Differential diagnosis of chronic fibrous pulpitis without tooth cavity disclosure
Clinical signs |
Diagnosis
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Chronic fibrous pulpitis |
Acute deep caries |
Acute limited serous pulpitis |
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Character of pain |
Dull pain, arises only from stimuli; absent at night |
Acute, short-termed pain, arises from all kinds of stimuli |
Sharp, spontaneous, throbbing pain, increases from stimuli and at night. |
Duration of pain attack |
Lasts for 30 - 40 min. after removal of irritant |
Short-termed pain, stops immediately after removal of irritant |
During a day could be a few short attacks of pain with long “light-periods” |
Anamnesis of disease |
Previously there was acute or dull long-lasting pain |
There was no sharp pain in past |
Acute pain that arose for the first time during present day. |
EPT |
30-40 mcA |
10-15 mcA |
15-20 mcA |
X-ray data |
Enlargement of periodontal crevice |
There is no changes in periodontium |
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Differential and diagnostic criteria of chronic gangrenous pulpitis and chronic apical periodontitis
Clinical features |
Diagnosis |
|
Gangrenous pulpitis |
Apical periodontitis |
|
Character of pain |
Pain is absent or dull, arises from hot water |
Pain is absent, could arise during biting on the tooth |
Probing |
Sharply painful in root canal orifices |
Painless |
EPT |
40-80 mcA |
100-120 mcA |
Differential and diagnostic criteria of chronic forms of pulpitis
Clinical features |
Diagnosis |
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Chronic fibrous pulpitis |
Hypertrophic pulpitis |
Gangrenous pulpitis |
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State of carious cavity bottom |
Tooth cavity could be either disclosed or closed. Dentine is decayed and softened. |
Tooth cavity is disclosed and fulfilled with pulp polyp (granulating tissue) |
Tooth cavity is open (disclosed) |
Reaction to probing |
Probing is painful, in particular in point of disclosed pulp chamber. |
Probing of pulp polyp is slightly painful, it easily bleeds. |
Probing of root canal orifices is painful, pulp could easily bleeds. |
Reaction to temperature test |
Slowly increasing of pain due to cold or hot stimuli, especially when they appears in turn |
Is not stable |
Slowly increasing dull pain, especially due to hot irritants |
Percussion |
Painless |
Painful |
Sometimes there is presence of light pain |
EPT |
20-40 mcA |
20-40 mcA |
40-80 mcA |
X-ray data |
Insignificant enlargement of periodontal crevice |
Periodontal crevice without changes or a little enlarged |
In 50% cases there are changes of periapical tissues or enlargement of periodontal crevice |
