9 - Patient Evaluation and Diagnosis

Question 1

___% 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

Answer 1

80%; 15%, 5%

Question 2

what is defined as all possible diagnoses that fit a stated set of symptoms

Answer 2

differential diagnosis

Question 3

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

Answer 3

d/d

Question 4

why is diagnosis so difficult

Answer 4

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

Question 5

when pulp testing, do you always test the tooth in question or adjacent teeth first?

Answer 5

adjacent teeth

Question 6

T/F: due to multiple canals, when completing a pulp test, the results may not fit your diagnosis

Answer 6

TRUE (can have a vital canal in a mult-rooted abscessed tooth)

Question 7

how to use endo ice

Answer 7

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

Question 8

how long should you leave endo ice

Answer 8

1-5 seconds

Question 9

why might older patients not feel cold

Answer 9

could have calcified chamberr

Question 10

does endo ice work on crowns

Answer 10

yes

Question 11

symbol and diagnosis for:
“cold goes away immediately”

Answer 11

(+) Normal

Question 12

symbol and diagnosis for:
“cold goes away quickly”

Answer 12

(++) Normal

Question 13

symbol and diagnosis for:
very intense responseto cold

Answer 13

(+++) irreversible pulpitis

Question 14

symbol and diagnosis for:
very intense response and lingering pain to cold

Answer 14

(+++L) irreversible pulpitis with lingering

Question 15

symbol and diagnosis for:
no symptoms to endo ice

Answer 15

(-) non vital tooth

Question 16

what is the act of tapping on the coronal surface or incisal edge of a tooth to assess periapical tissue response

Answer 16

percussion test

Question 17

percussion test asseses what response

Answer 17

periapical tissue response (usually use mirror handle)

Question 18

symbol for percussion test:
periapical tissue WNL

Answer 18

(-)

Question 19

symbol for percussion test:
the periapical tissue is tender (inflammation is extending past the apex or is an occlusion problem)

Answer 19

(+)

Question 20

symbol for percussion test:
the periapical tissue is very tender (more likely is inflammation due to inflammatory agents in PA tissue)

Answer 20

(++)

Question 21

what is the rate for EPT

Answer 21

4-5 speed or “ouch”

Question 22

what is the scale for EPT

Answer 22

0-80 (64 on Digitest3)

Question 23

what EPT reading indicates necrotic tooth

Answer 23

78-80 (64 on digitest 3)

Question 24

what to put on EPT probe? why

Answer 24

toothpaste to allow for conduction of impulse to tooth

Question 25

does the dentist or patient hold EPT probe

Answer 25

patient

Question 26

can you use EPT on crowns?

Answer 26

no! unless there is exposed tooth

Question 27

should you use EPT on wet or dry tooth

Answer 27

dry tooth - saliva must not be present or false positive results will occur

Question 28

EPT is a good test for what

Answer 28

calcified pulp chambers (where cold didn’t respond)

Question 29

for any diagnosis, there are 5 tools to assist in arriving at a definitive diagnosis. what is it

Answer 29

1. What the patient tells you about their symptoms
2. Results of your oral examination (exposed dentin, caries, perio, occlusion)
3. Diagnostic test results (palp, perc, EPT, cold)
4. Radiographic evaluation
5. INTUITION /COMMON SENSE

Question 30

what are categories of common oral pain

Answer 30

1. Disorders of endodontic origin
2. Disorders of periodontal origin - teeth vital possible cold/sweet sensitivity (ging/perio abscess, pockets, exposed dentin)
3. Disorders of other oral or perioral structures vital teeth (occlusion/tongue/salivary glands, sinus, trigeminal
   neuralgia)
4. Disorders that are not related to the oral cavity but have oral manifestations (neural, vascular disorders)

Question 31

what are categories of uncommon oral pain

Answer 31

Psychosomatic disorders
“I need the drugs”
Undetermined (I don’t know)

Question 32

If treatment is required, choose the most conservative treatment possible, but always present the patient what?

Answer 32

with the possibility that a more aggressive approach may be needed

Question 33

should you hesitate to get a second opinion or refer

Answer 33

no

Question 34

buy as much time as possible, why?

Answer 34

time usually clarifies a diagnosis