during endo Tx pt is complaining of pain with percussion what u suspect?
- A- apical periodontitis
- B- secondery apical periodontitis.
both apical periodontitis and secondary apical periodontitis are possible causes of pain during percussion in an endodontic (endo) treatment.
However, there are some key differences between the two:
A- Apical periodontitis:
- Definition:
Inflammation of the tissues surrounding the root tip of a tooth caused by bacterial infection.
- Causes:
- Untreated caries (cavities) reaching the pulp chamber.
- Trauma to the tooth.
- Cracked tooth syndrome.
- Leaky dental restorations.
- Procedural errors during dental procedures.
- Symptoms:
- Toothache, especially on biting or chewing.
- Sensitivity to hot and cold.
- Swelling and tenderness around the tooth.
- Pus drainage from the gums.
- Discoloration of the tooth.
- Diagnosis:
- Clinical examination, including percussion and palpation.
- X-rays to assess the extent of bone loss around the root tip.
- Treatment:
- Root canal treatment to remove the infected pulp tissue and clean and disinfect the root canals.
- Antibiotics to treat any accompanying infection.
- Pain medication.
B- Secondary apical periodontitis:
- Definition:
Inflammation of the tissues surrounding the root tip of a tooth that has already undergone root canal treatment.
- Causes:
- Failure of the root canal treatment to completely remove the bacteria or seal the canals.
- Leakage of bacteria from the coronal (crown) filling.
- Fracture of the root.
- Symptoms:
- Similar to apical periodontitis, but may be less severe.
- Pain on biting or chewing.
- Sensitivity to hot and cold.
- Swelling and tenderness around the tooth.
- Pus drainage from the gums.
- Discoloration of the tooth.
- Diagnosis:
- Clinical examination, including percussion and palpation.
- X-rays to assess the extent of bone loss around the root tip.
- Additional tests, such as a cone beam CT scan, may be needed to diagnose fractures or other complications.
- Treatment:
- Retreatment of the root canal to remove any remaining bacteria and seal the canals.
- Apical surgery to remove infected tissue and seal the root tip if retreatment is not successful.
- Antibiotics to treat any accompanying infection.
- Pain medication.
Key Differences:
Here's a table summarizing the key differences:
|
Feature |
Apical Periodontitis |
Secondary Apical Periodontitis |
|
Cause |
Untreated infection, trauma, etc. |
Failure of root canal treatment, leakage, fracture |
|
Symptoms |
Toothache, sensitivity, swelling, pus, discoloration |
Similar to apical periodontitis, but may be less severe |
|
Diagnosis |
Clinical exam, X-rays |
Clinical exam, X-rays, additional tests |
|
Treatment |
Root canal treatment, antibiotics |
Retreatment, apical surgery, antibiotics |
In conclusion, both apical periodontitis and secondary apical periodontitis can cause pain during endo treatment with percussion. The specific cause will depend on the patient's dental history and the results of a thorough clinical examination and diagnostic tests.
