I just tried my best

2. Diagnosis of pulpul
pathologies

3. Keys of Diagnosis:
History
• Medical History
• Dental History
Examination
• Extra oral
Examination
• Intra oral
Examination
• Vital signs
Investigation
• Pulp sensitivity tests
• Radiograph

4. History
 Presenting Complaint:
Patients are asked to describe their
complaint in there own words;
All this data should be documented.

5. Presenting Complaint:
 How it is done?? It can be done in Five basic
directions..
I. Localization; can you point to the offending tooth???
II. Commencement; when did the symptoms first
occur???
III. Intensity; How intense is the pain???
IV. Provocation and Relief of Pain; What produces of
reduces the symptoms???
V. Duration; Do the symptoms subside shortly, or take
some time???

7. Dental history;
 Past dental clinical attendance.
 Possible contributing factors towards patient’s present
condition.
 Proper documentation.

8. Medical History;
 Medical history is important because there are some
medical conditions which leads to the delay or restrict
dental treatment..
 What are the “medical” conditions that affect dental
treatment?

9. MEDICAL CONDITIONS AFFECTING DENTAL TREATMENT;
•DIABETES
•PREGNANCY
•EATING DISORDERS (BULIMIA, ANOREXIA)
•Leukemia
•Cardiovascular Disease (High Blood Pressure, Stroke, Prosthetic valves, Infective
Carditis, Cardiac Transplants with Valvulopathy, Some types of Congenital Heart
Disease)
•Anemia
•Hemophilia
•HIV, Hepatitis B and C (Blood Borne Pathogens)

10. •Leukemia
•Allergies (latex and others)
•Poor nutrition
•Obesity
•Mouth breathing
•Obstructive Sleep Apnea
•Drug abuse including methamphetamine use.
•Renal Disease
•Cancer

11. Examination;
 Vital Signs.
 Extra oral Examination.
 Intra oral Examination

12. Vital Signs;
 Blood pressure: 120/80 mm Hg for person under age 60, 140/90 mm
Hg for person over age 60.
 Pulse rate: 60-100 beats/mint.
 Respiratory rate: 16-18 breaths/min
 Temperature: 37 degree centigrade.

13. Extra oral Examination;
 Localized swellings
 Facial asymmetry
 Change in colour (bruises,abrasions,cuts or scars)
 Lymph nodes examination
 Trauma
 Sinus tracts
 Cancer

14. Intra oral examination;
 Visual and tactile inspection
 Percussion
 Palpation
 Periodontal examination
 Radiographic examination
 Pulp tests
 Wedging and staining

15. Visual and tactile inspection;
 It depends on Colour,Contour and Consistency.
 Lips, Cheeks, Vestibule and mucosa examined for
localized swellings, sinus tract and colour changes.
 Hard tissue is examined for fracture.
 Its requirements are good vision, tactile sensation, an
explorer, periodontal probe and a good light.

20. Palpation;
 In Palpation the buccal/labial and palatal/lingual
mucosa are palpated.
 Light finger pressure is applied in a rolling motion on
the soft tissues.
 It done by using index finger.
 The sign of tenderness usually indicate inflammation
of underlying tissues.

21. Palpation;

22. Percussion;
Teeth are percussed in axial and buccal direction.
It is done by using fore finger or handle of mouth
mirror.
Tenderness to gentle percussion indicates
inflammation.
Percussive sound: A dull note signifies Abscess
formation, a sharp note denotes Inflimmation.

24. Periodontal Probing;
 Probing depths should be assessed by Walking the
periodontal probe around the entire circumference of
the tooth.
 It is done for assessing periodontal health, root
fractures and iatrogenic perforations.

25. Periodontal probing:

26. Mobility;
 An increase in mobility of tooth is indication that pulp
is not vital.
 It is indication of compromised periodontium.

27. Classification of mobility;
 Grade 1: tooth movement is greater then normal.
 Grade 2: horizontal tooth movement not greater then
1mm.
 Grade 3: horizontal tooth movement greater then 1mm
with or without rotation or vertical depressibility.

30. Mobilometers:
 It is electronic device determining tooth mobility.
 It is consists of two electrodes.(prongs that hold facial
and lingual surface of the teeth)
 The degree of mobility is reflected as numerical
reading;
 The presence of 3-5 mm pockets indicate moderate
periodontitis.
 Pocket more then 5mm indicates severe periodontitis.

31. Mobilometer:

32. Furcation;
 Furcation is examined with mouth mirror and Naber’s
probe.
 It is classified as:
 Class I; furcation defects can be probed but not to a
significient depth.
 Class II; furcation defects can be entered into but cannot be
probed completely through the opposite side.
 Class III; furcation defects can be probed completely through
the opposite side.

33. Nabers probe and furcation;

34. Investigation:

35. These are the tests by which a clinician determine
neural response and vascular supply of the tooth.

36. It is accurate in 86% of cases.
Helpful in differentiating reversible and irreversible pulpitis.
It also help in identifying teeth with necrotic pulp.
It is performed with;
 Air blast
 Ice sticks
 Ethylene chloride spray
 Frozen carbon dioxide

37. Cold test;
 Procedure;
 Teeth are isolated.
 Ice sticks applied immediately to the middle third of the
facial surface.
 Kept in contact for 5 seconds or until the patient begins to
feel pain.
 Start with most posterior tooth and advance towards the
anterior s.
 During test if pain lingers then it is evidence for irreversible
pulpits.
 If pain subsides immediately after the removal of stimulus
then there is evidence of reversible pulpits.

38. Heat tests:
It is perform by;
 Heated GP sticks
 Hot water
 Hot burnisher
 Hot green stick compound

39. Heat test:
Procedure;
 Teeth are protected with light coating of petroleum jelly
prevent the warm temporary stopping from sticking to
them.
 The stopping is warmed until it begins to glisten.
 Applied on the middle third of the facial surface of the
crown.
 Usually a clinician gets response in less then 5 seconds.

40. Electric pulp Test (EPT);
Relies on electric impulses
stimulating the nerves especially A-
delta sensory nerve of the pulp.
Checks the status of nerve fibers.
It fails to give information about
the vascular supply or histological
status of the pulp.

41. EPT;
 Procedure;
 Explain the procedure to the patient.
 Isolate and dry the teeth with cotton rolls.
 Cover the tip of the electrode with toothpaste or a similar
electrical conductor.
 To complete the circuit, patient should place a fingeron the
handle of a device or a lip clip can be used.
 In multirooted teeth the electrode is placed on more then one
location of the crown.
 Electrode is applied to the dried surface middle third of facial
surface.
 Current is slowly increased until the tingling sensation
becomes painful.
 EPT should b test 2-3 times and average result shoul be
recorded.

42. Laser Doppler Flowmetry (LDF):
This method is used to assess the blood flow in
microvasculature system.
It use a laser beam of known wavelength, which is
directed through the crown of the tooth to the blood
vessels within the pulp.
 Moving red blood cells cause the frequency of the
laser beam to be Doppler shifted and some of the light
to be back-scattered out of the tooth. This reflected
light is detected by a photocell on the tooth surface,
the out put of which is proportional to number and
velocity of the blood cells. However, the frequency will
not change as it passes through a static tissue (necrotic
pulp),

43. Pulse oximeter;
It is designated to measure the oxygen concentration
in the blood and pulse rate.
Widely use d technique during administration of I/V
anesthesia.
Increased metabolic rate produce by inflammation
causes deoxygenation of hemoglobin which changes
oxygen concentration level of blood.

44. Pulse oximetery:
 It use a probe containing containing a diode that emits
light in two wavelengths.
 Red light 660 nm
 Infrared light 850nm
 Procedure;
 Light is received by a photo detector diode connected to a
microprocessor.
 The device compares the amplitude of both light.
 By monitoring oxygen changes, pulse oximetry can detect
pulpal inflammation or partial necrosis.

45. Test cavity preparation:
This is performed when all other tests fails.
Procedure
 Small class I cavity is papered with high speed No 1 or 2
round bur with proper air and water till it reach DEJ.
 Tooth is unanaesthetized.
 Sensitivity and pain is indication of pulp vitality.
 No endodontic treatment is indicated.
 If there is no pain, pulp is necrotic and endodontic
treatment is indicated.

46. Radiographs:
Radiovisuography(RVG)
Xeroradiography
Digital subtraction radiography(DSR)
Computerized tomography(CT)
Magnetic Resonance Imaging(MRI)
Tuned aperture computed tomography (TACT)