what's up guys welcome to our channel if you're new here i'm zoh i'm a foundation
dentist working here in london and i'm ali a final year dental student
studying at newcastle this video you're about to watch is a much shorter clip of
the longer video we did on diagnosis we just thought we'd put a shorter clip
out there just in case anyone wanted to focus on this little topic
if you want to watch the full video i'll put a link in the description
the first diagnosis we're going to be covering is caries there's loads of
different ways of diagnosing carries but the main ones are visual
tactile and radiographic carriers can start as an active white spot lesion and
these look smooth frosty opaque and non-cavitated and
they're detected more easily when air dried with a three-in-one syringe as the
carries progresses they become roughened chalky and cavitated and now you can
detect them by running a probe along the surface
there are no symptoms at this stage and if the plaque is removed the lesion can
arrest and become a brown spot lesion with a hard shiny surface
the carys progresses into dentine without much lateral spread but once it
reaches the enamel dentine junction it can spread laterally along this
junction and down to the internal tubules towards the pot
this is where the patient may start experiencing some symptoms of what we
call reversible pulpitis the standout symptoms are a localized sharp pain
which lasts a few seconds and comes on when the patient has
something hot cold or sweet and it's called reversible
because basically if you treat the carriers by doing a filling the pulp
should return back to its normal healthy state and
stop causing symptoms to the patient if the caries isn't treated it will
approach the pulp and cause it to become chronically inflamed
at this stage it's called symptomatic irreversible parpitus
with symptoms of a spontaneous dull and prolonged pain that lasts
several minutes it's irreversible because if we just remove the carries
and do a filling the pulp will remain inflamed and cause pain
and so there's a need for root canal treatment other than the presentation of
pain there's a few questions you can ask your patients to differentiate whether
it's reversible or irreversible parpitus does the pain
keep you up at night for example if it does
then it's irreversible popeitis do painkillers help if they don't
again it's irreversible pulpitis do cold drinks alleviate the pain
it tends to with irreversible parpitus sometimes you might see a patient with a
large caries lesion that's already reached the pulp but they don't
experience any pain with hot or cold stimuli
this is known as asymptomatic irreversible pulpitis now as the
infection advances the pulp will start to die
this is called pulp necrosis and at this stage the patient may actually present
with a history of corporate symptoms which they no longer have so while the
pulp is dying the bacteria will also travel to the peripheral tissues
and cause symptoms of apical periodontitis or some others call it
acute apical periodontitis at this stage they get a well-localized
pain when biting and this is because the periodontal ligament
is inflamed and biting stimulates the pain and pressure sensitive fibers in
the area the bacteria in the necrotic pulp will also leach toxins through the
apex causing a chronic inflammatory response which leads to bone resorption
now if enough bone resorption occurs this will be seen in the radiograph as
an apical radiolucency symptomatic apical periodontitis often
presents with symptoms of irreversible popitis as well because this is all a
dynamic process one disease leads to another and some
diseases also happen at the same time so as the pulp is inflamed the person might
experience symptoms of irreversible pulpitis
and now that the pdl is also inflamed they may also experience periapical
symptoms but if it's left untreated at this stage
the pop might die and they might only experience periapical
symptoms for example if the symptomatic apical periodontitis is left to progress
this may become an asymptomatic apical periodontitis
also known as chronic apical periodontitis and this happens because
of chronic inflammation and destruction of the periodontium this would be
visible on a radiograph but has a much larger
well-defined radiolucency and can re-exacerbate to become
symptomatic aprioperodontitis again or as others would call it
an acute exacerbation of chronic apical periodontitis
at any point from once the infection has gone through the apex an acute
apical abscess can form this is a pus-filled swelling which can cause
severe spontaneous pain and extreme tenderness to touch
there's lots of pain because the abscess is causing a lot of pressure in the area
and if the abscess is able to be drained for example through a sinus
tract in the gums then the pressure is relieved and the patient will experience
little or no pain a draining abscess like this is called a chronic apical
abscess find out which tooth is causing the
abscess you can put a gp point in the sinus and then take a radiograph
the gp will follow the track and point to the infected tooth
the next diagnosis is one that is often missed out if you carry a root canal
treatment there's a slight chance that the patient might come back to you soon
after with severe pain sometimes described as
even worse than before and maybe a swelling this is known as a phoenix
abscess and is mainly caused by inadequate cleaning of the root canals
you should always warn your patients of this before you
start root canal treatment you might also have come across a disease process
called condensing osteitis we're not going to go into too much
detail on this one because it's a lot rarer but it's a reaction to dental
infection on the radiograph it's radio opaque
because instead of bone destruction there's more bone deposition
it can happen when there's a low degree of virulence from the infection
and the host's healthy immune system triggers a sclerotic reaction
so now we've covered all the purple diagnoses which are reversible
proprietors symptomatic irreversible pulpitis
asymptomatic irreversible prophytous pulpone necrosis and the periapical
diagnosis which are symptomatic apical periodontitis
asymptomatic a-copradontitis acute apical abscess
chronic ape collapses and condensing osteotis it's important to note that
when you provide a diagnosis for a tooth you have to give both a purple diagnosis
and a periapical diagnosis so for example you might say pop
necrosis and symptomatic april periodontitis of the upper left six
okay guys so that was it for this clip thank you guys for watching if you want
to see the full video on diagnosis i'll put in the suggestions here or you can
check out the other videos that we have on the channel