9 - Patient Evaluation and Diagnosis Flashcards
___% of cases you see, the definitive diagnosis will be obvious, more or less, from the beginning.
___% of cases you see you will need to establish a d/d
___% of cases you will be left with differential and will not be able to immediately determine a definitive diagnosis
80%; 15%, 5%
what is defined as all possible diagnoses that fit a stated set of symptoms
differential diagnosis
what is the first step in process of eliminating all other possibilities to arrive at a d/d when a d/d isn’t readily apparant
d/d
why is diagnosis so difficult
Diagnosis is 75% science and 25% experience and intuition
Unreliable symptoms
Unreliable pulp tests
Overlapping (non-unique) and vague symptoms
(Mis)interpretation of radiographs
Unreliable patients
- Inadvertent - old lady that wants to talk to someone
- Intentional - asks to pain pills (specific) - drug seeking
when pulp testing, do you always test the tooth in question or adjacent teeth first?
adjacent teeth
T/F: due to multiple canals, when completing a pulp test, the results may not fit your diagnosis
TRUE (can have a vital canal in a mult-rooted abscessed tooth)
how to use endo ice
Tell pt to raise their hand when they feel anything (Tingling, burning, cold, itching, or pain)
Leave cotton on tooth for 1-5 sec
Refreeze cotton after each tooth tested
how long should you leave endo ice
1-5 seconds
why might older patients not feel cold
could have calcified chamberr
does endo ice work on crowns
yes
symbol and diagnosis for:
“cold goes away immediately”
(+) Normal
symbol and diagnosis for:
“cold goes away quickly”
(++) Normal
symbol and diagnosis for:
very intense responseto cold
(+++) irreversible pulpitis
symbol and diagnosis for:
very intense response and lingering pain to cold
(+++L) irreversible pulpitis with lingering
symbol and diagnosis for:
no symptoms to endo ice
(-) non vital tooth
what is the act of tapping on the coronal surface or incisal edge of a tooth to assess periapical tissue response
percussion test
percussion test asseses what response
periapical tissue response (usually use mirror handle)
symbol for percussion test:
periapical tissue WNL
(-)
symbol for percussion test:
the periapical tissue is tender (inflammation is extending past the apex or is an occlusion problem)
(+)
symbol for percussion test:
the periapical tissue is very tender (more likely is inflammation due to inflammatory agents in PA tissue)
(++)
what is the rate for EPT
4-5 speed or “ouch”
what is the scale for EPT
0-80 (64 on Digitest3)
what EPT reading indicates necrotic tooth
78-80 (64 on digitest 3)
what to put on EPT probe? why
toothpaste to allow for conduction of impulse to tooth
does the dentist or patient hold EPT probe
patient
can you use EPT on crowns?
no! unless there is exposed tooth
should you use EPT on wet or dry tooth
dry tooth - saliva must not be present or false positive results will occur
EPT is a good test for what
calcified pulp chambers (where cold didn’t respond)
for any diagnosis, there are 5 tools to assist in arriving at a definitive diagnosis. what is it
- What the patient tells you about their symptoms
- Results of your oral examination (exposed dentin, caries, perio, occlusion)
- Diagnostic test results (palp, perc, EPT, cold)
- Radiographic evaluation
- INTUITION /COMMON SENSE
what are categories of common oral pain
- Disorders of endodontic origin
- Disorders of periodontal origin - teeth vital possible cold/sweet sensitivity (ging/perio abscess, pockets, exposed dentin)
- Disorders of other oral or perioral structures vital teeth (occlusion/tongue/salivary glands, sinus, trigeminal
neuralgia) - Disorders that are not related to the oral cavity but have oral manifestations (neural, vascular disorders)
what are categories of uncommon oral pain
Psychosomatic disorders
“I need the drugs”
Undetermined (I don’t know)
If treatment is required, choose the most conservative treatment possible, but always present the patient what?
with the possibility that a more aggressive approach may be needed
should you hesitate to get a second opinion or refer
no
buy as much time as possible, why?
time usually clarifies a diagnosis
