tic diagnostic aids

8/2/2019 tic Diagnostic Aids

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Endodontic diagnostic aids

Dr.P.Ravishanker,M.D.S.,


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Before initiating treatment, one mustfirst assemble collective information

regarding signs, symptoms, and history.


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4 steps of diagnostic process

Assemble all available facts.

Interpretation of the facts.

Formulation of differential diagnosis.

Operational or working diagnosis.


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Symptom

Is a sign of departure from the normal and

indicative of illness.

Can be subjective or objective.

Eg. Pain

Can be sharp ,lancinatingor dull &

boring.


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Examination & testing.

Extra oral

Look for facial asymmetry

Palpate TMJ.

Check mouth opening


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Intra oral examination

The lips and cheeks are retracted whilethe teeth are in occlusal contact and the

oral vestibules and buccal mucosa areexamined for localized swelling andsinus tract or color changes.

Particular tooth causing the complaint isreadily noted.


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Using a mouth mirror and an explorer,

and possibly a fiber-optic light source,the dentist carefully and thoroughlyexamines the suspected tooth or teethfor caries,defective restorations,

discoloration.

Tissue to be examined should be driedwith an air syringe or gauze.

Check for 3 Cs.

Check for sinus tracts.


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Transillumination with a fiber-optic

light, directed through the crowns ofteeth, can add further information.

Changes in translucency helps todistinguish between vital & non vitalteeth.

Transillumination may also locate teethwith vertical cracks or fractures.


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Palpation


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Percussion

use a mirror handle and very gently tapthe occlusal/incisal surfaces of several

teeth in the area in question.


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Mobility

1st degree- barely perceptible horizontal

movement.

2nd deg- 1 mm horizontal movement or

vertical depressibility.

How to check?


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Periodontal evaluation


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Pulpal evaluation

Thermal tests


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Pulp tests alone areusually not adequate for

establishing a diagnosis but

can provide very usefulinformation.


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Cold test

used in differentiating between reversible andirreversible pulpitis and in identifying teethwith necrotic pulps.

Type of response- lingering or not.

In testing, if the pain lingers, that is taken asevidence for irreversible pulpitis.

If pain subsides immediately after stimulus

removal, hypersensitivity or reversible pulpitisis the more likely diagnosis.


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How do u perform ? Ice sticks

Ethyl chloride spray

Carbon di oxide snow

Isolating the teeth with rubber dam &

bathing each tooth with ice water from a

syringe for 5 secs will elicit the most

accurate response because it simultaneously

cools all the surfaces of the teeth.


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Heat test

Hot water baths under rubber dam isolation.

Gutta percha sticks

A positive response of pain, similar tothe chief complaint, provides theinformation needed to identify the

problem tooth.


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Response to thermal tests

1. No response

2. Mild to moderate degree of awareness of slight pain that

subsides within 1 to 2 secs after the stimulus has been

removed.

3. Strong momentary painful response that subsides within

1-2 secs after the stimulus has been removed.

4. Lingering response.


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Electric pulp test


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Dry the teeth to be tested and isolatethem with cotton rolls. Cover the tip of

the electrode with toothpaste or asimilar electrical conductor.

With or without gloves


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Contraindications

cardiac pacemaker


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False +ve false - ve

Patient reports

sensation in a tooth

with necrotic pulp. Due to anxiety, saliva,

metallic restorations.

Although the pulp is

vital, patient does not

indicate any sensation Due to drugs,

immature

teeth,trauma,partial

necrosis with vitalpulp in the apical 3rd

alone.


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Occlusal pressure test The orangewood stick, the Tooth

Slooth, and Burlew disks allow pinpointtesting of individual cusp areas.

This test is useful in identifying teeth

with symptoms of apical periodontitis,abscess, or cracks. An interestingclinical observation in patients with toothinfractions (cracked tooth syndrome) is

pain often experienced when bitingforce is released rather than during thedownward chewing motion.


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Selective anesthetic test

Intra ligamentary inj of 0.2 ml of L.A.

points out the involved tooth.

If pain still persists afetr L.A., other causesof pain should be thought about.


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Test cavity

often a last resort in testing for pulpvitality.


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Radiographic examination

In the sequence of examination,radiographic evaluations should come

last. it is a two-dimensional representation

of a three-dimensional object.


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(1) size and character of periradicularlesion,

(2) curvature of root end,

(3) relationship of root to adjacent roots,

(4) mesial or distal inclination of root,(5) approximate length of tooth,

(6) relationship of exploring instrument to

root curve,


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Radio-visio graphy


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True indicator of pulp vitality

Blood flow

IndicatorsLaser Doppler Flowmetry

Pulsoximetry

Liquid crystal testing.

Hughes probeye camera

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