Eugene A. Pantera, Jr.

, DDS, MS Department of Periodontics and Endodontics

Clinical Diagnosis University at Buffalo

Pulpal Diagnosis
Endodontic Treatment is NOT Needed
CLINICAL CLASSIFICATION Normal A pulpal condition, usually called normal, in which the pulp responds to thermal and electrical tests in a manner similar to that of a corresponding control tooth. Hypersensitive Dentin A pulpal condition, with no apparent histologic changes, in which the patient feels pain when the dentin is exposed to touch from a dental explorer, fingernail or tooth brush and to thermal or to other stimuli. However the pain disappears when the stimulus is removed. Reversible Pulpitis Syn: hyperemia, inflamed-reversible. A pulpal condition commonly induced by dental caries and operative procedures, in which the patient responds to thermal or osmotic stimuli, but the symptoms disappear when the etiology is eliminated. SIGNS AND SYMPTOMS Pain No history of pain. None to mild to moderate intensity Pain is non-spontaneous No pain with percussion Moderate to sharp response to thermal, sweet, or sour stimuli; response subsides when stimulus is removed. Etiology Usually caries, defective restoration, restorative procedures, mechanical pulp exposures, tooth brush abrasion, tooth fracture, recent prophylaxis, or subgingival scaling and curettage. Radiology No radiographic evidence of pulp calcifications, internal resorption, or periapical changes. DIAGNOSTIC TEST RESULTS EPT Response is normal and not in extremes. Is generally in the same range as control teeth.

Thermal Tests Usual, normal response, for duration of the stimulus. Reaction may be severe, but BRIEF.

Percussion and Palpation Negative, no response.

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Sharp. Irreversible pulpitis with periapical pathosis A pulpal condition similar to above. rapid/delayed onset. and erosion). DIAGNOSTIC TEST RESULTS EPT Tooth may test within normal limits. DDS. Pantera. persistent. narrow pulp chamber. Radiographs show no periapical changes. An enlarged PDL may also be present. in which spontaneous pain may occur or be precipitated by thermal or other stimuli. Etiology Deep caries and/or restorations. usually caused by deep dental caries or restorations. or condensing osteitis. but in which periapical or lateral radiographic changes are evident. exaggerated. Percussion Test May or may not be positive. rapid/delayed onset. Pain with mastication. "calcified" canals. Traumatic injuries. and may be of severe intensity. . often continuous pain. abrasion. SIGNS AND SYMPTOMS Pain May have acute or chronic symptoms. calcifications. Radiographic evidence may reveal normal pulp. greater intensity and longer duration. Thermal Test A key factor in making a diagnosis.. Orthodontic forces. evidence of previous pulp cap. maybe past repeated episodes of pain.Eugene A. MS Department of Periodontics and Endodontics Pulpal Diagnosis Endodontic Treatment IS Needed CLINICAL CLASSIFICATION Irreversible Pulpitis Irreversible pulpitis without periapical pathosis A pulpal condition. Resorption (especially perforating). painful response to thermal stimulus. Exposed dentin (attrition. Palpation May or may not be positive. May be abnormal. 2 . Radiology May be normal. The pain last for several minutes to hours. Response may be markedly different from control. Jr. Pain may be spontaneous. pain lingers after stimulus is removed.

Radiology May be normal. An enlarged PDL may also be present. often continuous. Exposed dentin (attrition. Palpation May or may not be positive. 3 . Etiology Deep caries and/or restorations. Thermal Test No response. evidence of previous pulp cap. Pain may be spontaneous. SIGNS AND SYMPTOMS Pain May have acute or chronic symptoms. Orthodontic forces. except that in this category periapical or lateral lesions are evident in radiographs. and erosion). Traumatic injuries. DDS. dull. Pantera. pain. DIAGNOSTIC TEST RESULTS EPT No response. Carious pulp exposures. maybe past repeated episodes of pain. Response to various testing modalities is usually absent.Eugene A. MS Department of Periodontics and Endodontics Pulpal Diagnosis Endodontic Treatment IS Needed CLINICAL CLASSIFICATION Necrotic Pulp Necrotic pulp without periapical pathosis A pulpal condition in which there may or may not be spontaneous moderate to severe pain or pain elicited by various stimuli. Radiographic changes are not evident. Percussion Test May or may not be positive.. May have false positives. May be periapical lesions or lateral lesions. Jr. abrasion. Pain with mastication. Resorption (especially perforating). Necrotic pulp with periapical pathosis A pulpal condition similar to above. throbbing.

4 . Radiology Usually thickening of PDL. Radiographs reveal periapical or lateral radiolucencies. Pain may be absent or constant. also can have periapical or lateral radiolucency. Chronic Apical Periodontitis A periapical condition characterized by none to slight pain on mastication but may present itself with varying degrees of apical swelling. Periapical pain usually requires stimulus (eg mastication). DIAGNOSTIC TEST RESULTS Pulp Tests EPT and Thermal tests may be normal. Pain can be sharp. Aggravating factors are usually present. Pulp Tests EPT and Thermal tests may be normal. Palpation Moderate to none. Jr. DDS. or normal.Eugene A. or similar to irreversible pulpitis or pulpal necrosis. Moderate to severe intensity that may be intermittent. Periapical pain can be spontaneous. May be swelling. Percussion Moderate to severe pain. Etiology Irreversible pulpitis. Percussion Moderate to none. Etiology Same as for Acute apical periodontitis. Palpation Moderate to severe pain. Pain History of pain. periodontal disease. MS Department of Periodontics and Endodontics Periapical Diagnosis There MAY be Need for Endodontic Treatment PULPAL DIAGNOSIS IS REQUIRED FOR DEFINITIVE DETERMINATION CLINICAL CLASSIFICATION Acute Apical Periodontitis SIGNS AND SYMPTOMS Pain History of pulpal pain. Radiology Periapical or lateral radiolucency. restoration in hyperocclusion. Pain is dull throbbing. or similar to irreversible pulpitis or pulpal necrosis. pressure from periapical tumors. Slight intensity to no pain.. Pain can occur with mastication. Pantera. traumatic injuries. orthodontic forces maxillary sinusitis.

. Percussion Moderate to severe. periodontal disease. 5 . Radiology PDL thickening. restoration in hyperocclusion. A draining sinus tract or other evidence of suppuration is evident. Pain can occur with mastication. Pain is pulsing and throbbing. Acute Alveolar Abscess Syn: Acute apical abscess An acute alveolar abscess is a severe clinical manifestation of periapical infectious disease. Palpation Moderate to severe. Usually no pain present. DIAGNOSTIC TEST RESULTS Pulp Tests EPT and Thermal tests may be normal. Radiographs reveal periapical or lateral radiolucencies.Eugene A. Radiology Periapical or lateral radiolucency. orthodontic forces. or similar to irreversible pulpitis or pulpal necrosis. Palpation Slightly tender. Pulp Tests No response. Etiology Irreversible pulpitis. Pain History of pain. DDS. (Is this a lesion of endodontic origin?) Percussion None to slight pain. Constant and spontaneous pain. Jr. MS Department of Periodontics and Endodontics Periapical Diagnosis There IS a Need for Endodontic Treatment PULPAL DIAGNOSIS IS REQUIRED FOR DEFINITIVE DETERMINATION CLINICAL CLASSIFICATION Chronic Suppurative Apical Periodontitis A periapical condition characterized by non pain on mastication. Pantera. Etiology The result of coronal apical progression of pulpal necrosis with resultant release of antigens into the periapical tissues. traumatic injuries. Severe intensity. characterized by severe pain and swelling. Swelling probable. Visual Sinus tract present. SIGNS AND SYMPTOMS Pain History of pain. periapical or lateral radiolucency.

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