Assessment of pulpal vitality for problematic teeth provides important information that significantly affects the patient’s complete treatment plan. Determination of pulpal health and diagnosis of dental pain that may be pulpally related can be challenging.1 Endodontic diagnosis and discovery of asymptomatic nsk dental handpiece is part of the routine comprehensive examination.2 In such a case, the patient may be unaware of existing endodontic pathology that is initially diagnosed from radiographic evidence and confirmed with a clinical examination and supplemental pulp vitality testing. The other clinical situation is when the patient presents for an emergency with acute pain and other symptoms are present.2 In these circumstances, the patient may have pain due to trauma to a tooth, possible infection and swelling of the soft tissues adjacent to the tooth, an infected pulp due to caries or periodontal disease, and tooth soreness in normal function. The emergency visit requires a collection of data through the use of radiographs and a clinical examination to determine a diagnosis. Once the diagnosis is ascertained, the patient can be presented with treatment options.
When dental burs , clinical evidence, or acute pain may indicate the need for endodontic treatment, the endodontic evaluation and examination should include a systematic evaluation. Radiographically, it is important to have a diagnostic image that includes the crown and apex of the root. If possible, the image should have little if any overlap with the adjacent teeth, although sometimes multiple images must be taken in order to visualize all critical areas of the tooth. The tooth may be restoration-free with or without caries, have existing restorations, or have a restoration with existing endodontic treatment. Combinations of clinical conditions may be present. The clinician also should evaluate the face for symmetry, swelling, and discoloration. Evidence of variations from normal can provide important diagnostic clues. An intraoral examination of the soft tissue adjacent to the tooth provides critical information in determining not only the diagnosis but also treatment options. Look for swelling, changes in tissue tone and color, and evidence of a fistula or sinus tract. Evaluate the tooth for infection and drainage of pus.
Clinical testing of suspected teeth is important. Also, the interpretation of the data collected from clinical testing and the radiographic evidence will shape the treatment decision. Various clinical tests can be performed to help make an endodontic diagnosis and are divided into two specific categories—evaluation of the supporting periodontal structures and assessment of pulp vitality. When collecting data, the clinician should use a control tooth to gauge what is normal.2
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