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
Necrotic Pulp
Necrotic pulp without periapical pathosis
A pulpal condition in which there may or
may not be spontaneous moderate to severe
pain or pain elicited by various stimuli.
Response to various testing modalities is
usually absent. Radiographic changes are not
evident.
Necrotic pulp with periapical pathosis
A pulpal condition similar to above, except
that in this category periapical or lateral
lesions are evident in radiographs.
Pain
May have acute or chronic symptoms.
Pain may be spontaneous; maybe past repeated
episodes of pain, often continuous, dull,
throbbing, pain.
Pain with mastication.
Etiology
Deep caries and/or restorations, evidence of
previous pulp cap.
Carious pulp exposures.
Exposed dentin (attrition, abrasion, and erosion).
Traumatic injuries.
Resorption (especially perforating).
Orthodontic forces.
EPT
No response.
May have false positives.
Thermal Test
No response.
Percussion Test
May or may not be positive.
Palpation
May or may not be positive.
Radiology
May be normal.
May be periapical lesions or lateral lesions.
An enlarged PDL may also be present.
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