Dental Clinical Practice 2
Diagnostic Tests- Dental Pulp status- Tooth biting teeth-Dr Bill Kahler, University of Adelaide, School of Dentistry-Dr. V. K. Gopinath M.D.S., PhD. University of Sharjah
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Introduction
The purpose of a diagnosis is to determine what problem the patient is having and why the patient is having the problem ultimately this will directly relate to what treatment, if any will be necessary.
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Process of making diagnosis
Patients tell why he or she seeks advice Clinician questions about symptoms and
history Clinician performs objective clinical test Correlate objective findings with subjective
details and creates tentative diagnosis Clinician formulates a definitive diagnosis
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Dental pulp status
A healthy pulp is vital without inflammation
A healthy pulp will be asymptomatic and be responsive to vitality tests such as thermal or electric pulp tests
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Dental pulp status
For older patients thermal tests may be less conclusive though electric pulp testing may be the more appropriate test
Tests on immature teeth can be inconclusive
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Dental pulp status
The test can be responsive and indicate
1.A vital and healthy pulp2.Reversible pulpitis3.Irreversible pulpitis
A non-responsive test may indicate a necrotic pulp or a false-negative test
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Reversible pulpitis
Generally indicates that the pulp is vital with mild inflammation
Discomfort following pulp sensibility test does not linger after test
Symptoms usually resolve after conservative treatment
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Irreversible pulpitis
Generally indicates that the pulp is vital with severe inflammation that will not respond to conservative treatment
Discomfort following pulp sensibility test does linger after test
A history of spontaneous pain, throbbing and interrupted sleep is typical
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Following trauma
Pulp tests do NOT assess vitality (blood circulation)
Tests rather assess neural activity which may be disturbed/destroyed following a traumatic incident
A non-responsive test may not indicate a necrotic pulp following trauma
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Electric pulp test
The electric pulp tests utilize an electric current to excite sensory nerves in the pulp
The response of immature teeth is unreliable
Be aware that some patients may over react and generate false positives
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Electric pulp testing
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Electric pulp testing
Apply any toothpaste to tip before use
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Thermal tests
Application of cold, carbon dioxide, heat to the tooth
The most effective cold tests are with sticks of carbon dioxide (-78C) or sprayed with diflourodichloromethane (-50C)
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Correct placement of CO2 stick on the incisal edge
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Correct placement of CO2 stick on the MB cusp
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Diflourodichloromethane (-50C)
Must be kept in cold storage
Spray till adsorbed into pellet and place onto tooth for testing
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Teeth can be isolated with rubber dam and cold/hot water applied directly
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Mechanical tests
These are tests of an inflamed periodontal ligament rather than a true pulp test
A positive response is generally indicative of pulp necrosis
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Percussion-light tapping
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Palpation- an inflamed muco-periosteum
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Mobility- possibly periodontal disease?
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Probing- Periodontal disease or tooth fracture?
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Radiography- An important test and record
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Occlusion-Eccentric contacts
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Tooth biting test
Patient generally complains of sharp pain after biting or on release of bite pressure
Generally indicates a crack in one or more cusps of the tooth
Pulp usually reversibly inflamed
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Apply Fracfinder to individual cusps
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Dental Clinical Practice 2Introduction Process of making diagnosisDental pulp statusDental pulp statusDental pulp statusReversible pulpitisIrreversible pulpitisFollowing traumaElectric pulp testElectric pulp testingElectric pulp testingThermal testsCorrect placement of CO2 stick on the incisal edgeCorrect placement of CO2 stick on the MB cuspDiflourodichloromethane (-50C) Teeth can be isolated with rubber dam and cold/hot water applied directlyMechanical testsPercussion-light tapping Palpation- an inflamed muco-periosteum Mobility- possibly periodontal disease?Probing- Periodontal disease or tooth fracture?Radiography- An important test and recordOcclusion-Eccentric contactsTooth biting testApply Fracfinder to individual cuspsSlide Number 27