Every Dentistry Diagnoses you NEED to know when seeing patients!

Summary

In this comprehensive guide by Two Dentists, Zoh, a foundation dentist, and Ali, a final-year dental student, dive into the essential diagnoses every dental professional needs to know before seeing patients. The video meticulously segments each diagnosis with timestamps, covering cavities, periodontal diseases, tooth surface loss, and more complex conditions such as pulpal necrosis and periodontal abscesses. This engaging tutorial is designed to equip new dental practitioners with crucial insights into diagnosing various dental conditions effectively.

Highlights

• Caries can progress to complex conditions like pulpal necrosis and require different diagnostic approaches. 🦷
• Periodontal diagnosis involves a structured assessment using the BPE and understanding gingivitis stages. 🌟
• Tooth surface loss isn't just about caries; it involves erosion, attrition, abrasion, and more. 📉
• Phoenix abscess and cracked tooth syndrome are critical conditions to diagnose accurately. 🔍
• Dental practitioners should know emergency indicators for conditions like pericoronitis and alveolar osteitis. 🚨

Key Takeaways

• Learn the progression of caries and how it affects dental diagnoses.
• Understand the nuances of periodontal diagnostics using the Basic Periodontal Examination (BPE).
• Recognize different types of tooth surface loss: erosion, attrition, abrasion, and abfraction.
• Explore the syndromes caused by dental procedures and natural tooth decay processes.
• Master key diagnosable conditions outside typical categories, like dentine hypersensitivity and cracked tooth syndrome.

Overview

This insightful video by Two Dentists breaks down complex dental diagnoses into understandable segments, perfect for new practitioners. Starting with caries, Zoh and Ali explain how simple cavities can lead to more significant issues like pulpal necrosis. They provide clarity on diagnosing each stage and condition.

Following this, the video delves into periodontal disease diagnosis, emphasizing the use of the Basic Periodontal Examination to categorize gum health accurately. This section is crucial for understanding the progression from gingivitis to periodontitis and respective treatment approaches.

Additionally, the duo explores tooth surface loss, detailing the differences between erosion, attrition, and other forms, explaining how these affect treatment plans. With a fun and enlightening style, they prepare viewers to handle various dental diagnosis scenarios efficiently.

Chapters

• 00:00 - 00:30: Introduction and Overview of Diagnoses The chapter provides an introduction to essential dental diagnoses, crucial for beginners before seeing patients. Presented by Zoh, a foundation dentist, and Ali, a final-year dental student, the content is organized into categories with timestamps for easier navigation. It starts with an overview of dental caries and its potential progression to pulpal and periapical diagnoses.
• 00:30 - 01:00: Caries Diagnosis and Progression The chapter begins by introducing various methods for diagnosing dental caries. It categorizes diagnosis methods into visual, tactile, and radiographic tactics. The text highlights how caries initially appear as inactive white spot lesions that are smooth, frosty, opaque, and non-cavitated. These early lesions can be more effectively detected when dried with air from a three-in-one syringe.
• 01:00 - 05:00: Understanding Pulpal Diagnoses This chapter explains the progression of dental caries and its impact on the pulp. It describes how, once caries reach the enamel-dentine junction, it can spread laterally and towards the pulp, potentially causing symptoms of reversible pulpitis. Symptoms include localized sharp pain triggered by hot, cold, or sweet substances, usually lasting only a few seconds.
• 05:00 - 10:00: Diagnosing Gum Disease The chapter 'Diagnosing Gum Disease' focuses on the process of identifying gum disease symptoms. It discusses the importance of treating dental caries promptly to prevent pulp inflammation. When caries are left untreated, they can lead to symptomatic irreversible pulpitis, characterized by spontaneous, dull, prolonged pain. This condition requires root canal treatment as simply removing the caries and performing a filling will not resolve the inflammation or pain. The chapter suggests asking specific questions to patients as part of the diagnostic process.
• 10:00 - 15:00: Periodontal Diseases and Treatments This chapter focuses on the differentiation between reversible and irreversible pulpitis, a condition characterized by inflammation of the dental pulp. It provides key indicators for diagnosis such as the persistence of pain, effectiveness of painkillers, and response to cold drinks. The chapter explains how irreversible pulpitis can sometimes present without symptoms, known as asymptomatic irreversible pulpitis. As the condition progresses, it can lead to pulp necrosis, indicating further advancement of the infection.
• 15:00 - 20:00: Tooth Surface Loss Types The chapter 'Tooth Surface Loss Types' discusses the progression of dental issues related to the necrosis of pulp within a tooth. It highlights how bacteria can spread from dying pulp to the periapical tissues, leading to symptoms such as apical periodontitis, characterized by localized pain during biting due to inflammation of the periodontal ligament. This pain is a response to the bacteria releasing toxins, causing a chronic inflammatory reaction and subsequent bone resorption.
• 20:00 - 25:00: Additional Diagnoses This chapter discusses the interrelation of oral diseases, focusing on symptoms and progression. It highlights how an apical radiolucency seen in radiographs can be a sign of symptomatic apical periodontitis, which often presents alongside irreversible pulpitis. The text explains that due to the dynamic nature of these diseases, as the pulp becomes inflamed, symptoms of irreversible pulpitis manifest, while inflammation of the periodontal ligament (PDL) leads to periapical symptoms. If these conditions are not treated, the pulp may eventually die, resulting in exclusive periapical symptoms.
• 25:00 - 28:20: Conclusion and Viewer Interaction This chapter explores the progression of apical periodontitis, specifically chronic apical periodontitis. It discusses how it is caused by chronic inflammation and destruction of the periodontium, and how it can be detected on radiographs as a large, well-defined radiolucency. The discussion includes the potential for chronic apical periodontitis to become re-exacerbated into symptomatic apical periodontitis, or an acute exacerbation of the condition. Additionally, it touches on the formation of an acute apical abscess, which is a pus-filled swelling that can occur once the infection has passed through the apex.

Every Dentistry Diagnoses you NEED to know when seeing patients! Transcription

• 00:00 - 00:30 hey guys for those of you that don't know us i'm Zoh i'm a foundation dentist working here in london and this is ali he's a final year dental student at university of newcastle today we're going to be covering all the essential diagnoses that you should know before you start seeing patients for the first time so we're going to be covering a lot in this video and you could probably see that by the length of the video as well so to make sure you guys can follow along we'll split them into categories with timestamps so we'll start by talking about carries and how that can progress to pulpal and periapical diagnosis and we'll follow that by covering all
• 00:30 - 01:00 the periodontal diagnosis and tooth surface loss and at the end we'll talk about some of the other diagnosis that don't really fit into a category 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 micro-cavitated and now you can detect them by running a probe along the surface there are no symptoms at this stage and
• 01:00 - 01:30 if the plaque is removed the lesion can arrest and become a brown spot lesion with a hard shiny surface so caries 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 dentinal tubules towards the pulp 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
• 01:30 - 02:00 because basically if you treat the caries 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 pulpitis 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
• 02:00 - 02:30 differentiate whether it's reversible or irreversible pulpitis does the pain keep you up at night for example if it does then it's irreversible pulpitis do painkillers help if they don't again it's irreversible pulpitis do cold drinks alleviate the pain it tends to with irreversible pulpitis sometimes you might see a patient with a large carious 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
• 02:30 - 03:00 stage the patient may actually present with a history of pulpotic symptoms which they no longer have so while the pulp is dying the bacteria will also travel to the periapical 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 leech toxins through the apex causing a chronic inflammatory response which leads to bone resorption now if enough bone resorption occurs this will
• 03:00 - 03:30 be seen in the radiograph as an apical radiolucency symptomatic apical periodontitis often presents with symptoms of irreversible pulpitis 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 a 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 pulp might die and they might only experience periapical symptoms for example if the symptomatic
• 03:30 - 04:00 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 as a much larger well-defined radiolucency and can re-exacerbate to become symptomatic apical perodontitis 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
• 04:00 - 04:30 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 tract and point to the infected tooth the next diagnosis is one that is often
• 04:30 - 05:00 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
• 05:00 - 05:30 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 pulpal diagnoses which are reversible pulpitis symptomatic irreversible pulpitis asymptomatic irreversible pulpitis pulpal necrosis and the periapical diagnosis which are symptomatic apical periodontitis asymptomatic apical periodontitis acute apical abscess chronic apical abscess and condensing osteitis it's important to note that when you provide a diagnosis for a tooth you have to give both a pulpal diagnosis
• 05:30 - 06:00 and a periapical diagnosis so for example you might say pulp necrosis and symptomatic apical periodontitis of the upper left 6. so we're going to move on to the diagnosis of gum disease or periodontitis you first need to take a periodontal screening for every patient that walks through your door the screening tool used is called a basic periodontal examination and if you're unsure of what that is you can pause the video now and have a little look on your screen now that you've got a code for each
• 06:00 - 06:30 sextant the british society of periodontology have formed an in-depth sheet to follow which we'll go through in this video and keep in mind that this classification is also used internationally a bpe score of zero indicates healthy gums while one and two would indicate some level of gingivitis depending on how much bleeding you estimate to have seen so let's start by discussing a patient who scores zeros and ones on their bpe if while you were carrying out your bp you saw less than 10 bleeding when probing this indicates clinical gingival health if you saw between 10 and 30 beating on probing you'll diagnose them
• 06:30 - 07:00 with localized gingivitis and finally if there were more than 30 bleeding on probing this would be a generalized gingivitis now if they also scored a co2 anywhere you would supplement the gingival diagnosis with any plaque protective factors or calculus which might have led to that score of two so for example localized gingivitis due to overhanging restorations on upper right five upper at six let's start with code threes only no code fours you start by taking radiographs in the sextants with scores of three to assess if there's any bone loss in those areas you will then do an initial periodontal
• 07:00 - 07:30 therapy which is just a combination of good super gingival scaling and oral hygiene instructions and then wait eight to twelve weeks for the inflammation to cool down this will reduce any false pocketing and if it was real pocketing sometimes just good oral hygiene is enough to close the pocket once you have the patient back after eight to twelve weeks the guidelines say that you do a six point pocket chart in the involved sextants but we think it's best if you just redo a bpe and if they score a three then you carry out a six point pocket shot in the involved sextants the six point pocket chart will record the pocket depths at six sites on each
• 07:30 - 08:00 tooth bleeding on probing mobility recession and vacations so that was for a bp over three but if the first time you saw the patient that had the bp of four you skip the initial periodontal therapy and the eight to twelve week wait and you go straight into taking radiographs doing a four mile six month pocket chart and forming your diagnosis so now let's discuss formula diagnosis if they're scores of three initially but after the initial therapy had no pockets deeper than four millimeters and no radiographic evidence of bone loss you can diagnose them using the simpler diagnosis system of bps of 0 1 and 2. if however you find that to
• 08:00 - 08:30 have pockets deeper or equal to 4 millimeters or have bone loss or both then you proceed to diagnose them using the code 4 pathway and if your patient had bpr4 from the beginning you also diagnose them with this pathway in this pathway if you notice that there's a pattern on just the molars and the incisors this is diagnosed as periodontitis molar incisor pattern followed by the staging grading stability and risk factors which we'll talk about in just a bit if you find that there is less than 30 percent of teeth with pocket depths of less than or equal to 4 millimeters and teeth with radiographic evidence of
• 08:30 - 09:00 bone loss this is diagnosed as localized periodontitis more than 30 will be generalized periodontitis to classify the stage and grade you need the radiograph that you took on that first appointment staging refers to the severity of the disease and is calculated using the worst site of bone loss while grading refers to the rate at which the disease is progressing and this is calculated using the percent of bone loss and the patient's age you don't actually need to whip out a calculator on clinic by the way it's really simple maths if the patient is 30 and you have more than 30
• 09:00 - 09:30 bone loss then the ratio is more than one and that's grade c and if it's that same 30 year old who had a bone loss of 15 that would be grade a and if it's anything in between then it would be grade b stability also needs to be assessed and it would be tedious for me to just recite to you what you can already read but it's important to note that anything which has a pocket depth of more than or equal to five millimeters will always be classified as unstable which is something i've heard so many of my clinicians saying it's a flaw in the classification because if someone went from having eight millimeter pockets down to five millimeter pockets that's an amazing
• 09:30 - 10:00 improvement right even if it stays at five millimeters for the rest of their life they will classify that as unstable risk factors include things like smoking and diabetes but you can pause here for a full list taken from the bsp guidelines finally combine everything you've found so far and there you go you've got your periodontal diagnosis one last diagnosis involving period that we want to mention is a lateral periodontal abscess this is similar to a periapical abscess which we discussed before but the difference is that it's on the side of the tooth instead of the apex and the pulp is
• 10:00 - 10:30 usually vital because pump necrosis is not the cause here a periodontal abscess is actually caused by the bacteria inside of a deep periodontal pocket a pass filled abscess may form when the immune system responds to the bacteria and attempts to isolate the infection from spreading usually the pus will drain naturally through their pocket but if there's something in there blocking the drainage like calculus or trapped food then the abscess can grow the next thing we're going to be discussing is tooth surface loss to surface loss is the loss of heart tissue caused by factors other than caries
• 10:30 - 11:00 the four types we're going to be discussing are erosion attrition abrasion and abstraction the first one is erosion which is two surface loss caused by a chemical process like an acid attack not involving bacteria and there are both intrinsic and extrinsic sources of acid intrinsic sources are things like acid reflux or vomiting and these patients usually present with palatal to surface loss on the upper teeth with these patients you don't see much to surface loss on the lower molars or the incisors because as they have acid reflux or they throw up their tongue goes over
• 11:00 - 11:30 and protects those teeth now extrinsic sources are mainly diet related like fizzy drinks and juices these patients mostly present with two surface loss on the labial surfaces of incisors and the occlusal surfaces of molars in both types you might see bold like where facets sometimes called a ring of enamel and this happens because the dentine wears away at a faster rate than the enamel there's also environmental sources of acid like working in environments such as a battery factory this is a lot rarer now because of stricter health and safety regulations there are plenty of other causes for two surface loss as well so pause here for the full list that we've come up with
• 11:30 - 12:00 once you've identified the cause there's a couple things to look out for when assessing patients as to whether the two surface loss is ongoing or arrested if they're staining on the teeth this suggests that it's been arrested because if it was active the stained layer would have worn out a sign of inactive to surface loss is when they used to experience hypersensitivity but now they don't and when you look into their mouth you can see signs of two surface loss like the ones that we talked about before the sensitivity here has stopped because the cause of two surface loss has stopped as well and has allowed time for tertiary dentine to form
• 12:00 - 12:30 the next type of to surface loss is attrition which is tooth wear caused by tooth to tooth contact usually associated with grinding and parafunctional activities patients usually present with smooth facets which are flat and match the opposing teeth and you usually see it happening at the same time as erosion that's because erosion will demineralize the heart tissues which weakens it and then grinding wears it away if the tooth surface loss by attrition is extensive and rapid you should expect to see a reduction in the ovd so the patient would look over closed or like a grammar with no teeth you wouldn't see this if the tooth well was gradual
• 12:30 - 13:00 because dental alveolar compensation will maintain their ovd dental alveolar compensation is the process where alveolar bone remodels and elongates the compensate for the loss of vertical dimension for example you can see the difference in these photos you've got no dental aveolar compensation on the left and the gingival margins of all the lower in sizes are in one straight line in the photo on the right you can see the lower incisors are at a higher level compared to the canines due to the dental alveolar compensation you can also see an increased width of the attached gingiva
• 13:00 - 13:30 the next type of two surface loss is abrasion and it's tooth wear caused by tooth to non-tooth contact so for example hard tooth brushing with charcoal activated toothpaste or habits like pen biting depending on the habit the patient will often present differently so for example if a patient is right-handed and constantly over-brushing the left side of their mouth you would see that the tooth were on the buccal cervical margins of the upper left teeth whereas with pen biting you will see chipped inside the edges the last type of to surface loss is known as abfraction this is defined as a fracture on the cervical margin which is
• 13:30 - 14:00 caused by flexures upon occlusal loading this is how it looks ab fraction is sometimes missed out from books which talk about tooth surface loss because it's not believed to be as relevant or necessarily true now we're going to talk about some of the diagnosis that didn't really fit into a category but are still essential for you to know first one on the list is dentine hypersensitivity and it occurs when there's exposed dentine and can be caused by things like the tooth surface loss that we discussed trauma caries gingival recession and maybe even
• 14:00 - 14:30 an over-etched composite filling the patient would present with a localized sharp pain to hot cold and or sweets the pain usually only lasts a few seconds and goes away after the stimulus is removed this pain can be replicated if you blow air from your three in one syringe at the tooth but be careful when you do this and make sure you warn the patient before you do because it can really surprise them another diagnosis you should be aware of is called cracked tooth syndrome this is defined as an incomplete fracture in a vital posterior tooth your patient might present with a sharp localized pain which might be made worse
• 14:30 - 15:00 by releasing after biting down the best way to test this is with something called a tooth sleuth and there are two places that you should test the fishes and each of the individual cusps the way you use it is by placing the pointy end on the tooth in question and asking the patient to buy and hold then release and ask them at what point it hurt them second to last on the list is pericoronitis which is the inflammation of the operculum which is the soft tissue surrounding an impacted tooth you'll pretty much only see this on the eight but it can technically happen to any other partially erupted tooth the patients are usually between 17 and
• 15:00 - 15:30 24 as well since this is the time when their wisdom teeth are erupting and they present with localized pain swelling and they might have difficulty opening their mouth it's not uncommon to also see lymphadenopathy bad breath or pus sometimes patients even come in with very large swellings and you'll need to know when it's an emergency or not the signs that would make you consider referring them straight to a e are difficulty breathing difficulty swallowing or difficulty sticking their tongue out swellings like this in the floor of their mouth can be especially dangerous since they can block the airways known as ludwig's angina and be a cause of
• 15:30 - 16:00 death the last diagnosis we think you should know is called alveolar osteitis this is a fancy way of saying a dry socket it's the inflammation of the exposed alveolar bone in the socket when a blood clot fails after an extraction the patient would usually come back two to five days post-extraction complaining that they have a severe throbbing pain which is worse now than it was before they had the tooth removed they also tell you that they have bad breath and taste and that's because food would have been packing into the socket blood clots fail by dislodging or never forming in
• 16:00 - 16:30 the first place it can dislodge by the change in air pressure from smoking or using a straw or even mouthwashing too aggressively within 24 hours of the extraction other risk factors are difficult extractions a previous dry socket diabetes anticoagulants or even if someone suffers from blood clotting disorders if you made it this far in the video thank you so much for watching we hope you found that video helpful if you did would really appreciate it if you guys gave us a like and subscribed you might also enjoy some of the other videos that we have on the channel so feel free to check out some of the suggestions we have here also if your uni teaches you a different
• 16:30 - 17:00 way of diagnosing then put that in the comments and we can compare and have a conversation about it see you guys in the next video peace