Diagnosis & treatment planing /certified fixed orthodontic courses by Indian dental academy

Diagnosis and treatment
Planning in
Endodontics

INDIAN DENTAL ACADEMY
Leader in Continuing Dental Education
www.indiandentalacademy.com


contents
 Introduction.
 Requirements of a diagnostician
 Definition
 Diagnostic sequence

– Demographic information and
social history.
– Chief compliant and history
of present illness.
– Past medical and dental
history.
– Clinical examination.
– Other clinical tests.

 To be continued…. .


Introduction


Requirements of a diagnostician


Knowledge

“One recognizes only what one already knows and understands “


Interest

•Good diagnostician's asset.


Intuition

•Sixth sense


Curiosity

•Delve a little deeper
•Probe a little further
all of this takes little more time


Patience

•Listen to the patient,
•Wait for the diagnosis.


Diagnosis can be defined as :

“The translation of data gathered by clinical and
Radiographic examination in to an organized,
classified definition of the conditions present”.


Diagnostic sequence
 Demographic information with respect to name, age, sex etc

 Chief complaint and history of present illness

 Medical and dental history

 Clinical examination

 Radiographic findings

 Other tests, laboratory values or consultations if required

 Provisional diagnosis / diagnosis

 Treatment plan


Interaction

“Patients often judge

the dentists
competence more by
their feelings than by
his fillings”.


1) Demographic information and name age,sex etc

– Name
– Age
– Sex
– Occupation, address and phone no.
– Habits: like smoking, pan chewing, bruxism etc.
– Patients education
– Address and telephone no. of a
• Friend or next of kin : who should be contacted in
emergency
• Referring dentist or physician
• Patients regular dentist or physician
– Family history :
- Inherited disorders
- Hemophilia
- Drug allergy
- Other infective diseases of family
members like tuberculosis, hepatitis etc


2) Chief complaint and history of present
illness

a) Chief complaint :

Chief complaint is obtained by asking the patient to describe the
problem for which help is sought, or the reason for seeking treatment.

The chief complaint is recorded in patients own words
as much as possible and should not be translated into
technical (formal diagnostic) language unless reported in
that fashion by the patient.


b) History of present illness:
 When did the problem start?
 What did you notice first?
 Is the pain mild, moderate or severe?
 What is the nature of pain, dull, sharp, stabbing,
throbbing etc?
 Could you point to the tooth that hurts?
 Do heat, cold, biting, chewing, sweets cause pain?
 When heat or cold causes pain is it momentary or
does it lasts longer?
 Does the pain occur without provocation?
 Have the symptoms got better or worse at any time?
 Have you done anything to treat the symptoms ?


3) Medical and dental history:

a) Medical history
i. Serious or significant illness
ii. Hospitalizations
iii. Transfusions
iv. Allergies:
v. Medications:
vi. Pregnancy and lactating


Serious or significant illness

•required the attention of a physician,
necessitated staying in bed for longer than 3
days for which patient was routinely medicated.


Hospitalizations

•Cause,
•Duration,
•Any complications,

Transfusions

•Indicates previous serious medical or
surgical problem.


Allergies:

•Urticaria, hay fewer, asthma etc
•Drug allergies,


Medications:

•drug interactions
•chronic or systemic disease patent is suffering from.


Pregnancy and lactating

Medication prescription

Radiological investigations

 In doubtful cases the
patient should be treated as
pregnant.


vii. Problems of major significance for dental
treatment
 History of spontaneous bleeding or bruising
associated with extraction, other minor surgical
procedures or menstrual period.
 Previously diagnosed hematological disorder.
 Therapeutic radiation to head or neck.
 Cancer chemotherapy or immunosupression.
 Heart murmur, rheumatic fever of congenital heart
disease.

 Diabetes mellitus.

 Contagious diseases like T.B, hepatitis, HIV etc.

 Seizure disorders

b) Dental history

Frequency of dental visit?
Purpose of last dental visit?
The type of care provided?
Any complications during
treatment?
Recent dental radiographs?


During these questioning we will come to know about,

Patients dental I Q
Priority given to dental care
Fears associated with dental treatments.
Past dental treatments.


Review of systems

 If he or she gets short of breath easily, has
excertional pain in the chest or down the
left arm, or

 If he or she urinates frequently ,or

 Has knee or ankle swelling so forth.

 And some specific questions which patient
did not answer completely during initial
questioning.


Examination of patient:
“never treat a stranger”

Blood pressure
Pulse rate
Temperature
Respiratory rate
Height and weight
Clubbing


1.Blood pressure

 Blood pressure: Normal –
120/80 mm of Hg.
 can be measured mainly by,
- Palpatory method and
- Auscultatory method
 Auscultory method : 1
Brachial artery
 Palpatory method :
Radial artery

 In any conditions the patient
should not be treated if the
diastolic blood pressure is more
than 100 mm of Hg.


2.Pulse rate: 60 – 90 / min

•Radial artery,
•Brachial artery.


3. Temperature: 37 º C or 98.6 ° F.

4. Respiratory rate: 16-18 / min


5. Clubbing

Presence of clubbing indicates
serious systemic diseases.

6. Height and weight


b) Extra oral examination:

 Inspection

 Palpation

 Percussion

 Auscultation


1. Visual inspection:
 Here we should observe the general
appearance of the individual and evaluate
nutritional state and emotional reaction of
the patient.

 Visual inspection of skin or mucus membrane
yields information concerning color changes,
dryness and edema, changes in morphology
such as size, shape, symmetry, etc.

 Examination for deviation of mandible during
opening or closing. Muscular movements
should be observed.

 Mouth opening also should be examined to
check for the presence of trismus.


2. Palpation

 Palpation is a procedure where
in the examiner feels or
presses the structures to be
examined. Palpation gives
more detail about things
inspected Visually and reveals
information about things that
can’t be seen.


Palpate for adenopathy
Normal lymph nodes are difficult
to palpate and inflamed ones are
readily palpable.

During lymph node examination
check for

- Mobility of lymph node i.e. mobile
or fixed Submandibular lymph
node examination
-Tender ness of lymph node  type
of pain.

- Size and shape of lymph node

-Consistency: soft, rubbery, hard

- Number of lymph nodes: matted or
solitary. Sub mental lymph node
examination

If any extra oral swelling is present, it should
be examined for,

 Extension and position of swelling.

 Dimension (Shape and size).

 Skin over the swelling  color changes, free or attached

to underlying tissue, ulceration, Temperature changes etc

 Consistency of swelling.


If sinus is present, it should be examined for,
 the character of their base, edges, depth, color, discharge
and relation to surrounding tissues.
 A flat sloping edge shows it is a healing
ulcer.

 Punched out edge border shows it is a
syphilitic ulcer.

 Undermined border shows tuberculosis
ulcer.

 Rolled border shows basal cell carcinoma.

 Everted edge shows squamous cell carcinoma.


Examination of temporomandibular joint

Is done during palpation procedure for any crepetius or pain in TMJ.


Percussion:

It is the technique of striking the tissue with fingers or
instrument. The examiner observes the response of
the patient.

Extra orally percussion is often
used to detect tenderness in the
frontal and maxillary sinuses by
tapping the finger tips against a
finger placed over the sinus.


Auscultation:

Auscultation is the act of listening to sounds with in
the body.

 Bruits in the tissues overlying
vascular lesions

 T.M.J sounds


c) Intra oral examination
Before the start of the examination the area to be examined
should be dry, all removable dentures, Obturators or other
appliances must be removed.

 Soft tissue examinations

 Hard tissue examination


Soft tissue examination

 Inner surfaces of lips, buccal mucosa, the

cheeks, maxillary and mandibular mucosal folds

the palate, tongue, floor of the mouth, gingiva,

tonsils etc are inspected.


Hard tissue examination:
Visual inspection

The teeth to be examined should be dry for proper examination
Inspection procedures are normally done under dental light.

But in some special cases fiber optic, or ultra violet light can be used.

Fiber-optic light is used to Transilluminate the teeth
for inter-proximal caries and cracks.


Palpation:

 Sensitivity to finger pressure on the
mucosa over the apex of a tooth, signals the
spread of inflammation from the PDL to the
periostium.

 In this manner, an incipient swelling
may be detected before it is clinically evident

 Additional information about
fluctuation or indurations of soft tissues and
changes in the underlying bony architecture
can also be detected.
Bimanual palpation is most
efficient.

Percussion:

finger is sufficient to A mouth mirror handle is gently
tapped on the occlusal or incisal
elicit the pain. surface.

Percussion test tells us about the periodontal condition of the tooth in the
Root apex. As apical periodontitis is usually an extension of pulpal
inflammation percussion tests are included in pulpal examination.


Auscultation:
 It is the technique of striking
the tissue with the fingers
or instrument. The examiner
listens to the resulting sounds
to gather the data.

Ex: Ankylosis of teeth in bone
produces a charge in sound


Aspiration:

Aspiration is withdrawal of fluids from a body cavity. The area
aspirated may be limited to soft tissue or may be central in bone.

Aspirate may be used for culture and sensitivity tests to
identify the pathogen and its best treatment

Straw colored or blood tinted fluid may indicate cyst, similarly
pus indicates a abscess etc.

Aspiration is best performed under local anesthetic with a
large needle of 16 to 20 gauze.


Mobility test:

 The clinician should use two mouth-
mirror handles to apply alternating
lateral forces . The degree of
depressiblity of the tooth with in
its alveolus should also be tested.

Degree of mobility can be classified as,

1st degree of mobility: Perceptible horizontal movement

2nd degree of mobility: No more than 1 mm of horizontal
movement.

3rd degree of mobility: Greater than 1mm of horizontal
movement and or Vertical depressibility.

Other clinical tests:
1) Transillumination
Transillumination may also locate teeth with vertical cracks or
interproximal caries and non vital pulp.


2) Thermal tests:

Two types of thermal tests are available, cold and hot

 the patients reaction after application of

heat or cold to specific tooth not only pin

points the involved tooth but also strongly

suggests the presence of the condition.


i. Hot test:

 gutta-percha sticks are used to elicit a

response to heat

 The teeth to be treated are isolated. A

strip of gutta-percha is heated and applied to

the cervical area of the tooth. This produces

a response from pulp.

o in cast crown sufficient heat is produced

by using a rubber wheel mounted on a mandrill

revolving at a polishing speed


ii. Cold test:
 The cold test may be used to differentiate between
reversible and irreversible pulpits and identifying
teeth with necrotic pulpits.

Cold testing can be done with

 An air blast

 A cold drink

 An ice stick

 Ethyl chloride

 Carbon dioxide dry ice sticks etc.


Carbon dioxide dry ice sticks

Application to tooth
Co2 cylinder Ice stick surface

 It can be used on teeth with metal restorations.
 It don't cause any damage to the health of pulp
even if it is used for 5 minutes continuously.
Disadvantages:
 Micro cracks on enamel
 Pitting on porcelain
 Expensive apparatus

Results of thermal pulp tests

 No response
*pulp is either non vital or possibly vital but giving a
false-negative response because of excessive
calcification, an immature apex, recent trauma, or
patient premedication.

 A moderate transient response
*usually considered normal

 A painful response that subsides quickly after the
stimulus is removed
* characteristic of reversible pulpits.

 A painful response that lingers after the thermal stimuli
is removed.
*indicates symptomatic irreversible pulpits


Electric pulp testing

 Before the use of electric pulp tester
the tooth to be examined should be
air-dried and should be surrounded by
cotton rolls. A electrolytic gel should
be used to transmit the current from
the machine to the hard structures of
the tooth. The electric tip should be
placed as much civically as possible

 With the electrode contacting the
tooth, an electric charge is applied, a
small charge being given initially and
gradually increased until the response
is felt. The patient experiences a
sense of heat or tingling in the tooth
when the nerve tissue is stimulated


3) Electric pulp testing:
results interpretation
 If the current required to gain a response from a test tooth
is the same as that needed to exite the control, the pulp of
the test tooth is considered normal.

 The pulp of the test is considered degrading when much more
current is required.

 If much less current is required then the pulp is hyperactive.

 If no response it indicates pulpal necrosis.


Ideal situations for electric pulp testing:
 Testing anterior teeth has a high degree of reliability because
these teeth are single rooted, easy to isolate, have cast
restorations less frequently than posterior teeth and have good
access to reach cervical responsive areas
 Excellent evaluation of teeth involved in traumatic accidents is
available with an electric pulp tester.
 To differentiate between pulpal and periodontal problems.

 To identify the diseased tooth when
periapical radiolucency is involving
many tooth apices etc.


Drawbacks of electric pulp tester:
 Use of EPT in patients with pacemakers is questionable.

 The electric output may vary from time to time.
 Some false positive response may be seen in molars due to
multiple roots.
 It gives us the condition of the nerve fibers but not the blood
supply to the pulp.

 In splinted or tooth with bridges response may be due to
stimulation of adjacent teeth.

 Teeth are usually non responsive to electric pulp testing shortly
after eruption, after trauma and older tooth.

 Results of electric pulp testing are always subject to the errors
of human interpretation and should be evaluated along with
results from the other diagnostic aids before a final diagnosis is
made.


a) Selective anesthesia:

Selective anesthesia
refers to administration
of a local anesthetic to
facilitate identification of
the tooth causing a painful
episode.


5) Test cavity (or) test drilling
 It is the final and
unquestionably the most
accurate pulp vitality test.

 The preparation is placed in
the lingual or palatal surface
of an anterior tooth or
occlusal area of a posterior
tooth.
 The cavity is best prepared
by using an airrotor without
water spray.

 After the response is
noted the cavity may be
temporarily restored with
ZOE.


Thank you for watching


Diagnosis & treatment planing /certified fixed orthodontic courses by Indian dental academy

Recomendados

Recomendados

Mais conteúdo relacionado

Mais procurados

Mais procurados (20)

Destaque

Destaque (20)

Semelhante a Diagnosis & treatment planing /certified fixed orthodontic courses by Indian dental academy

Semelhante a Diagnosis & treatment planing /certified fixed orthodontic courses by Indian dental academy (20)

Mais de Indian dental academy

Mais de Indian dental academy (20)

Último

Último (20)

Diagnosis & treatment planing /certified fixed orthodontic courses by Indian dental academy