DIAGNOSTIC PROCEDURES l Endodontics MCQs

 DIAGNOSTIC PROCEDURES l Preclinical Endodontics MCQs for dental students 

Diagnosis and treatment planning in endodontics

 

•   If you are in doubt postpone initiating treatment until symptoms localize
•   Diagnosis must always include identification of the cause of the disease so it can be removed

1- History:

• Chief complaint [ when did it start, where is the pain, describe the pain [ throbbing, sharp, dull etc ] , provoking and alleviating factors]

2- Clinical examination:

• Soft tissue : [ look for redness, swelling, sinus tracts etc ]
• Hard tissue : [ examine tooth structure for caries, fracture , exposed dentine, integrity of current restorations if present, check restorability of the tooth ]

Pulp sensibility tests

• reproduce the patient’s symptoms [ you need at least 2 signs and symptoms to confirm a disease]
• You always test the suspicious tooth LAST – do the test on an adjacent tooth + contralateral tooth and a tooth from the opposing arch.

1- Electrical pulp test [ EPT]

• Gives no indication about vascular blood supply
• Make sure the field is dry and apply conductive paste [ toothpaste or prophy paste] – apply EPT on the buccal surface of the tooth
• If the tooth is crowned → apply EPT on the margin of the crown
• EPT reaches a high # and the patient doesn’t feel anything → -ve response

Causes of false positive of EPT

1. stimulation of nerve fibers in the periodontium or adjacent tooth
2. In multirooted teeth one canal might be non vital and the rest might be vital
3. Not objective test because it depends on pt’s response
4. C- fibers might still be present in the pulp [ more resistant to necrosis]
5. Cell bodies of neurons are located in ganglia outside the pulp

Causes of false negative of EPT

1. Inadequate contact with the stimulus.
2. Tooth calcification
3. Immature apical development
4. Traumatic injury
5. The test is subjective (Not objective)
6. Regressive neural changes in elderly patients
7. Patients who have taken analgesics

 

2- Heat testing [ only used if the CC is pain on hot food / drink ] – you can use:

1. Heated Gutta percha / hot compound stick
2. Dry rubber prophylaxis cup
3. Hot water under rubber dam isolation [ best for testing full coverage restorations]

• Apply a lubricant [petroleum gel] onto the tooth surface to prevent hot material from sticking - then place the heated GP or hot compound stick on the buccal surface

 

3- Cold testing [ used when the CC is pain to cold ] – you can use :

• Ice sticks [ rarely used because cold water will leak into the gingiva and cause a false positive response ]
• Ethyl chloride spray [ best ]
• Carbon dioxide [ dry ice sticks – extremely cold and can cause infraction lines in the enamel or pulpal damage]

 

N.B :

• in case you need to repeat the cold test – wait for 5 mins
• in electrical / thermal pulp testing → A- delta fibers conduct the pain [ sharp and well localized] – but in case of inflammation C – fibers are activated [ not very well localized pain]
• electrical and thermal pulp tests are called sensibility tests because they only indicate nerve response not blood supply [ we assume since there is nerve response that the pulp has viable blood supply and is vital]

 

 

4- Cavity test :

• Drilling the tooth without LA to ensure a negative response to cold/ hot test [ specially when you can’t notice a direct reason for necrosis]
• Used if all the other tests an inconclusive

Other tests that should be done during endo diagnosis:

1- Percussion test:

• when the inflammation spreads from the pulp to the PDL → the ability to localize the pain increases [ because the PDL contains proprioceptive fibers]
• Tapping on incisal or occlusal surface by [ digital pressure, end of a hand instrument , tooth sloth or a cotton swab] → TTP indicates periapical involvement
• Always do percussion test first with your finger then with the handle of an instrument
• tooth slooth allows the application of forces on individual cusps → very useful to detect fractured teeth
• Ask the pt to bite down deeply and slowly then open very quickly- If the pain occurs on releasing → cracked tooth

 

To check for cracked tooth :

• Anterior tooth → transillumination
• Posterior tooth → bite test

other causes of +ve percussion test :

1. Traumatic occlusion / trauma injury
2. High restoration
3. Cracked tooth or vertical root fracture
4. Maxillary sinusitis
5. Periodontal abscess

 

2- Palpation test:

•  when inflammation spreads beyond cortical bone → swelling can be detected by digital palpation

 

3- Mobility:

• done in buccolingual direction using index finger and the back of a hand instrument  

 

Causes of isolated deep pockets:

1. Periodontal disease
2. PA pathology draining through the periodontium
3. Developmental defect like Vertical grooves
4. Vertical root fracture
5. External root resorption

 

To detect cracks or fractures:

1. Fiber optic transillumination can be used to detect cracks [ the piece closer to the light will appear brighter]
2. dye staining : dye is applied inside the access cavity and then re examined after one week.

 

1.    Radiolucent lesion associated with a vital tooth is NOT FROM ENDODONTIC ORIGIN
2.    PA radiolucency resulting from pulp necrosis has “ hanging drop appearance” – beginning on the lateral surface of the root then extending apically. – this lesion does not change location when angles radiographs are taken.