Clinical Diagnoses
Never start a treatment without a diagnoses.
The endodontic diagnoses are made from the use of diagnostic
aids, such as information from the patient's history, clinical findings,
radiographic findings, and results from any sensitivity test (cold, heat,
electric). Do not anesthetize tooth prior to testing.
The following endodontic diagnoses are presently used at the School of
Dental and Oral Surgery, Columbia University.
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Pulpal Diagnosis
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Vital, normal
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The pulp is vital and free from inflammation. This diagnosis is
made during the first hours after a traumatic exposure, or e.g.
when endodontic treatment has to be performed to provide a post
space.
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Hyperreactive
Treatment
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The pulp is vital and hyperreactive, meaning that it responds to,
changes in temperature more readily than normally. The sensation
has a short duration (seconds). The word hyperaemic pulp is sometimes
improperly used for this "condition". As we do not know the state
of the pulp's circulatory system this word should be avoided.
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Symptomatic pulpitis
Treatment
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The pulp is inflamed and there are symptoms, usually sensitivity
to temperature changes which last for more than seconds.
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Asymptomatic pulpitis
Treatment
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The pulp is inflamed due to e.g. carious exposure, but there are
no symptoms.
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Necrotic pulp
Treatment
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The pulp tissue is non-vital. Pulp necrosis is suspected when there
is no response to sensitivity testing. The correct diagnosis is
made when the canal is open to inspection and probing. Pulp necrosis
may be complete or partial. In multirooted teeth one canal can be
necrotic and another vital.
Note: It is difficult or impossible to diagnose a pulp necrosis
if the tooth is anesthetized.
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Internal resporption
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Resorption emanating from the pulp cavity. Different angulations
are necessary to verify the diagnosis radiographically. Note: A
"pink spot" can be caused by internal as well as external resorption.
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There are two descriptive terms REVERSIBLE and IRREVERSIBLE PULPAL
INFLAMMATION which have traditionally been used instead of diagnoses:
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Reversible pulpal inflammation
Treatment
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The pulp is vital and, according to our knowledge, inflamed. However,
we believe that the inflammation can heal after treatment, e.g.,
excavation of caries without exposure of the pulp.
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Irreversible pulpal inflammation
Treatment
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The pulp is vital but inflamed. To our knowledge, this inflammation
will not heal after palliative treatment, e.g., if the pulp is exposed
by caries.
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Periapical Diagnosis
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Normal
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An intact periapical contour.
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Symptomatic apical periodontitis (Acute periapical lesion)
Treatment
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There are symptoms from periapical inflammatory process.
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Symptomatic apical periodontitis (Chronic periapical lesion)
Treatment
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There are no symptoms from the periapical inflammatory process,
but a periapical radiolucency of endodontic origin is present.
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Note: The words "acute" and "chronic" do not have the same meaning
as they have in histologic diagnoses. Clinical diagnoses
are being used here. Please, understand these words are synonymous with
"symptomatic" and "asymptomatic".
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