Diagnosis: PAP and diagnosis

[Contach]

Something that I was arguing with a classmate about...
Question: if there is a periapical pathology (radiolucency on radiograph) on tooth 6, and the tooth is sensitive to percussion and palpation, what is the diagnosis of the pulp? Is it a definitive diagnosis, what is the differential?

Thanks

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[HupHolland]

Something that I was arguing with a classmate about...
Question: if there is a periapical pathology (radiolucency on radiograph) on tooth 6, and the tooth is sensitive to percussion and palpation, what is the diagnosis of the pulp? Is it a definitive diagnosis, what is the differential?

Thanks

diff periapical dx:
symptomatic apical periodontitis
acute apical abscess

if there is swelling, then dx is the latter.

Hup

 

[Vapor1122]

diff periapical dx:
symptomatic apical periodontitis
acute apical abscess

if there is swelling, then dx is the latter.

Hup

Those are periapical diagnoses. The pulp will be necrotic.

 

[HupHolland]

Oops...

To answer the OPs question: No, not definitive. It is dependent upon the vitality of the pulp. Endo ice will give you your answer 🙂

 

[lemoncurry]

Most likely the pulp is necrotic, but to be certain, I would do your hot/cold/EPT testing just to cover your bases. It's not like the treatment is going to change.

My understanding is that once you have a PAP, the pulp is automatically necrotic, as the PAP is a result of the necrosis, but don't quote me on that.

 

[djeffreyt]

Most likely the pulp is necrotic, but to be certain, I would do your hot/cold/EPT testing just to cover your bases. It's not like the treatment is going to change.

My understanding is that once you have a PAP, the pulp is automatically necrotic, as the PAP is a result of the necrosis, but don't quote me on that.

I'm gonna quote you on it.

If the PAP is due to pathology from the pulp, then it is likely necrotic, but there are a few other possibilities. If there is a PAP, but maybe it's a cyst and not of pulpal origin, then necrosis is unlikely. There is also a real odd thing I've seen at times when you have a multirooted tooth that has a PAP on one root but still tests with some vitality. I've never been sure what to call this so I usually call it irreversible pulpitis with periapical pathology.

 

[beannaithe]

I'm gonna quote you on it.

If the PAP is due to pathology from the pulp, then it is likely necrotic, but there are a few other possibilities. If there is a PAP, but maybe it's a cyst and not of pulpal origin, then necrosis is unlikely. There is also a real odd thing I've seen at times when you have a multirooted tooth that has a PAP on one root but still tests with some vitality. I've never been sure what to call this so I usually call it irreversible pulpitis with periapical pathology.

My endo prof in dental school used to love multi-rooted teeth with periapical radiolucencies and reactive cold test. They're usually called partially necrotic and AAP. AAA/SAP are usually only in completely necrotic cases. Though not every time...

 

[DrJeff]

PAP = RCT or EXT - It is that simple 😉

There are plenty of times when you can have PAP with the tooth being asymptomatic. Typically though when you have PAP you'll atleast have some degree of percussion sensitivity. Most of the time though a tooth with PAP won't have temperature sensitivity (unless its a multi rooted tooth and there's still some vital tissue in one of the roots for the bugs to "snack" on) as by the time there's been enough radiographic changes to the bone to show up on a radiograph, the pulp tissue in that tooth is long since gone