Diagnosis ideas

• Diagnosis by various exams
  • Patient Dental history
    • Localization
    • commencement
    • intensity
    • Provocation or Attenutation
    • Duration
  • Intraoral palpation
    • Intraoral Swellings:
      • diffuse or localized?
      • firm or fluctuant?
      • Location
        • attached gingiva
          • Chronic endodontic infections will sometimes drain through sinus tract
        • mucobuccal fold
          • Intraoral swelling present in the mucobuccal fold can result from an infection assocaited with the apex of the root of any maxillary tooth that exists the alveolar bone o nthe facial aspect is is inferior to the muscle attachements in that areas
        • alveolar mucosa
        • palate
          • A swelling in the posterior palate (Fig. 1.12) is most likely associated with the palatal root of one of the maxillary molars (Berman and Hargreaves, 2020, p. 11)
        • sublingual tissues
          • similarly to swellings in the mucobuccal fold
  • Percussion
    • “if the patient is experiencing acute sensitivity or pain on mastication, this response can typically be duplicated by individually percussing the teeth, which often isolates the symptoms to a particular tooth. Pain to percussion does not indicate that the tooth is vital or nonvital but is rather an indication of inflammation in the periodontal ligament (i.e., symptomatic apical periodontitis).” (Berman and Hargreaves, 2020, p. 14)
  • Mobility
  • Perio probing
  • Pulp Testing
    • Thermal
      • The baseline response is either cold or hot that is felt but disappears immediately upon removal
      • Abnormal responses include:
        • A lack of response to the stimulus
        • A lingering or intensification of a painful sensation after the stimulus is removed
        • an immediate painful sensation as soon as stimulus is placed on tooth
      • To be most reliable, cold testing should be used in conjunction with an electric pulp tester
  • Bite Testing
    • indicated when a patient presents iwth pain on biting
    • Periradicular periodontitis/ symptomatic apicla periodontitis will be painful no matter what cusp the bite test is performed on
      • a cracked tooth will usualy only be painful in one position

Pulp sensibility

“It should be noted that the sensibility of the pulp is determined by the intactness and health of the vascular supply, not by the status of the pulpal nerve fibers.” (Berman and Hargreaves, 2020, p. 17) Contents

To Read

“Clinical Classification of Pulpal and Periapical Diseases” (Berman and Hargreaves, 2020, p. 28)