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PLANNING
Diagnosis:
Diagnosis plays a major role in any branch of
dentistry.Stedman’s Medical Dictionary describes
clinical diagnosis as ‘‘the determination of the nature
of a disease made from a study of the signs and
symptoms of a disease.’’ Accurate diagnosis of the
patient condition is essential before an appropriate
treatment plan can be formulated for an individual.
For an appropriate diagnosis all the signs, symptoms
and history of the patient is necessary to initiate a
treatment plan. It includes :
• Chief complaint
• History of present illness
• Medical history
• Clinical examination
• Investigations
• Differential diagnosis
• Treatment plan
CHIEF COMPLAINT:
• General evaluation
• Soft tissue examination: oral vestibules and
buccal mucosa are examined for localized
swelling,sinus tract or colour changes.
• Hard tissue examination:Carious lesions
,enamel fractures,discolorations,other
abnormalities of teeth including loss /retained
deciduous teeth.
Coronal evaluation
• Most obvious tooth is examined first.
• Mouthmirror,explorer, fiber-optic light are
used for examination.
• Examine tooth for caries,defective restorations
,enamel loss,periodontal problems &mobility.
• Fracture or teeth are examined by
transillumination and bite test with tooth sloth
and wet cotton roll.
PULPAL DIAGNOSIS
Classification of diseases of pulp
1.INFLAMMATORY DISEASES OF PULP
a)Reversible pulpitis
b)Irreversible pupitis
i) Symptomatic irreversible pulpitis
ii)Asymtomatic irreversible pulpitis
iii)Chronic hyperplatic pulpitis
iv)Internal resorption
2.PULP DEGENERATION
a)Calcific degeneration(radiographic)
b)Atrophic degeneration(histopathologic)
c)Fibrous degeneration
3.PULP NECROSIS
Normal pulp
This is clinical diagnostic category in which
pulp is symptom free and normally responsive
to vitality testing. The normal pulp may exhibit
a strong response but is not painful.
Reversible pulpitis
When the pulp with in the tooth is irritated so
that the stimulation is uncomfortable to the
patient but reverses quickly after irritation ,it
is classified as reversible pulpitis.
CAUSES:
• Caries
• Exposed dentin
• Recent dental treatment
• Defective restorations
Symptoms :
• Indicates that inflammation should resolve and pulp return
to normal.
• Increased response to cold,sweets
• Pain is always specific to a stimulus
• Pain relieved on removal of stimulus
Diagnosis :
• As the pulp is sensitive to cold ,application of cold is
excellent method of locating and diagnosing involved tooth.
• Tooth reacts normal to percussion,palpation,mobility
• On radiographic examination periapical tissue is normal
Treatment :
• Thr best treatment for reversible pulpitis is
prevention.
• Removal of noxious stimuli will bring the pulp
back to a healthy state.
Irreversible pulpitis
It is defined as the point where an inflammed
pulp is no longer capable of healing and
returning to normal.
TYPES
i) symptomatic irreversible pulpitis
ii)asymptomatic irreversible pulpitis
Symptomatic irreversible pulpitis
Symptoms :
• Teeth exhibit intermittent or spontaneous pain.
• Rapid exposure to temperature changes elicit prolonged episodes of pain
even after stimulus has been removed.
• Sharp,dull loaclised ,diffuse or referred pain
• Postural pain due to increase in intrapulpal pressure when patient changes
position from standing posture to supine.
• Nocturnal pain
Diagnosis :
• On radiographic examination no periapical changes.
• With advanced irreversible pulpitis show thickening of periodontal ligament.
• Deep restorations,caries,pulp exposure and any direct or indirect insult to
pulp are present on radiograph
Asymptomatic irreversible pulpitis
Symptoms :
• Deep caries will not produce any symptoms.
• Exposed pulp exhibits little or no pain.
Diagnosis :
• More current is used to elicit a response to
electric pulp test than control tooth.
• On radigraphic examination, caries may extend
well into pulp but no periradicular changes.
Treatment :
• Treatment consists of complete removal of
pulp or pulpectomy.
• In posterior tooth ,in which time is a
factor,removal of coronal pulp or pulpotomy
should be performed as an emergency
procedure.
• Surgical removal should be considered if tooth
is not restorable.
Chronic hyperplastic pulpitis
• Also called pulp polyp
• Growth of pulp tissue fron pulp chamber that is usually
covered by epithelium.
• Seen in young population in both primary and
permanent dentition.
Causes :
• Slow progressive exposure to pulp
• Large open cavity ,young,resistant pulp
• Mechanical irritation from chewing &bacterial infection
often provide stimulus.
SYMPTOMS :
• It is symptomless ,except during mastication,when pressure of
food bolus may cause discomfort.
• Fleshy reddish pulpal mass fills most of the pulp chamber or cavity.
• In early stages it may be the size of pin.
• Tissue bleeds easily because of rich network of blood vessels
DIAGNOSIS :
• Radiographs show large open cavity with direct access to pulp
• Electric pulp testing ,tooth responds to more current than normal .
TREATMENT :
• Elimination of polyploid tissue & extirpation of pulp
,tooth can be restored.
• Pulpal mass is removed with a curette or spoon
excavator,bleeding can be controlled with pressure.
• Pulp tissue is completely removed &temporary dressing
is sealed in contact with radicular pulp tissue.
• Radicular pulp is extirpated in next visit.
• If time permits,pulpectomy can be completed in single
visit.
INTERNAL RESORPTION
SYMPTOMS :
• Tender on palpation
• As inflammation progresses,tooth gets elevated fron its
socket & becomes sensitive
• Mucosa over periradicular area may appear red & swollen
RADIOGRAPHIC DIAGNOSIS :
• Radiograph shows well defined periradicular radiolucency
TREATMENT :
• Establishing drainage and controlling systemic
reactions
• When symptoms have subsided,tooth is
endodontically treated
• In 1st visit,through debridement by instrumentation
and irrigation before medicating and sealing the canal
• Once canal is sealed, the endodontic treatment is
completed.
CONDENSING OSTEITIS
Localised bony reaction to a low grade inflammatory
stimulus,usually seen at the apex of a tooth in which
there has been long standing pulpal pathosis.
CAUSES :
• Mild irritation from pulpal disease that stimulates
osteoblastic activity in alveolar bone
SYMPTOMS :
• Usually asymptomatic
• Discovered during routine radiographs
RADIOGRAPHIC DIAGNOSIS :
• It shows localised area of radiopacity
surrounding affected root.
• Dense bone with reduced trabecular pattern.
TREATMENT :
• Endodontic treatment is indicated
EXTERNAL ROOT RESORPTION
It is a lytic process occuring in cementum or
cementum & dentin of roots of teeth.
CLASSIFICATION:
1. External surface resorption
2. External inflammatory root resorption
3. External replacement resorption or ankylosis
• SYMPTOMS:
• Asymptomatic
• When root is completely resorbed ,tooth may become mobile.
• If resorption extends to crown,pink tooth appearance seen as
internal resorption.
• in replacement type of resorption ,gradually replaced bone
• RADIOGRAPHIC EXAMINATION:
• Appears as concave or ragged areas on root surface & blunting
of apex.
• In replacement resorption roots are resorbed with no pdl space
• TREATMENT:
• If external resorption is due to extension of pulpal
disease into supporting tissues,ROOT CANAL
THERAPY will stop resorptive process.
• Excessive forces from orthodontic appliances can
be stopped to reduce resorption.
• In case of cervical external root resorption,surgical
exposure &restoration with suitable restorative
material is treatment of choice.
DENTAL CARIES
It is a multifactorial,infectious,microbiologic
disease of teeth that results in localised
dissolution and destruction of the calcified
tissues
DIAGNOSIS
• TRADITIONAL METHODS
Patients complaint
Meticulous clinical examination
Tactile examination
Radiographic examination
Tooth seperation
Dental floss or tape
Fiberoptic transillumination
Patients complaint: It provides a hint about presence of caries.
Yes no
Vital responses
Yes
preoperatively Direct pulp capping
no radiographic
no evidence
periradicular
pathology