Diagnosis
Dentist
● is a medical professional who specializes in dentistry, the
diagnosis, prevention, and treatment of diseases and
conditions of the oral cavity?
Definition
It is the art and science of collecting data and utilizing the operator
skills, senses and knowledge aiming at reaching a definite and
accurate treatment for the patient’s presented illness.
The procedure of accepting a patient, recognizing that he has a
problem, determining the cause of the problem, and developing a
treatment plan that will solve or alleviate the problem.
differential diagnosis
● The distinguishing of a disease or condition from others presenting with
similar
signs and symptoms
● Medical or dental
● Dental or periodontal
● Pulpal or exposed dentin
● Pulpal or peri radicular
● Pulpal Acute or chronic
Diagnosis is proceeded into:
1. Case history
a) Personal data
b) Chief complains
c) Medical history
d) Past dental history
2. Clinical Examination
● Extra oral
● Intra oral
● Diagnostic aids
3. Lab investigation
1) Case history:
a) Personal data
Name
Age
Sex
Address
Telephone number
Occupation
Marital status
Habits
1) Case history:
b) Chief Complaint:
“Present dental illness”
What is the problem?
(Patient’s own words.)
Followed by descriptive questions.
b) Chief Complaint:
Pain History
○ Location
1) Case history:
○ chronicity
○ Intensity
○ Onset
○ Course
○ Duration
○ Exacerbating factors
○ Relieving factors
○ Spontaneity
○ Recurrence
1) Case history:
c) medical history
• Review/update written medical
questionnaire
• Medications
• Allergies
• Need for SBE prophylaxis
• Diabetes
• Pregnancy
• Written consultation with physician
as required
Diagnosis is proceeded into:
1. Case history
a) Personal data
b) Chief complains
c) Medical history
d) Past dental history
2. Clinical Examination
● Extra oral
● Intra oral
● Diagnostic aids
3. Lab investigation
● A clinical examination of the patient is carried out after
the case history has been completed.
● The temptation to start treatment on a tooth without
examining the remaining dentition must be resisted.
Extra-oral examination
● The patient's face and neck are examined and any swelling, tender areas,
lymphadenopathy, or extra-oral sinuses noted
● An assessment of the patient's general dental
state is made, noting in particular the following
aspects:
Standard of oral hygiene.
○ Amount and quality of restorative work.
○ Prevalence of caries.
1.Intra-oral ○ Missing and unopposed teeth.
examination ○ General periodontal condition.
○ Presence of soft or hard swellings.
○ Presence of any sinus tracts.
○ Discolored teeth. Tooth wear and facets.
○
2.Diagnostic tests
● Most of the diagnostic tests used to assess the state of the pulp and
periapical tissues. No single test is sufficient to make a firm diagnosis of
reversible or irreversible pulpitis.
● There is a general rule that before drilling into a pulp chamber there
should be two independent positive diagnostic tests.
● An example would be a tooth not responding to the electric pulp
tester and tender to percussion.
● The tissues overlying the apices of any suspect teeth are palpated to locate
tender areas. The site and size of any soft or hard swellings are noted and
examined.
● Gentle tapping with a finger or with a mirror handle both laterally and
vertically on a tooth is sufficient to elicit any tenderness.
● The mobility of a tooth is tested by placing a finger on either side of the
crown and pushing with one finger against metal object while assessing
any movement with the other. Mobility may be graded as:
● 1 - slight (normal)
● 2 - moderate
● 3 - extensive movement in a lateral or mesiodistal direction
combined with a vertical displacement in the alveolus.
1- Radiographic examination
Preoperative During Operation Post-operative
Estimation of the working length.
Periapical Film
Diagnostic Aids:
dental X Ray machine:
● Preoperative Radiographs:
➢ Size & Level of pulp chamber.
➢ No. and Direction of roots and canals.
➢ Presence of any periapical pathosis and degree of
bone and root resorption if present.
• Root obstructions by pulp stone or obliteration of the
root by secondary dentin.
• Presence of vertical or horizontal roots fracture.
• Root resorption or immature root and open apex.
• Old root canals treatment if present.
Limitation of radiographs
2D image of a 3D object
Distorted image
No indication on pulp & soft tissue conditions
2D image of a 3D object
2D image of a 3D object
● Elongation or shortening
Distorted image
● Contrast changes
When do we need panoramic X-Ray View in our field?
- Radio-Visio-graphy (RVG):
1- Intra oral electronic sensor or detector attached to
processing unit, sensor replace dental intra oral film.
- Radio-vasography (RVG):
2- An analogue to digital converter.
3- Computer (Central processing unit) CPU.
4- Monitor or printer for the image display.
Radio-vasography (RVG):
Depends on:
○ a programmed computerized receiver that processes signals from an intra
oral sensor that is stimulated by X ray from a standard machine.
○ The computer-enhanced signal then appears immediately on the video
monitor as an image
Pulp Testing
● Pulp testing is often referred to as 'vitality' testing.
● Pulp testers should only be used to assess vital or non-vital pulps.
● Pulp testing gives no indication of the state of the vascular supply but
more accurately indicate the degree of pulp vitality.
● The only way pulpal blood-flow may be measured is by using a Laser-
Doppler Flow Meter.
● Doubt has been cast on the efficacy of pulp testing the corresponding tooth on
the other side of the mid-line for comparison.
Pulp Testing
1.Neural 2.Vascular elements
elements (Blood flow) (vitality test)
(Sensitivity test)
Thermal
Electrical Laser Doppler
pulp Flow metrics
Testing
Pulse oximetry
Cavity
test
Thermal Test
1. Hot test
• Hot gutta percha (76 °C)
• Rubber cup to create frictional heat
• System B (66 °C)
• A flame-heated instrument
• Hot water bath (58 °C)
- Syringing 60°C hot water onto a tooth that has been carefully
isolated with a rubber dam
Thermal Test
2. Cold test
• Ice rods (0 °C)
• Endo ice (Tetrafluoroethene) (- 45°C)
• Ethyl chloride (- 7 °C)
• Dry ice (CO2 ice (- 78 °C))
• Cold water bath
Cold water bath
Electric pulp testing:
Passage of high frequency pulsating current (5- 15 MS) of high voltage and very
low current intensity, then gradually increasing the intensity until the patient feels
'pain'.
Electric pulp testing:
● Delivers a small electrical stimulus to the pulp.
● Measure the sensory nerve response to a current of electricity
which first pass through a resistant layer of enamel.
The teeth to be tested are dried and isolated with cotton wool rolls.
A conducting medium should be used; the one most readily
available is toothpaste.
Pulp testers should not be used on patients with pacemakers
because of the possibility of electrical interference.
Teeth with full crowns present problems with pulp testing. A pulp
tester is available with a special point fitting which may be placed
between the crown and the gingival margin. There is little to
commend the technique of cutting a window in the crown in order
to pulp test.
Electric pulp testing:
Pulp Testing
Neural Vascular elements
elements (Blood flow) (vitality test)
(Sensitivity test)
Thermal
Electrical Laser Doppler
pulp Flow metrics
Testing
Pulse oximetry
Cavity
test
Laser Doppler flowmetry:
Used to measure the blood flow in the pulp to detect the condition of the
pulp.
Laser Doppler Flowmetry:
➢ Laser Doppler Flowmetry (LDF) is used to assess blood flow in
microvascular systems.
➢ A diode laser is used to project an infrared light beam through the crown
and pulp chamber of a tooth. The infrared light beam is scattered as it
passes through the pulp tissue.
➢ The Doppler states the light beam will be frequency-shifted by moving red
blood cells but will remain unshifted as it passes through static tissue.
➢ The average Doppler frequency shift will measure the velocity at which the
red blood cells are moving.
Pulse oximetry
It measures the oxygen supply in pulpal
blood flow
Pulse Oximetry:
❖ Determine pulpal blood flow, uses a pulse oximeter, which is designed to
measure the oxygen concentration of the blood and the pulse rate.
❖ The oximeter works on the principle that two wavelengths of light
transmitted by a photoelectric diode detect oxygenated & deoxygenated
hemoglobin as they pass through a body part to a receptor.
Pulse oximetry
Assess blood oxygen saturation
Recording blood oxygen saturation levels during the
administration of intravenous anesthesia
red light
Light Source (640 nm)
probe
Target tissue Photodetector
infrared light
(opposite side)
(940 nm)
Absorption of red
Absorption of IR
Light (oxygenated
Light (Deoxygenated
hemoglobin)
hemoglobin)
● In cases where the patient cannot locate the pain and routine thermal tests have
been negative.
If a patient complains of pain on chewing and there is no evidence of
periapical inflammation, an incomplete fracture of the tooth may be
suspected.
When other tests have given an indeterminate result, a
test cavity may be cut in a tooth which is believed to be
pulpless.
Test of last resort
Gutta-percha point tracing
Purpose:
- Localizing the endodontic lesion
to a specific tooth
- Aiding to the differential
diagnosis between a periodontal
and endodontic lesion
Crown surface temperature / heat registration
● Technique is based on the hypothesis that vital teeth are
warmer and will rewarm quicker after cooling than non-vital
teeth.
● Tooth surface changes is measured using electronic
thermometer, Cholesteric Liquid Crystals or infrared
thermographic camera.
Ultrasonic pulse echo
● Used to detect the dentino–enamel and dentino–pulpal
interfaces using transmission and reflection of sound from
the dental hard tissues.
133 Xenon radioisotope
● Radioactive materials for measurement of pulpal blood
circulation.
● utilizing a radiation probe with 133 xenon radioisotopes to
differentiate between vital and pulpless teeth on the basis of
blood supply.
● Expensive and requires special licensing.
Analysis
● Analyze the data gathered via:
○ History
○ Examination
○ Special tests
● Arrive at a clinical diagnosis:
○ Pulpal diagnosis
○ Periapical diagnosis
