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Endodontics Diagnosis (2007) by Mind Map: Endodontics Diagnosis (2007)
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Endodontics Diagnosis (2007)

Diagnosis: The art and science of detecting and distinguishing deviations from health and the cause and nature thereof

Pulpal Diagnosis

Normal Pulp

pulp is symptom free and normally responsive to vitality testing

Reversible Pulpitis

Inflammation should resolve and the pulp return to normal

Irreversible Pulpitis

Symptomatic, Lingering thermal pain, spontaneous pain, referred pain

Asymptomatic, No clinical symptoms but inflammation produced by caries

Pulp Necrosis

The pulp is non-responsive to vitality testing

Previously Treated

tooth has been endodontically treated and the canals are obturated with various filling materials, other that intracanal medicaments.

Previously Initiated Therapy

tooth has been previously treated by partial endodontic therapy (e.g. pulpotomy, pulpectomy)

Periapical Diagnosis

Normal apical tissues

Symptomatic apical periodontitis

painful response to biting and percussion

It may or may not be associated with an apical radiolucent area

Asymptomatic apical periodontitis

apical radiolucent area

does not produce clinical symptoms

Acute apical abscess

Rapid onset

spontaneous pain

tenderness of the tooth to pressure

pus formation and swelling of associated tissues

Chronic apical abscess

Gradual onset

little or no discomfort

intermittent discharge of pus through an associated sinus tract

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Diagnosis Stages

Patient tells the clinician why the patient is seeking advice.

Clinician questions the patient about the symptoms and history that led to the visit.

Clinician performs objective clinical tests.

Clinician correlates the objective findings with the subjective details and creates a tentative differential diagnosis.

Clinician formulates a definitive diagnosis.

Methods

Pulp testing

Thermal, Cold, By causing contraction of the dentinal fluid within the dentine tubules. Acting on the Aδ nerve fibres. ‘Hydrodynamic forces’, Sharp Sensation, lasting for up few seconds, Cold tests appear to be more effective in assessing nerve status than heat tests, Ice sticks (0°C), Refrigerant spray containing tetrafluoroethane (−50°C), Carbon dioxide snow (−78.5°C), Heat, Using a heat-softened gutta-percha stick., Running a rubber prophylaxis cup dry, in a slow handpiece, to generate frictional heat, Prolonged application of heat to a tooth can result in stimulation of C-fibres, Heat should only be applied to a tooth for a maximum of 5 seconds

Electrical, Determine vitality Vs non-vitality, but not health or disease

Laser Doppler Flowmetry (LDF)

Pulse Oximetry

Palpation

Percussion

Approaches

Bite test

Test Cavity

Staining/transillumination

Selective anesthesia

Radiographic examination/interpretation

Introral-periapical/bitewing

Extroral-occlusal, APs

Digital

MicroCT, cone beam computed tomography (CBCT), other scans

Related Dental Mindmap

Difficulties with the electric pulp test

Rules to be followed

Test teeth that are not suspected to be pulpally involved are tested before testing the suspected tooth (baseline patient response)

Duplicate the symptoms

Correlate finding (signs and symptoms)

place stimulus on the middle 1/3 of the facial surface of the tooth to be tested