is periodontal abscess situated and what is localised to so it doesnt involve the..

situated at the gingival margin, infection localised to the periodontist and doesnt involve the pulp

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what response would sensibility testing give for periodontal abscess

normal

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talk about craze lines

effect only enamel, cross marginal ridge and buccal, lingual surfaces. diagnosed by transillumination

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talk about fractured cusp

complete or incomplete fracture initiated from crown. treating by removing cusp and restoring, only RCT if crack affects pulp

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give examples of types of cracks

craze lines, fractured cusp, cracked tooth, split tooth, vertical root fracture

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talk about split tooth

complete fracture initiated from the crown and extending subgingivally, usually M-D. more centred occlusally and extends apically

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talk about vertical root fracture

complete or incomplete fracture initiated from the root at any level usually B-L. minimal signs or symptoms. difficult to diagnosis as mimic other conditions. virtually all have been RCT'd, CBCT, sinus with narrow isolated pocket in RCT'd tooth

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3BDS: Endodontics 2

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