Diagnostic Tests in dentistry

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

Copyright 2006/07 The University of Adelaide slide 2

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.


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


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


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


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


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


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


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


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


Electric pulp testing


Electric pulp testing

Apply any toothpaste to tip before use


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)


Correct placement of CO2 stick on the incisal edge


Correct placement of CO2 stick on the MB cusp


Diflourodichloromethane (-50C)

Must be kept in cold storage

Spray till adsorbed into pellet and place onto tooth for testing


Teeth can be isolated with rubber dam and cold/hot water applied directly


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


Percussion-light tapping


Palpation- an inflamed muco-periosteum


Mobility- possibly periodontal disease?


Probing- Periodontal disease or tooth fracture?


Radiography- An important test and record


Occlusion-Eccentric contacts


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


Apply Fracfinder to individual cusps


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

Diagnostic Tests in dentistry

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