Endodontics | Pulpal and Periapical Diagnoses | INBDE, ADAT

Summary

This video covers essential endodontic diagnosis classifications, focusing on pulp and periapical diagnoses, as outlined by the American Association of Endodontists. The speaker explains diagnostic tests like the cold test and electrical pulp test, comparing their effectiveness in determining pulp health. The video also discusses different types of pulpitis, including reversible, irreversible, and pulp necrosis, and their symptoms. For periapical diagnoses, the video highlights conditions like symptomatic apical periodontitis, apical abscesses, and the importance of using percussion, palpation, and radiographs for diagnosis.

Takeaways

• 🦷 Every tooth requires two diagnoses: one for the pulp and one for the periapical tissues.
• 🥶 The cold test (using Endo Ice) and electric pulp test (EPT) are the two primary diagnostic tools for pulp health.
• 🔋 EPT is less reliable than the cold test and only indicates sensory fiber vitality, not the true vascular health of the pulp.
• 👍 Reversible pulpitis is symptomatic but can return to a normal state if the irritant is removed.
• 🔥 Symptomatic irreversible pulpitis causes severe pain and lingering responses to cold stimuli, indicating irreparable damage.
• 😐 Asymptomatic irreversible pulpitis shows no symptoms, but the pulp is irreversibly damaged and still requires treatment.
• 💀 Pulp necrosis refers to the death of pulp tissue, often asymptomatic but with potential discoloration of teeth.
• 🔨 Percussion and palpation are key tools for diagnosing periapical conditions, especially when cold tests aren't useful.
• 😣 Symptomatic apical periodontitis causes painful inflammation around the tooth’s apex, often requiring endodontic therapy.
• 💧 Chronic apical abscesses involve sinus tracts that drain, causing less pain and swelling compared to acute abscesses.

Q & A

What are the two primary types of endodontic diagnoses?

The two primary types of endodontic diagnoses are pulp diagnoses, which concern the health of the pulp, and periapical diagnoses, which concern the health of the tissues around the apex of the tooth.

What are the main categories of pulp diagnoses?

The main categories of pulp diagnoses are: normal pulp, reversible pulpitis, symptomatic irreversible pulpitis, asymptomatic irreversible pulpitis, pulp necrosis, and previously treated pulp.

How is normal pulp defined?

Normal pulp is asymptomatic and, when tested with thermal or electrical stimuli, has a mild to moderate transient response that subsides when the stimulus is removed.

What is the difference between reversible and symptomatic irreversible pulpitis?

Reversible pulpitis is characterized by a heightened but non-lingering response to cold stimuli and can return to a normal state if the irritant is removed. Symptomatic irreversible pulpitis involves heightened, lingering pain even after removing the stimulus, and the pulp is irreversibly damaged.

What tests are commonly used to assess pulp health?

The most commonly used tests are the cold test (using chemicals like Endo Ice) and the electric pulp test (EPT). The cold test evaluates the pulp's thermal response, while the EPT indicates the presence of vital sensory fibers.

What can cause a false positive or false negative in an electric pulp test?

A false positive can occur if the gingiva is accidentally touched or if the tooth is not properly isolated and dried. A false negative can occur if the tooth has been recently traumatized or if there is excessive calcification in the canal.

What is asymptomatic irreversible pulpitis?

Asymptomatic irreversible pulpitis occurs when the pulp is microscopically and physiologically damaged beyond repair but the patient experiences no pain or clinical symptoms.

What characterizes pulp necrosis?

Pulp necrosis is the death of pulp tissue, which can occur over a short or long period. It is often asymptomatic, though it can sometimes be painful. Crown discoloration may also occur, especially in anterior teeth.

What are the main categories of periapical diagnoses?

The main categories of periapical diagnoses are: normal apical tissues, symptomatic apical periodontitis, asymptomatic apical periodontitis, acute apical abscess, and chronic apical abscess.

How do you differentiate between acute and chronic apical abscesses?

Acute apical abscess is characterized by rapid swelling, severe pain, and the presence of pus. Chronic apical abscess, on the other hand, usually involves a draining sinus tract and minimal pain or swelling.