1. Pulpal Diagnosis
1.1. Normal Pulp
1.1.1. pulp is symptom free and normally responsive to vitality testing
1.2. Reversible Pulpitis
1.2.1. Inflammation should resolve and the pulp return to normal
1.3. Irreversible Pulpitis
1.3.1. Symptomatic
1.3.1.1. Lingering thermal pain
1.3.1.2. spontaneous pain
1.3.1.3. referred pain
1.3.2. Asymptomatic
1.3.2.1. No clinical symptoms but inflammation produced by caries
1.4. Pulp Necrosis
1.4.1. The pulp is non-responsive to vitality testing
1.5. Previously Treated
1.5.1. tooth has been endodontically treated and the canals are obturated with various filling materials, other that intracanal medicaments.
1.6. Previously Initiated Therapy
1.6.1. tooth has been previously treated by partial endodontic therapy (e.g. pulpotomy, pulpectomy)
2. Periapical Diagnosis
2.1. Normal apical tissues
2.2. Symptomatic apical periodontitis
2.2.1. painful response to biting and percussion
2.2.2. It may or may not be associated with an apical radiolucent area
2.3. Asymptomatic apical periodontitis
2.3.1. apical radiolucent area
2.3.2. does not produce clinical symptoms
2.4. Acute apical abscess
2.4.1. Rapid onset
2.4.2. spontaneous pain
2.4.3. tenderness of the tooth to pressure
2.4.4. pus formation and swelling of associated tissues
2.5. Chronic apical abscess
2.5.1. Gradual onset
2.5.2. little or no discomfort
2.5.3. intermittent discharge of pus through an associated sinus tract
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4. Diagnosis Stages
4.1. Patient tells the clinician why the patient is seeking advice.
4.2. Clinician questions the patient about the symptoms and history that led to the visit.
4.3. Clinician performs objective clinical tests.
4.4. Clinician correlates the objective findings with the subjective details and creates a tentative differential diagnosis.
4.5. Clinician formulates a definitive diagnosis.
5. Methods
5.1. Pulp testing
5.1.1. Thermal
5.1.1.1. Cold
5.1.1.1.1. By causing contraction of the dentinal fluid within the dentine tubules. Acting on the Aδ nerve fibres. ‘Hydrodynamic forces’
5.1.1.1.2. Sharp Sensation, lasting for up few seconds
5.1.1.1.3. Cold tests appear to be more effective in assessing nerve status than heat tests
5.1.1.1.4. Ice sticks (0°C)
5.1.1.1.5. Refrigerant spray containing tetrafluoroethane (−50°C)
5.1.1.1.6. Carbon dioxide snow (−78.5°C)
5.1.1.2. Heat
5.1.1.2.1. Using a heat-softened gutta-percha stick.
5.1.1.2.2. Running a rubber prophylaxis cup dry, in a slow handpiece, to generate frictional heat
5.1.1.2.3. Prolonged application of heat to a tooth can result in stimulation of C-fibres
5.1.1.2.4. Heat should only be applied to a tooth for a maximum of 5 seconds
5.1.2. Electrical
5.1.2.1. Determine vitality Vs non-vitality, but not health or disease
5.1.3. Laser Doppler Flowmetry (LDF)
5.1.4. Pulse Oximetry
5.2. Palpation
5.3. Percussion
6. Approaches
6.1. Bite test
6.2. Test Cavity
6.3. Staining/transillumination
6.4. Selective anesthesia
6.5. Radiographic examination/interpretation
6.5.1. Introral-periapical/bitewing
6.5.2. Extroral-occlusal, APs
6.5.3. Digital
6.5.4. MicroCT, cone beam computed tomography (CBCT), other scans