Endodontic Examination and Diagnosis Flashcards
What is a dentist? (definition)
A licensed practitioner whos is skilled in the prevention, diagnosis, and treatment of diseases, injuries, and malformations of the teeth, jaws, and the mouth
What are the stages of the diagnostic process?
History
Clinical exam
Test results
Radiographs
Diagnosis and cause
Management plan
Discuss with patient
Written records
What is the diagnostic process?
An information gathering exercise; different pieces are put together to form a big picture
What follows diagnosing a patient?
Once the diagnosis has been made the management options are obvious. Prognosis can be assessed from this information.
What must be identified in addition to the diagnosis?
Must always identify the cause of the disease so that it can be removed. Pulp and periapical disease are caused by bacteria so it must be assessed how the bacteria have entered the tooth/canal then the appropriate treatment becomes obvious.
What is essential for taking history?
Communication skills (get the patient telling the practitioner what the problem is)
A clean environment with nothing except whats relevant for the patient
Ask general questions if they aren’t giving relevant information then get more specific
What information should be looked for regarding history?
Previous restorations
Previous caries, trauma, etc
Previous symptoms
Previous treatment
Why is history so useful with treatment?
Helps to establish previous events which may decrease the pulp’s reparative functions
What kind of clues help to identify the cause of endodontic pain?
Nature of pain
Duration of pain (seconds, minutes, or lingering)
Onset of pain
Stimuli that cause the pain (thermal, percussion, etc)
Relationship to past events (Do analgesics help with the pain and do the patients take a lot of them)
What is the outcome we should get from a good patient history?
Provisional diagnosis could be come up with as a result
How can we confirm the diagnosis, which tooth, and determine the cause of the provisional diagnosis?
Radiographic and clinical examinations
What external signs should we look for and what can they tell us?
Look for external signs like swelling of the face, reaction to questioning, ability to localize, tenderness avoided when speaking, sleeplessness leading to irritability and anxiety, etc
What diagnostic tests can be done during endodontic examination?
Pulp sensibility testing: Cold, heat, and electric (indicate root canal status)
Percussion (periradicular and periapical status of the tooth)
Palpation (periradicular and periapical status of the tooth)
Periodontal probing (indicate periodontal status)
Mobility (indicate periodontal status)
Radiographs (periodontal status, indicate possible causes of condtiion)
Transillumination and bitig tests tell us possible causes.
Local anaesthesia (Giving LA to anaesthetize 1 tooth at a time to see if the pain goes away to narrow pain down) [hard to anaesthetize one tooth at a time]
Test cavity (Drill hole into tooth without anaesthetic to see if it can be felt; not a good test at all)
Which test is most reliable for endodontic diagnosis?
All of them should be done for reliable results
NEED AT LEAST 2 SYMPTOMS OR SIGNS TO CONFIRM. Preferably more.
How should the cold test be performed?
Start by testing the teeth that are not suspected to be the cause then move to the causative tooth.
Why are cold sprays not as reliable as CO2?
Cold sprays are not as cold as CO2 and evaporate quickly so its very slow.
Gas to liquid change touches gingiva which could explain pain instead of tooth itself.
Do restorations affect the reliablilty of the tests?
Porcelain restoration or composite will still work
Amalgam restoration conducts the temperature but it can still be tested with CO2
Doesn’t matter what the surface is and the restoration the cold test still works.
Should heat tests be conducted on the teeth?
Heat tests are unreliable and dangerous. They should be avoided.
Hot water over teeth can also be used.
Hold near the tooth but not on the tooth. Ideally the heat will radiate towards the tooth.
Only do if patients are complaining of sensibility to hot things and not to cold things.
What is the issue with heat tests that make them not used ever?
No control over the temperature with any of the heat tests
Potentially dangerous and can burn lips, cheek or tongue.
Teeth with clinically normal pulp do not react to heat as well as teeth with a pulp.
How does the electric pulp test?
Electric pulp tests feed an electric current through the tooth which leads to a tingling pain sensation.
Clinically normal teeth respond at 32.
If it gets up to 80 with no response then its considered a non-responsive tooth.
