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ePaper created 2016-03-31, 16:35:38 | version 1.38.0
diagnosis CE article | 11roots1 2016 Diagnostic terminology approved by the American Association of Endodontists and the American Board of Endodontics5-7 Pulpal diagnoses9-14 Normal pulp is a clinical diagnostic category in which the pulp is symptom-free and normally re sponsive to pulp testing. Although the pulp may not be histologically normal, a “clinically” normal pulpresultsinamildortransientresponsetother mal cold testing, lasting no more than one to two secondsafterthestimulusisremoved.Onecannot arrive at a probable diagnosis without comparing thetoothinquestionwithadjacentandcontralat eral teeth. It is best to test the adjacent teeth and contralateral teeth first so that the patient is fa miliar with the experience of a normal response to cold. Reversiblepulpitis is based upon subjective and objective findings indicating that the inflamma tion should resolve and the pulp return to normal following appropriate management of the aetiol ogy. Discomfort is experienced when a stimulus such as cold or sweet is applied and goes away within a couple of seconds following the removal of the stimulus. Typical aetiologies may include exposed dentin (dentinal sensitivity), caries or deep restorations.Therearenosignificantradiographic changes in the periapical region of the suspect tooth and the pain experienced is not sponta neous. Following the management of the aetiol ogy (e.g. caries removal plus restoration; covering the exposed dentin), the tooth requires further evaluation to determine whether the “reversible pulpitis” has returned to a normal status. Al thoughdentinalsensitivityperseisnotaninflam matory process, all of the symptoms of this entity mimic those of a reversible pulpitis. Symptomaticirreversiblepulpitis is based on sub jective and objective findings that the vital inflamed pulpisincapableofhealingandthatrootcanaltreat ment is indicated. Characteristics may include sharp pain upon thermal stimulus, lingering pain (often 30 seconds or longer after stimulus removal), spon taneity (unprovoked pain) and referred pain. Some times the pain may be accentuated by postural changes such as lying down or bending over and over-the-counter analgesics are typically ineffec tive. Common aetiologies may include deep caries, extensiverestorations,orfracturesexposingthepul pal tissues. Teeth with symptomatic irreversible pul pitismaybedifficulttodiagnosebecausetheinflam mation has not yet reached the periapical tissues, thusresultinginnopainordiscomforttopercussion. In such cases, dental history and thermal testing are the primary tools for assessing pulpal status. Examination procedures required to make an endodontic diagnosis8 Medical/dental history Past/recent treatment,drugs Chief complaint (if any) How long,symptoms,duration of pain,location,onset,stimuli,relief,referred, medications Clinical exam Facial symmetry,sinus tract,soft tissue,periodontal status (probing,mobility), caries,restorations (defective,newly placed?) Clinical testing: pulp tests periapical tests Cold,electric pulp test,heat Percussion,palpation,Tooth Slooth (biting) Radiographic analysis New periapicals (at least 2),bitewing,cone beam-computed tomography Additional tests Transillumination,selective anaesthesia,test cavity Fig.2