Guest guest Posted April 1, 2012 Report Share Posted April 1, 2012 Please explain your answers Thanks For each of the clinical scenarios (a–d), consider carefully the symptoms and the outcomes of investigations that are described, then select from the list below (1–10) the single most likely diagnosis. Each diagnosis may be used once, more than once or not at all: 1Reversible pulpitis 2Irreversible pulpitis 3Hyperplastic pulpitis 4Acute apical periodontitis 5Chronic apical periodontitis 6Combined periodontal-endodontic lesion 7Condensing osteitis 8Acute apical abscess 9Chronic apical abscess aA 26-year-old patient complains of pain from a lower left back tooth but is unable to locate exactly which one. The pain starts after hot drinks, lasts for a few minutes and then resolves without the need for analgesics. A periapical radiograph suggests recurrent caries beneath an amalgam restoration in the second molar but there is no radiographic evidence of periapical change. bA 40-year-old patient complains that a lower back tooth has been very painful to bite on for about 2 weeks with some swelling and that the pain is getting noticeably worse. Investigations show that a lower right second molar has a fractured amalgam and extensive recurrent caries. It is painful to percussion and a periapical radiograph shows distinct widening of the periodontal membrane space adjacent to one of the mesial root apices. cA 50-year-old patient complains of a ‘lump on the gum’ and points to a localised swelling at the mucogingival junction adjacent to an upper premolar. The swelling has been present ‘on and off’ for almost a year and gentle pressure leads to a purulent exudate from a sinus opening within the lesion. A periapical radiograph shows a periradicular radiolucency. The tooth is periodontally healthy. dA 25-year-old patient attends for obturation of an upper incisor on which you had completed root canal preparation 1 week earlier. Although he is keen to complete the treatment, he reports that this previously symptom-free tooth had become exceedingly painful as soon as the local anaesthetic had worn off. The symptoms lasted for about 3 days but were controlled using codeine-based analgesics. The symptoms have largely resolved but he is still aware of a ‘feeling’ that something isn't quite right. dA 25-year-old patient attends for obturation of an upper incisor on which you had completed root canal preparation 1 week earlier. Although he is keen to complete the treatment, he reports that this previously symptom-free tooth had become exceedingly painful as soon as the local anaesthetic had worn off. The symptoms lasted for about 3 days but were controlled using codeine-based analgesics. The symptoms have largely resolved but he is still aware of a ‘feeling’ that something isn't quite right. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 1, 2012 Report Share Posted April 1, 2012 A)Irreversible pulpitis... key being hard to locate exact source of the tooth, followed by mentioning HOT stimulus which then lingers for a few minutes.. I would say Acute apical abscess but the whole 2 week pain would state otherwise. C) Chronic apical abscess.. the periodontium is healthy, yet there is a sinus opening which indicates it being chronic and related to the tooth. D)Acute apical periodontitis? due to over instrumentation possibly? what are other people's thoughts? > > Please explain your answers > Thanks > For each of the clinical scenarios (a†" d), consider carefully the symptoms and the outcomes of investigations that are described, then select from the list below (1†" 10) the single most likely diagnosis. Each diagnosis may be used once, more than once or not at all: > > 1Reversible pulpitis > 2Irreversible pulpitis > 3Hyperplastic pulpitis > 4Acute apical periodontitis > 5Chronic apical periodontitis > 6Combined periodontal-endodontic lesion > 7Condensing osteitis > 8Acute apical abscess > 9Chronic apical abscess > aA 26-year-old patient complains of pain from a lower left back tooth but is unable to locate exactly which one. The pain starts after hot drinks, lasts for a few minutes and then resolves without the need for analgesics. A periapical radiograph suggests recurrent caries beneath an amalgam restoration in the second molar but there is no radiographic evidence of periapical change. > bA 40-year-old patient complains that a lower back tooth has been very painful to bite on for about 2 weeks with some swelling and that the pain is getting noticeably worse. Investigations show that a lower right second molar has a fractured amalgam and extensive recurrent caries. It is painful to percussion and a periapical radiograph shows distinct widening of the periodontal membrane space adjacent to one of the mesial root apices. > cA 50-year-old patient complains of a ‘lump on the gum’ and points to a localised swelling at the mucogingival junction adjacent to an upper premolar. The swelling has been present ‘on and off’ for almost a year and gentle pressure leads to a purulent exudate from a sinus opening within the lesion. A periapical radiograph shows a periradicular radiolucency. The tooth is periodontally healthy. > dA 25-year-old patient attends for obturation of an upper incisor on which you had completed root canal preparation 1 week earlier. Although he is keen to complete the treatment, he reports that this previously symptom-free tooth had become exceedingly painful as soon as the local anaesthetic had worn off. The symptoms lasted for about 3 days but were controlled using codeine-based analgesics. The symptoms have largely resolved but he is still aware of a ‘feeling’ that something isn't quite right. > dA 25-year-old patient attends for obturation of an upper incisor on which you had completed root canal preparation 1 week earlier. Although he is keen to complete the treatment, he reports that this previously symptom-free tooth had become exceedingly painful as soon as the local anaesthetic had worn off. The symptoms lasted for about 3 days but were controlled using codeine-based analgesics. The symptoms have largely resolved but he is still aware of a ‘feeling’ that something isn't quite right. > Quote Link to comment Share on other sites More sharing options...
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