Pulpal Diagnosis - University at Buffalo

Eugene A. Pantera, Jr., DDS, MS
Department of Periodontics and Endodontics
Pulpal Diagnosis
Endodontic Treatment IS Needed
CLINICAL CLASSIFICATION SIGNS AND SYMPTOMS DIAGNOSTIC TEST RESULTS
Irreversible Pulpitis
Irreversible pulpitis without periapical pathosis
A pulpal condition, usually caused by deep
dental caries or restorations, in which
spontaneous pain may occur or be
precipitated by thermal or other stimuli.
Radiographs show no periapical changes.
The pain last for several minutes to hours.
Irreversible pulpitis with periapical pathosis
A pulpal condition similar to above, but in
which periapical or lateral radiographic
changes are evident.
Pain
May have acute or chronic symptoms.
Sharp, exaggerated, painful response to thermal
stimulus; pain lingers after stimulus is
removed.
Pain may be spontaneous; maybe past repeated
episodes of pain, often continuous pain.
Pain with mastication.
Etiology
Deep caries and/or restorations, evidence of
previous pulp cap.
Exposed dentin (attrition, abrasion, and erosion).
Traumatic injuries.
Resorption (especially perforating).
Orthodontic forces.
EPT
Tooth may test within normal limits.
Response may be markedly different from
control, rapid/delayed onset, persistent, and
may be of severe intensity.
Thermal Test
A key factor in making a diagnosis.
May be abnormal, rapid/delayed onset, greater
intensity and longer duration.
Percussion Test
May or may not be positive.
Palpation
May or may not be positive.
Radiology
May be normal.
Radiographic evidence may reveal normal pulp,
calcifications, narrow pulp chamber,
"calcified" canals, , or condensing osteitis.
An enlarged PDL may also be present.
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