Endodontic diagnosis update

The diagnostic terminology presented in this update provides for a more accurate description and communication of the health or pathological conditions of both pulpal and apical tissues. This information is summarized in Table I. Endodontic diagnostic terminology update. N2 - Determination of the etiology of the patient's chief complaint and a correct diagnosis are paramount prior to a recommendation of endodontic therapy.

AB - Determination of the etiology of the patient's chief complaint and a correct diagnosis are paramount prior to a recommendation of endodontic therapy. Scott B. McClannahan, Michael K. Baisden, Walter R Bowles.

Click Here! Successful endodontic treatment is predicated upon correct pulpal and periradicular diagnoses. It is paramount that endodontic etiology be identified before any endodontic treatment is initiated.

There is often confusion among clinicians as to which test to perform in order to arrive at pretreatment pulpal and periradicular diagnoses. Below are five objective clinical tests used to determine the pulpal and periradicular diagnoses:. It is important to note that heat and cold tests do not jeopardize the health of the pulp 1. Also, teeth with porcelain or metal crowns do conduct temperature and, therefore, can be tested for pulpal vitality with cold or heat. There is often confusion on what the numerical readings on an EPT represent.

Although the use of an EPT can establish pulp vitality, the numerical readout should not be used to determine the overall health of the pulp. The EPT is used to determine if the pulp is vital or not.

When using an EPT, be aware that teeth with metal restorations can give false-positive or false-negative responses. In a study by Weisleder et al, 4 the investigators reported that cold test and EPT used in conjunction resulted in a more accurate method for diagnostic testing.

Percussion tests for determining the status of the periodontal ligament. All this specific test helps to determine is the status of the periodontal ligament Figure 1. A bite test may also need to be performed if a patient complains about pain upon mastication. Palpation of the buccal and lingual gingival tissue of the tooth in question. It is important to note that even when there is no radiographic evidence of an apical infection, clinically, an infection may be present.

Bender et al 5 reported that it is not uncommon to have extensive disease of the bone when there is no evidence on a radiograph. Periodontal examination that includes periodontal probings and tooth mobility.

Nociceptors are sensory receptors that respond to potentially damaging stimuli by sending nerve signals to the brain. This stimulus can cause the perception of pain in an individual. The pulpal nerve fibers A-Delta and C-fibers are nociceptors. Reversible pulpitis is pain from an inflamed pulp that can be treated without the removal of the pulp tissue.

It should be noted that this is not a disease, but a symptom. A classic clinical symptom is sharp, quick pain that subsides as soon as the stimulus is removed. Physiologically, it is the A-Delta fibers that are firing, not the C-fibers of the pulp. They are stimulated by cold and EPT and cannot survive in a hypoxic low oxygen environment.

Reversible pulpitis also does not involve an unprovoked spontaneous response. Irreversible pulpitis is an inflamed pulp that cannot be treated except by the removal of the pulp tissue.

C-fibers are the unmyelinated, high-threshold, aching pain nerve fibers. They are distributed throughout the pulp. They are stimulated by heat and can survive in a hypoxic environment. Pulpal necrosis can occur as a result of an untreated irreversible pulpitis or immediately after a traumatic injury that disrupts the vascular system of the pulp. A necrotic pulp does not respond to cold tests, EPT, or heat tests. When clinicians think of endodontic treatment, they often focus only on the pulpal diagnosis.

Although this diagnosis is important prior to performing root canal treatment, making a periradicular diagnosis is just as important. Proper endodontic treatment begins with the correct pulpal and periapical diagnoses. All dentists who provide endodontic treatment to their patients must be aware of these changes in diagnostic terms. The etiology should be identified and the correct diagnosis determined prior to the initiation of any endodontic treatment.

Lastly, because some nonodontogenic pain symptoms mimic endodontic type pain symptoms, dentists must be able to differentiate between odontogenic and nonodontogenic etiology. Login Sign Up. Registration on CDEWorld is free. Sign up today! Forgot your password? Click Here! Successful endodontic treatment is predicated upon correct pulpal and periradicular diagnoses.

It is paramount that endodontic etiology be identified before any endodontic treatment is initiated. There is often confusion among clinicians as to which test to perform to arrive at pre-treatment pulpal and periradicular diagnoses.

Below are five objective clinical tests used to determine the pulpal and periradicular diagnoses:. It is important to note that heat and cold tests do not jeopardize the health of the pulp. There is often confusion regarding what the numerical readings on an electric pulp test EPT represent. Although the use of an EPT can establish pulp vitality, the numerical readout should not be used to determine the overall health of the pulp. The EPT is used to determine if the pulp is vital or not.

When using an EPT, be aware that teeth with metal restorations can give false-positive or false-negative responses. In a study by Weisleder and colleagues, 4 the investigators reported that cold test and EPT used in conjunction resulted in a more accurate method for diagnostic testing.

Percussion tests for determining the status of the periodontal ligament. All this specific test helps to determine is the status of the periodontal ligament Figure 1. A bite test may also need to be performed if a patient complains about pain upon mastication.

Palpation of the buccal and lingual gingival tissue of the tooth in question. It is important to note that even when there is no radiographic evidence of an apical infection, clinically, an infection may be present. Bender and colleagues 5 reported that it is not uncommon to have extensive disease of the bone when there is no evidence on a radiograph.

Nociceptors are sensory receptors that respond to potentially damaging stimuli by sending nerve signals to the brain. This stimulus can cause the perception of pain in an individual. Pulpal nerve fibers A-delta and C-fibers are nociceptors. Reversible pulpitis is pain from an inflamed pulp that can be treated without the removal of the pulp tissue. It should be noted that this is not a disease, but a symptom.

Classic clinical symptoms are sharp, quick pain that subsides as soon as the stimulus is removed. Physiologically, it is the A-delta fibers that are firing, not the C-fibers of the pulp. They are stimulated by cold and EPT and cannot survive in a hypoxic low oxygen environment.

Reversible pulpitis also does not involve unprovoked spontaneous response. Irreversible pulpitis is an inflamed pulp that cannot be treated except by the removal of the pulp tissue. It can be symptomatic or asymptomatic. C-fibers are the unmyelinated, high-threshold, aching pain nerve fibers.

They are distributed throughout the pulp. They are stimulated by heat and can survive in a hypoxic environment. Pulpal necrosis can occur as a result of an untreated irreversible pulpitis or immediately after a traumatic injury that disrupts the vascular system of the pulp. A necrotic pulp does not respond to cold tests, EPT, or heat tests. When clinicians think of endodontic treatment, they often focus only on the pulpal diagnosis.