Diagnosis in endodontics



1- diagnosis in endodontics (record)

to download the record click here
to download handout click here 

Summary

  • Diagnosis is the first step in the care and management of any patient. A systematic and organized approach is important to avoid misdiagnosis. Special tests and additional investigations may be necessary to help confirm a provisional diagnosis. Until and unless a clear diagnosis is possible, invasive and irreversible treatment may have to be delayed. However, once a valid diagnosis is confirmed and in conjunction with the patient, various treatment options can be considered.
  • A plan is formulated and then carried out to resolve the patient’s complaint. Referral to a specialist may be indicated to help establish a diagnosis, or if complex endodontic treatment, is required.

Introduction

  • Diagnosis is the most important topics in endodontics and even all treatment procedures in dentistry as it is the foundation for any treatment plane in the future

 

Topics of diagnosis

1-pulp and preapical diseases
2-case selection
3-diagnosis and diagnostic tool
4-pain control

 

 

Pulp and periapical diseases

·       American association of endodontics have put a classification for pulpal and periapical condtions

 

A) Pulpal conditions

1-normal pulp

2-reversible pulpitis 

  • (can be recover to normal pulp by removing the insult present) bacterial free and canal tootlally sterile

3-irreverisible pulpitis 

  •          treated by endodontics due to irreversible  damage
  •          may be acute and may be chronic
  •          acute form is the emergency condition interfere with sleeping analgesic not have any whit pulp vitality test sever pain 
  •          chronic form  : pain with cold and hot but with less intense than acute form

4-pulp necrosis

  • negative  vitality test no pain whatever there is infection already exist or it will exist soon

5-previously treated

6-previously initiated 

  • some sort of pulpotomy or access is open and treatment not completed

 


B) periapical diseases and conditions

1-normal periapical tissues bacteria free and normal patient

2-apical periodontitis 

  • may be acute or chronic
  • acute no swelling and no pus but with severe pain on pitting with or without radiolucent round apex
  • chronic form less severe pain with  radiolucency around apex also without swelling or pus with pain comes and goes

3-apical abscess

  • there is infection pus and swelling may be acute or chronic
  • acute very severe pain and swelling  unable to occlude his teeth  this is also emergency treatment (I AND D procedure or open through access)
  • chronic form have sinus in the vestibule with pus arisisng from it 

4-condensing osteitis

  • it is reaction from bone against mild form bacterial infection

 

Case selection

contra indication of endodontics treatment
to reach the correct prognosis for the case we should respect the following:

A)general factors

1-inadequate access

  •  are you able to reach or refer to specialist to conform that  according to British dental journal if  you able to put two fingers between maxilla and mandible so that patient not have limited mouth opening if not able you would face a lot of complications

2-oral hygiene

  • total contraindication for not only endodontics but all treatment in dentistry otherwise re-habitation should performed to enhance oral hygiene and then perform the specific treatment

3-poor compliance

  • patient not interested to have a good treatment or even any treatment this patient should be educated before performing any treatment

4-poor medical conditions

  • According to assessment of the doctor if the treatment or the drugs may cause problems to the patient we should measure risk to benefits ratio and we should consult other doctors and refer to specialist 

B)local factors

1-non restorable tooth

  • it is one of the most important factors to put in consideration

2-poor crown to root ratio

  • The least accepted one is 1:1 less than that should be extracted as it will no indicated for further treatment options

3-root fracture

  • Vertical fracture should be extracted
  • Horizontal fracture have variable treatment options according to each case\

4-grade 3 mobility

  • with horizontal and vertical movement should be extracted