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Clinical Classification of Pulpal and Periapical Diseases

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Presentation on theme: "Clinical Classification of Pulpal and Periapical Diseases"— Presentation transcript:

1 Clinical Classification of Pulpal and Periapical Diseases
Van Hassel’s Theory of Pulpal Death ENDO 331, Friday, January 12, 2007 Dr. C.S. Wenckus

2 THANK YOU!

3 ALL ENDODONTIC Dx MUST INCLUDE A:
Pulpal Diagnosis Periapical Diagnosis

4 COLLECTION OF DATA

5 RECORD OBJECTIVE FINDINGS

6 CLINICAL DIAGNOSTIC TERMINOLOGY
Pulpal Diagnostic Terms Normal pulp Reversible Pulpitis Stressed Pulp Irreversible Pulpitis Acute Chronic Necrotic Pulp Previously Treated

7 CLINICAL DIAGNOSTIC TERMINOLOGY
Pulpal Diagnostic Terms Normal Pulp

8 CLINICAL DIAGNOSTIC TERMINOLOGY
Pulpal Diagnostic Terms Reversible Pulpitis

9 CLINICAL DIAGNOSTIC TERMINOLOGY
Pulpal Diagnostic Terms Stressed Pulp

10 CLINICAL DIAGNOSTIC TERMINOLOGY
Pulpal Diagnostic Terms Irreversible Pulpitis Acute? Or Chronic?

11 CLINICAL DIAGNOSTIC TERMINOLOGY
Pulpal Diagnostic Terms Irreversible Pulpitis Acute? Or Chronic?

12 CLINICAL DIAGNOSTIC TERMINOLOGY
Pulpal Diagnostic Terms Necrotic

13 THE STRANGULATION THEORY

14 Van Hassel chokes off the Strangulation Theory

15 SO, HOW DOES A PULP DIE? TOTAL PULPITIS INITIAL INSULT
INCREASED LOCAL TISSUE PRESSURE IRRITATION TO CLINICAL CROWN LOCALIZED PULPAL INFLAMMATION INITIAL INSULT LOCALIZED EFFECT VENOUS COLLAPSE STASIS ISCHEMIA LOCAL NECROSIS RELEASE OF INFLAMMATORY MEDIATORS LOCAL NECROSIS OF ADDITIONAL TISSUE CIRCUMFERENTIAL VASCULAR DISTURBANCE INCREASED TISSUE PRESSURE MECHANISM OF SPREAD TOTAL PULPITIS

16 CLINICAL DIAGNOSTIC TERMINOLOGY
Pulpal Diagnostic Terms Previously Treated

17 CLINICAL DIAGNOSTIC TERMINOLOGY
Periradicular Diagnostic Terms Acute Apical Abscess [AAA] Chronic Apical Abscess [CAA] Condensing Osteitis Lesions of Non-endodontic Origin Normal Acute Apical Periodontitis [AAP] Subacute Apical Periodontitis [SAP] Chronic Apical Periodontitis [CAP]

18 In the latest glossary of endodontic terms, the specialty is leaning toward substituting “periradicular” for “periapical” or “apical” . Seventh Edition, copyright 2003, AAE

19 CLINICAL DIAGNOSTIC TERMINOLOGY
Periradicular Diagnostic Terms Normal

20 CLINICAL DIAGNOSTIC TERMINOLOGY
Periradicular Diagnostic Terms Irreversible Pulpitis with AAP Acute Apical (Periradicular) Periodontitis

21 CLINICAL DIAGNOSTIC TERMINOLOGY
Periradicular Diagnostic Terms Subacute Apical (Periradicular ) Periodontitis

22 CLINICAL DIAGNOSTIC TERMINOLOGY
Periradicular Diagnostic Terms Chronic Apical Periodontitis

23 A clarification is needed in you text book.
Page 37 states “As a consequence of pulpal necrosis pathologic changes can occur in the periradicular tissues”. What is missing?

24 A clarification is needed in you text book.
Page 37 should state “As a consequence of pulpal necrosis, in the presence of microorganisms, pathologic changes can occur in the periradicular tissues”.

25 CLINICAL DIAGNOSTIC TERMINOLOGY
Periradicular Diagnostic Terms Acute Apical Abscess

26 CLINICAL DIAGNOSTIC TERMINOLOGY
Periradicular Diagnostic Terms Acute Apical Abscess

27 ACUTE APICAL (PERIRADICULAR) ABSCESS IS THE ONLY CONDITION WHICH MAY REQUIRE LEAVING A TOOTH OPEN FOR DRAINAGE!

28 CLINICAL DIAGNOSTIC TERMINOLOGY
Periradicular Diagnostic Terms Chronic Apical Abscess

29 CLINICAL DIAGNOSTIC TERMINOLOGY
Periradicular Diagnostic Terms Condensing Osteitis

30 CLINICAL DIAGNOSTIC TERMINOLOGY
Periradicular Diagnostic Terms Lesions of Non-Endodontic Origin

31 The Difficult Diagnosis
“CC”; “This tooth” (patient points to #30) “had been very sensitive to hot and cold, but recently it just sort of aches and will occasionally wake me out of a deep sleep.”

32 The Difficult Diagnosis
Pulp Tests: Thermal, percussion, palpation and EPT all WNL.

33 ARE YOU A LITTLE CONFUSED?
Can't find the correct tooth? Everything tests WNL and yet the patient has pain? Is that what's bothering you Bunky???

34 THEN DON’T DO ANYTHING!!!!

35 “There is no more miserable human being than one in whom nothing is habitual but indecision.”
William James ( )

36 The Difficult Diagnosis
The pain diminished and eventually disappeared altogether. Routine follow-up six months later….

37 “A pessimist sees the difficulty in every opportunity, an optimist sees the opportunity in every difficulty.” Sir Winston Churchill

38 FINIS

39


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