Pulpal Diagnosis - University at Buffalo

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Eugene A. Pantera, Jr., DDS, MS Department of Periodontics and Endodontics Periapical Diagnosis There MAY be Need for Endodontic Treatment PULPAL DIAGNOSIS IS REQUIRED FOR DEFINITIVE DETERMINATION CLINICAL CLASSIFICATION SIGNS AND SYMPTOMS DIAGNOSTIC TEST RESULTS Acute Apical Periodontitis Pain History of pulpal pain. Moderate to severe intensity that may be intermittent. Periapical pain usually requires stimulus (eg mastication). Pain can be sharp. Aggravating factors are usually present. Etiology Irreversible pulpitis, traumatic injuries, periodontal disease, orthodontic forces maxillary sinusitis, pressure from periapical tumors, restoration in hyperocclusion. Pulp Tests EPT and Thermal tests may be normal, or similar to irreversible pulpitis or pulpal necrosis. Percussion Moderate to severe pain. Palpation Moderate to severe pain. Radiology Usually thickening of PDL, also can have periapical or lateral radiolucency, or normal. Chronic Apical Periodontitis A periapical condition characterized by none to slight pain on mastication but may present itself with varying degrees of apical swelling. Radiographs reveal periapical or lateral radiolucencies. Pain History of pain. Slight intensity to no pain. Pain may be absent or constant. Periapical pain can be spontaneous. Pain is dull throbbing. Pain can occur with mastication. Etiology Same as for Acute apical periodontitis. Pulp Tests EPT and Thermal tests may be normal, or similar to irreversible pulpitis or pulpal necrosis. Percussion Moderate to none. Palpation Moderate to none. May be swelling. Radiology Periapical or lateral radiolucency. 4
Eugene A. Pantera, Jr., DDS, MS Department of Periodontics and Endodontics Periapical Diagnosis There IS a Need for Endodontic Treatment PULPAL DIAGNOSIS IS REQUIRED FOR DEFINITIVE DETERMINATION CLINICAL CLASSIFICATION SIGNS AND SYMPTOMS DIAGNOSTIC TEST RESULTS Chronic Suppurative Apical Periodontitis A periapical condition characterized by non pain on mastication. A draining sinus tract or other evidence of suppuration is evident. Radiographs reveal periapical or lateral radiolucencies. Acute Alveolar Abscess Syn: Acute apical abscess An acute alveolar abscess is a severe clinical manifestation of periapical infectious disease, characterized by severe pain and swelling. Pain History of pain. Usually no pain present. Etiology Irreversible pulpitis, traumatic injuries, periodontal disease, orthodontic forces, restoration in hyperocclusion. Pain History of pain. Severe intensity. Constant and spontaneous pain. Pain is pulsing and throbbing. Pain can occur with mastication. Etiology The result of coronal apical progression of pulpal necrosis with resultant release of antigens into the periapical tissues. Pulp Tests EPT and Thermal tests may be normal, or similar to irreversible pulpitis or pulpal necrosis. (Is this a lesion of endodontic origin) Percussion None to slight pain. Palpation Slightly tender. Radiology Periapical or lateral radiolucency. Visual Sinus tract present. Pulp Tests No response. Percussion Moderate to severe. Palpation Moderate to severe. Swelling probable. Radiology PDL thickening, periapical or lateral radiolucency. 5
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Pulpal Diagnosis - University at Buffalo

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