Summary of "Endodontics | Pulpal and Periapical Diagnoses | INBDE, ADAT"

Summary of Video:

Endodontics | Pulpal and Periapical Diagnoses | INBDE, ADAT

This educational video focuses on the classification and diagnosis of pulpal and periapical conditions based on guidelines from the American Association of Endodontists. It is designed for dental exam preparation (INBDE, ADAT) but also provides clinically relevant knowledge.

Main Ideas and Concepts

1. Endodontic Diagnosis Overview

Every tooth, whether vital or non-vital, requires two diagnoses:
- Pulpal diagnosis: Health status of the pulp inside the tooth.
- Periapical diagnosis: Health status of the tissues around the apex (root tip) of the tooth.
Diagnoses are important for treatment planning and prognosis.

2. Pulpal Diagnoses and Their Characteristics

Normal Pulp
- Asymptomatic.
- Mild to moderate transient response to thermal (cold) and electrical stimuli.
- Tested mainly by cold test (using Endo Ice) and Electric Pulp Test (EPT).
Diagnostic Tests for Pulp Vitality
- Cold Test: Application of cold (Endo Ice at -30°C) on the tooth surface for 5 seconds.
  - Measures intensity and duration of response.
  - Provides a spectrum of information about pulp health.
- Electric Pulp Test (EPT):
  - Detects presence of vital sensory nerve fibers.
  - Least reliable test; does not assess vascular supply.
  - Can give false positives (e.g., gingival contact) or false negatives (e.g., recent trauma, calcification).
  - Contraindicated in patients with cardiac pacemakers.
Reversible Pulpitis
- Symptomatic with quick, sharp, hypersensitive response to cold.
- No spontaneous pain.
- Caused by irritants like caries, deep restorations, or trauma.
- Removal of irritant can restore pulp to normal.
Symptomatic Irreversible Pulpitis
- Severe, spontaneous, intermittent or continuous pain.
- Lingering pain after cold stimulus removal (10-20 seconds).
- Microscopically shows microabscesses and inflammation.
- Not reversible even if irritant removed.
- Radiographs and EPT are less useful; diagnosis relies on history and cold test.
Asymptomatic Irreversible Pulpitis
- No clinical symptoms but irreversible pulp damage present microscopically.
- Patient may feel normal despite pulp pathology.
Pulp Necrosis
- Death of pulp tissue, often asymptomatic but can be painful initially.
- May be partial or total.
- Usually due to long-term blood supply interruption.
- May cause crown discoloration.
- Requires Root Canal Therapy; internal bleaching can treat discoloration.
Previously Treated Pulp
- Pulp tissue has been removed or is undergoing treatment (e.g., Root Canal Therapy).

3. Periapical Diagnoses and Their Characteristics

Diagnosed mainly by percussion, palpation, and radiographs.
Normal Apical Tissues
- Asymptomatic.
- No pain on percussion or palpation.
Symptomatic Apical Periodontitis
- Painful inflammation around apex.
- Pain on percussion.
- Throbbing pain due to localized inflammation.
- Occlusal adjustment may relieve pain if tooth is vital.
- Endodontic therapy needed if tooth is necrotic.
Asymptomatic Apical Periodontitis
- No symptoms but radiographic evidence of apical radiolucency.
- Associated with necrotic pulp.
- Radiolucency may represent cyst or granuloma.
Acute Apical Abscess
- Rapid swelling, severe pain, and pus formation.
- Characterized by liquefaction necrosis at apex.
- Easily diagnosed by clinical signs.
Chronic Apical Abscess
- Draining sinus tract present.
- Usually no pain or swelling.
- Sinus tract can be traced with Gutta-Percha Cone on radiograph to locate source.

Key Diagnostic Methodologies and Instructions

Cold Test Procedure:
- Dry tooth thoroughly.
- Spray Endo Ice on cotton pellet.
- Apply pellet to middle third of facial crown surface for 5 seconds.
- Note intensity and duration of response.
Electric Pulp Test Procedure:
- Apply electrode to tooth surface.
- Patient signals when sensation felt.
- Be cautious of false positives/negatives and contraindications.
Percussion Test:
- Tap tooth vertically with mirror handle.
- Assess for pain response.
Palpation Test:
- Press on gingival