:: Famdent :: Dr. Anil Arora

Endo Woes!

By Dr. Anish Naware

DIAGNOSING THE ENDO INVOLVED TOOTH

Introduction

Diagnosis of pulpally involved teeth still remains a challenge to clinicians all over the world. Since no single test gives confirmative diagnosis, it is very important to know the limitations of each diagnostic aid. A group of tests will conclude your diagnosis. It is not advisable to rely on only one particular test and conclude the diagnosis. As the patient enters your clinic and explains the chief complaint, your process of diagnosis should begin. An attempt is made to make a definite protocol of the diagnostic procedures during your day to day practice.

Diagnostic Aids

X-rays – radiographs give two-dimensional picture of the tooth, periodontium, bone & surrounding structure, minute study of a radiograph may conclude the diagnosis.
Caries detector application – only stained dentine should be removed and unstained dentine preserved to avoid traumatic pulpal exposure.
Clinical signs and symptoms – patient reactions, patients postures and answers to your questions may give concluding diagnosis.
Cavity Test - it is a confirmative test for non-vital tooth.
Pain on percussion – it shows inflammation at the periapical area.
Electric pulp tester - it has got a lot of limitations in clinical use.
Thermal test -When cold stimulus is applied to the tooth and if pain lingers after withdrawing the stimulus, then this test gives confirmative diagnosis.
Selective anaesthesia - to rule out referred pain
Transillumination test - to check the cracks in the tooth
Locating sinus tract with G.P. cone - to check the relation of sinus tract to the diseased tooth Signs & symptoms of pulpally involved teeth Following signs and symptoms may give confirmative diagnosis but one has to support the conclusion by following other group of tests.
Pain while drinking water even at room temperature - or lingering pain after a cold drink
Increase in pain at night - as you sit up, pain gets reduced
Pain on one side - pain radiates from temporal region to maxilla or mandible
Dull pain throughout the day - very dull but annoying pain during daytime
Eating only on one side for a prolonged period - atrophy of periodontium leads to pulpal involvement
Absence of any sensitivity or pain during cavity preparation - as you expose the pulp chamber without patient complaining of pain or sensitivity, then this gives confirmative diagnosis of a non-vital tooth
Discharging sinus (extra oral, intra oral) – all sinuses show signs of chronic infection and may conclude diagnosis for endodontic treatment or extractions.
Patient experiences severe pain which is relieved with cold water – indicative of suppurative pulpitis – cold-water con tracts gases in the pulp chamber which relieves the pain. This typical clinical condition of a gaseous pulpitis needs immediate endodontic treatment and no oral medication would help. Best endodontic approach is to avoid endodontic treatment. Though diagnostic aids and clinical signs and symptoms give exact picture of pulpally involved tooth, a good clinician will always be benefited by his clinical experience and good judgment.