1. Endodontic diagnosis.
R2: 馮聖傑

2. Endodontic diagnosis.
 Do we really know the status of the
pulps???
 Usually…endodontic procedures are
performed secondarily to the patients
presenting with symptoms.
 Accurately diagnose endodontic disease
no matter symptomatic or asymptomatic.

3. The reality.
 LEO (a lesion of endodontic origin).
 Many pulpally involved teeth do not
show…
 “Incipient” radiolucency.
 accurately diagnosis decrease the
risk factors comes from oral
infection of certain disease .

4. Etiology of pulpal breakdown.
 Pulp---a dynamic tissue.
 Restricted capacity to heal---
limited blood supply.
 Magnitude and duration of injury.
 Progression from reversible to
irreversible and rapidly advance
from ischemia, infarction and
partial necrosis to complete
necrosis.

5. The endodontic examinaton.
 Three-step diagnostic process.
 Clinical
 Radiographic
 Vital pulp testing.
 Symptom or not? LEO or not?

6. Clinical examinaiton.
 Evaluate all aspects of the
extraoral and intraoral tissues.

8.  Periodontal examination.

9.  Intraoral hard tissue---missing
teeth, fractured teeth, dark teeth
and developmental anomalies.

12.  Restoratives—marginal adaptation
 Caries, cervical erosion, abrasion and
abfraction.
 Mobility
 Palpation (laterally and apically.)
 Percussion---attachment apparatus.
 Biting test---fractures.
 Masticatory system.

13. Radiographic examination.
 Following the clinical examination.
 Three different well-angulated, and
high quality images.
 the location and extent of caries or
recurrent caries
 Pulp
 Crown and root relation.

16. Traumatic episodes

17. For retreatment.

18. Lateral canalsperiodontitis

20. Vital pulp testing.
 Vital pulp tests (VPT) to disclose the
status of the dental pulp.
 Contralateral  opposing  healthy
 suspicious.
 Establishment of baseline.
 Pulpal inflammation confined to the
root canal space. (proprioceptive n.
fiber.)
 Thermal test, EPT, cavity test.

21. Cavity test.
 Rarely used.
 Prove inclusive by clinical and
radiographic examination and pulp
test.

22. Thermal test.
 Based on pt‟s CC.(cold)
 Refractory period.
 On the cervical aspect.
 Immediacy, intensity, duration.

23. Cold test.
 Ice pencil.
 Reliable hand signal.
 Ice stick.
 Isolated teeth.

25. Hot test.
 Acutely inflamed or partially necrotic
pulp.
 Touch „n‟ heat, System B (hot pulp test
tip.)
 Wait several secs.
 Coffee first sip or after repeated sip.
 Isolated teeth---closely to the feeling
of food and liquid we have.

26. Others
 Localized anesthesia.
 Do no harm while doing good.

27. Endo-perio interrelationship
 Anatomical communication between
pulp and PDL---dentinal tubules,
lateral canals, apical foramen.
 Similar microflora (anaerobic ) ---
cross infection.

30. Effect of pulpal disease on the
periodontium
 Endodontic infections may cause
periodontium to have rapid
inflammatory responses.
 Inappropriately endodontic treatment.

31. Effect of periodontal disease on the
pulp.
 Periodontal involved tooth may have
atrophic change on pulp.
 Periodontitis lateral canal
sensitivity.

33. Conclusion.
 Reliable information serves to improve
diagnostics, treatment planning and patient
communication.
 The comprehensive endodontic examination
increases the possibility for patients to receive
more timely care

34. Craniofacial pain (CFP)
 Pain in the face and head.
 May be due to local pathology.
 Maybe referred to the face and head from
adjacent area.
 Maybe of psychogenic origin.
 Oro-facial pain.

35. VIP MEN
 Vascular CFP
 Intracranial CFP
 Psychogenic CFP
 Musculoskeletal CFP
 Extracranial CFP
 Neurologic CFP

36. Vascular CFP
 throbbing, pulsatile, episode,
recurrent , persistent and wide area.
 Associated with carotid pressure,
posture.
 Migraine
 Cluster headache
 Temporal arteritis.
 Chronic paroxysmal hemicarnia.

37. Migraine.
 Adult: 75% female, child: 70% male.
 18% of women, 8% of men.
 Age at onset: 2~40 y/o ( <20 teenager.)
 Family history: 60~70%
 Response to Ergotamine.
 TMD and muscle disorders…precipitate
a migraine attack

38.  Common migraine
 Duration---usually 12 to 72 hours
 Sex—female/male ratio is > 2:1
 Neurologic aura---40%
 Severe, intermittent, throbbing pain.
 Unilateral
 Nocturnal
 Photophobia

39. Cluster headache.
 Periodic migrainous neuralgia.
 Intensity: severe paroxysmal, explosive pain.
 Frequency: up to 8 per day.
 Duration: 15~180 mins.
 Cluster cycles: pain-free interval (week-
month)
 Nocturnal.
 Unilateral, orbital, supra-orbital, temporal
area (posterior maxilla, dental pain?)
 Male: 80% Age: 20~50 (36) y/o no family
history.

40. Temporal arteritis (Giant cell arteritis)
 Giant cell granulomatous reaction of
artery.
 Prevalent: over 50 y/o
 Dull or throbbing pain over temporal
area.
 ↑ weakness and pain in the jaw and
tongue---jaw claudication.
 Diagnosis : biopsy, ESR
 Ｔx :corticosteroid.

41. Intracranial CFP
 Headache, numbness, weakness.
 Tumor, trauma or hemorrhage.
 Symptom of trigeminal neuralgia.

42. Psychogenic CFP
 May evoke physical pain.
 Chronic, multiple, bilateral, migratory
pain.
 Unexpected response to treatment.
 50 % of pain of psychogenic origin is
experienced in the face and head.
 Atypical facial pain/atypical odontalgia.
 Oral dysaesthesia
 Hypochondriasis.

43. Atypical odontalgia
 Women (Menopause.)
 Like pulpal pain.
 Maxillary premolar or molar.
 Aching or burning, even throbbing pain.
 Etiology---neurovascular cause,
psychogenic origin or deafferentation.
 Tricyclic.

44. Musculoskeletal CFP
 Charater: dull (sharp), localized pain.
 Associated with function of jaws.
 Types:
 TMD
 Muscle contraction(tension)
headache.

45. Extracranial CFP
 Localized and acute pain.
 Diagnosis, treatment and improve.
 Types:
 Odontigenic
 ENT
 Eyes
 Salivary glands
 Lymph nodes
 bone

46. Neurologic CFP
 Paroxysmal, electrisic, free between
episodes, intermittent.
 short duration.
 Types:
 Trigeminal neuralgia
 Glossopharyngeal neuralgia.
 Deafferentation pain
 Systemic disease

47.  Trigeminal neuralgia.
 Severe paroxysmal pain
 Unilateral (96%); r>l
 Mild superficial
stimulation provokes pain.
 V2 and V3,
 no neurologic deficits
 No dentoalveolar cause found
 Local anesthesia of trigger zone
temporrarily arrests pain.

48. Conclusion.

49. Thank you!!!