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

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Presentation on theme: "Clinical Classification of Pulpal and Periapical Diseases Van Hassel’s Theory of Pulpal Death ENDO 331, Friday, January 12, 2007 Dr. C.S. Wenckus."— 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

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

4 COLLECTION OF DATA

5 RECORD OBJECTIVE FINDINGS

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

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? INITIAL INSULT TOTAL PULPITIS INCREASED LOCAL TISSUE PRESSURE IRRITATION TO CLINICAL CROWN LOCALIZED PULPAL INFLAMMATION 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

16 CLINICAL DIAGNOSTIC TERMINOLOGY Pulpal Diagnostic Terms Previously Treated

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

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 Normal Periradicular Diagnostic Terms

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

21 CLINICAL DIAGNOSTIC TERMINOLOGY Periradicular Diagnostic Terms SubacuteApical (Periradicular ) Periodontitis

22 CLINICAL DIAGNOSTIC TERMINOLOGY Periradicular Diagnostic Terms ChronicApicalPeriodontitis

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 Acute Apical Abscess Periradicular Diagnostic Terms

26 CLINICAL DIAGNOSTIC TERMINOLOGY Acute Apical Abscess Periradicular Diagnostic Terms

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

28 CLINICAL DIAGNOSTIC TERMINOLOGY Chronic Apical Abscess Periradicular Diagnostic Terms

29 CLINICAL DIAGNOSTIC TERMINOLOGY Condensing Osteitis Periradicular Diagnostic Terms

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

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: WNL. Pulp Tests: Thermal, percussion, palpation and EPT all WNL.

33 ARE YOU A LITTLE CONFUSED?

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 (1842 - 1910)

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

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