Changes

==Interpreting Endodontic Disease==

==Interpreting Endodontic Disease==

Radiographs may provide information about the presence, nature, and severity of periapical and [[Enamel Organ#|Root|root]] pathology. This information is essential for the diagnosis of endodontic disease as well as for the prognosis of its treatment. Radiographs do not provide direct information about [[Enamle Organ#Pulp|pulp]] health; however, many of the effects of pulp pathology are radiographically visible.<br><br>

Radiographs may provide information about the presence, nature, and severity of periapical and [[Enamel Organ#Root|root]] pathology. This information is essential for the diagnosis of endodontic disease as well as for the prognosis of its treatment. Radiographs do not provide direct information about [[Enamel Organ#Pulp|pulp]] health; however, many of the effects of pulp pathology are radiographically visible.<br><br>

Clinical findings that may indicate the presence of endodontic disease include a fractured tooth with exposure of the pulp chamber, a discolored tooth, or an intraoral or extraoral draining fistula. Except in the obvious case of a direct pulp exposure, a definitive diagnosis of endodontic pathology is difficult to make based only on [[Oral Examination|clinical examination]] of veterinary patients due to the limitations of pulp testing and lack of patient input. <br><br>

Clinical findings that may indicate the presence of endodontic disease include a fractured tooth with exposure of the pulp chamber, a discolored tooth, or an intraoral or extraoral draining fistula. Except in the obvious case of a direct pulp exposure, a definitive diagnosis of endodontic pathology is difficult to make based only on [[Oral Examination|clinical examination]] of veterinary patients due to the limitations of pulp testing and lack of patient input. <br><br>

Radiographs should be made of teeth that are fractured, close to a draining fistula, intrinsically discolored, anomalous, or compromised from [[Periodontal Disease|periodontal disease]] to determine the extent of the problem and to evaluate the endodontic and periradicular health.<br><br>

Radiographs should be made of teeth that are fractured, close to a draining fistula, intrinsically discolored, anomalous, or compromised from [[Periodontal Disease|periodontal disease]] to determine the extent of the problem and to evaluate the endodontic and periradicular health.<br><br>

Radiographic signs of endodontic disease that are associated with the '''tooth''' itself include:

Radiographic signs of endodontic disease that are associated with the '''tooth''' itself include:

*Root tip resorption

*Root tip resorption

*Internal root or crown resorption. Inflammation of the pulp can cause internal resorption.

*Internal [[Enamel Organ#Root|root]] or [[Enamel Organ#Crown|crown]] resorption. Inflammation of the pulp can cause internal resorption.

*External root resorption. Inflammation in the periodontal ligament can cause external root resorption.

*External root resorption. Inflammation in the periodontal ligament can cause external root resorption.

*Arrested tooth maturation (pulp necrosis). Pulp necrosis causes the opposite effect, arresting any further [[Enamel Organ#Dentin|dentin]] formation or tooth maturation. The result is a tooth that appears radiographically less mature (wider root canal space) than the adjacent teeth.

*Arrested tooth maturation (pulp necrosis). Pulp necrosis causes the opposite effect, arresting any further [[Enamel Organ#Dentin|dentin]] formation or tooth maturation. The result is a tooth that appears radiographically less mature (wider root canal space) than the adjacent teeth.

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Endodontic lesions in cats appear radiographically similar to those in dogs.<br><br>

Endodontic lesions in cats appear radiographically similar to those in dogs.<br><br>

Lucencies That Can Mimic Endodontic Lesions:<br><br>

 

Apical radiographs can be challenging to interpret due to the two-dimensional depiction of complicated anatomy that combines trabecular (spongy) bone, compact bone, soft tissue, and air spaces all projected at various angles and configurations. Other confusing lucencies and opacities can be created by the summation effect of superimposed structures, projecting overlying anatomy in a way that makes it appear to be associated with a tooth root or its supporting bone. These can include bony foraminae, bony fissures, bony canals, and trabeculae. Many nonpathological lucencies, opacities, and apparent deviations from normal can be distinguished from true lesions by comparison with a radiograph of the contralateral tooth.

==Lucencies That Can Mimic Endodontic Lesions==

 

Apical radiographs can be challenging to interpret due to the two-dimensional depiction of complicated anatomy that combines [[Bones - Anatomy & Physiology#Organisation of Bone|trabecular (spongy) bone, compact bone]], soft tissue, and air spaces all projected at various angles and configurations. Other confusing lucencies and opacities can be created by the summation effect of superimposed structures, projecting overlying anatomy in a way that makes it appear to be associated with a tooth root or its supporting bone. These can include bony foraminae, bony fissures, bony canals, and trabeculae. Many nonpathological lucencies, opacities, and apparent deviations from normal can be distinguished from true lesions by comparison with a radiograph of the contralateral tooth.

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Two categories of insult that most commonly cause endodontic disease are bacterial infection and dental trauma. <br><br>

 

Bacteria can also enter the endodontic system of a nontraumatized tooth through extension of periodontal disease. If the periodontal epithelial attachment migrates apically to an endodontic vascular entrance such as a lateral canal, furcation communication, or the apical foramen or delta, then the pulp could become infected. This is referred to as a primary periodontal lesion with secondary endodontic involvement (it has also been referred to as a “perio-endo lesion”). Apical and radicular LEOs can dissect coronally along the side of the root to exit in the sulcus, creating a primary endodontic lesion with secondary periodontal disease (has also been referred to as an “endo-perio lesion”). The bony defects around a tooth with primary endodontic disease and concurrent but unrelated periodontal disease can meet to form a combined periodontal and endodontic lesion.<br><br>

Pulp inflammation and necrosis can also result from deep dental caries with extension of the bacterial infection to the pulp.<br><br>

Two categories of insult that most commonly cause endodontic disease are '''bacterial infection''' and '''dental trauma'''. <br><br>

Blunt trauma can cause pulp hemorrhage and endodontic disease even when the tooth crown does not fracture. Although the pulp has some ability to heal after mild trauma, the most common result of pulp trauma is irreversible pulpitis even when there is no bacterial contamination of the pulp. <br><br>

Bacteria can also enter the endodontic system of a nontraumatized tooth through extension of [[Periodontal Disease|periodontal disease]]. If the periodontal epithelial attachment migrates apically to an endodontic vascular entrance such as a lateral canal, furcation communication, or the apical foramen or delta, then the pulp could become infected. This is referred to as a primary periodontal lesion with secondary endodontic involvement (it has also been referred to as a “perio-endo lesion”). Apical and radicular LEOs can dissect coronally along the side of the root to exit in the sulcus, creating a primary endodontic lesion with secondary periodontal disease (has also been referred to as an “endo-perio lesion”). The bony defects around a tooth with primary endodontic disease and concurrent but unrelated periodontal disease can meet to form a combined periodontal and endodontic lesion.<br><br>

[[Enamel Organ#Pulp|Pulp]] inflammation and necrosis can also result from deep [[Dental Caries|dental caries]] with extension of the bacterial infection to the pulp.<br><br>

Blunt trauma can cause pulp haemorrhage and endodontic disease even when the tooth crown does not fracture. Although the pulp has some ability to heal after mild trauma, the most common result of pulp trauma is irreversible pulpitis even when there is no bacterial contamination of the pulp. <br><br>

Radiographic signs depend on the pulp response:

Radiographic signs depend on the pulp response:

*Arrested development of a tooth (wide pulp with thin dentin)

*Arrested development of a tooth (wide pulp with thin dentin)

[[Category:Intra-Oral Radiography]]

[[Category:Intra-Oral Radiography]]