12 STEPS TO DIAGNOSE THE TEETH

STEPSto

DIAGNOSE

TEETHDr. Sarang Suresh Hotchandani1

1. TAKE GOOD HISTORY• Listen to everything the patient wants to say. Not only will you get

useful information, but you are letting the patient know that you

have time and concern for him or her. • What do you think the problem is?

• Does it hurt to hot or cold?

• Does it hurt when you’re chewing?

• When does it start hurting?

• How bad is the pain?

• Does anything relieve it?

• How long has it been hurting?

DR. SARANG SURESH HOTCHANDANI 2

2. TAKE a RADIOGRAPH•It may show a periapical or periodontal area, decay, resorption, deep fillings, fracture, or thickened PDL. Radiographs are indispensable. No diagnosis should be made without them.


3. Percuss & Tap• Percussion-tapping with the mirror handle on the tooth in a

vertical direction often allows you to identify the tooth that has inflammation in the ligament and, consequently, hurts the most to tapping.

• If two teeth together hurt to tapping, immobilize one with your finger while tapping the other and then reverse the process. Often you will find that one hurts significantly more than the other and will be the more suspicious of the two.


4. Palpate•Press into the fold above the apex of the root or

roots. • Often the endodontically involved tooth will be more tender than

the others if the inflammation has extended into the periapical region, and palpating in this way will produce a greater sensation.

•You should also be able to detect any swellings or fistulas that may be present. Palpate the lingual of teeth with the same goals in mind .


5. Cold Test• This is simply done with cylindrically shaped ice sticks. Make

them by placing water in empty anesthetic carpules and adding a piece of dental floss that extends to the bottom of the carpule and has a handle on the open end of the carpule. Keep them in the freezer and withdraw the frozen cylinder when needed.

• A good site of cold application is generally the buccal surface as close to the cemento-enamel junction as possible. If a metal crown restoration is on the tooth, attempt to apply the ice on the lingual metal collar, an area where the cold travels most easily.


5. Cold Test• If a tooth has irreversible pulpitis it will either give a

prolonged response, possibly after some delay, or no response. Transient pain (less than ten seconds) after the application and removal of ice is normal. No response may mean the tooth is endodontically involved, especially if all other teeth respond to cold.

• If sharp transient pain occurs that is greater than the pain felt in surrounding teeth, check to see if the bite is high. Root canal is probably not needed and the bite adjustment will eliminate the hyper response to cold.


6. Heat Test• Using a ball of hot gutta percha on the tip of a plastic

instrument, place the gutta percha onto the tooth the same way you would the ice. Wait approximately 15 seconds between teeth to assess the possibility of a delayed, but, prolonged response.

• Compare the results from other tested teeth. If one tooth gives a prolonged response, whether immediate or delayed, it is a most suspicious candidate for endodontics. If the pain is immediately relieved by cold, the tooth probably needs root canal.


7. Electric Pulp Test• This test should be used when the hot and cold tests

fail to give clear information on the state of vitality of the tooth. Again, the information supplied by the electric pulp test must be weighed against the response from other teeth. the fact that a tooth does not respond to the EPT has little meaning if all the other teeth also do not respond, unless of course this is the only tooth with a well-defined area at the apex or is quite tender to percussion.


8. Bite Sticks• Use bit sticks to check for incipient fractures that are causing pain to a

tooth when under function. By having a patient bite on each cusp and laterally move the lower jaw, each cusp is subjected to lateral stresses. If a section of the tooth under a cusp has an incipient fracture it will often hurt when pressure is applied.

• If a fracture does exist, the tooth may not need endodontics if the fracture does not extend into the pulp. The pain generally disappears if the fractured portion of the tooth can be cleaved off.


9. Trans illumination• Trans illumination often confirms the portion of the tooth that has

the fracture. By placing the trans illumination light source on the

lingual side of the tooth and turning out the chairside light source,

fractures may be picked up as a dark horizontal line against a light

amber background. Trans illumination can sometimes differentiate

between vital and non-vital teeth with the non-vital appearing

duller than the surrounding ones when the light source is applied. DR. SARANG SURESH HOTCHANDANI 11

9. Trans illumination• Trans illumination often confirms the portion of the tooth that has

the fracture. By placing the trans illumination light source on the

lingual side of the tooth and turning out the chairside light source,

fractures may be picked up as a dark horizontal line against a light

amber background. Trans illumination can sometimes differentiate

between vital and non-vital teeth with the non-vital appearing

duller than the surrounding ones when the light source is applied. DR. SARANG SURESH HOTCHANDANI 12

10. Binocular Microscope

•It is excellent for picking up incipient

fractures simply because you can look

at teeth magnified up to 30 X with

excellent illumination. DR. SARANG SURESH HOTCHANDANI 13

11. Selective Anesthesia• It should be applied with an intraligamentary

gun. If specific anesthesia to one tooth makes

all pain disappear for a short time and the

effect is repeatable, the anesthetized tooth is

probably endodontically involved. DR. SARANG SURESH HOTCHANDANI 14

12. Drill Test Cavity• If you believe that a non-vital tooth is causing

symptoms, but cannot confirm non-vitality with

assuredness, a test cavity without anesthesia

may allow entry into the pulp without any pain,

thus confirming your suspicions.DR. SARANG SURESH HOTCHANDANI 15

THE ENDDR. SARANG SURESH HOTCHANDANI 16

Health & Medicine

12 STEPS TO DIAGNOSE THE TEETH