Pulpal and Periapical Diagnoses

1. Thermal
   1. Endo Ice (-30º)

      Nota:

      • Chilled pellet immediately to tooth for 5 seconds DRY TEETH
      1. Intensity
      2. Duration
2. Electrical
   1. Least reliable pulp vitality testing
      1. False positives & negatives
   2. Presence of vital sensory fibers
   3. Contraindicated

1. Cold stimuli response

   Nota:

   • Important to test healthy teeth to compare and have a baseline response (contralateral teeth, adjacent teeth, oposing, etc.)
   1. sharp hypersensitve
   2. Transient

Nota:

• - Deep restorations without a proper liner of base - Deep cleaning - Caries

1. when removed, reversion to normal pulp status

1. Spontaneous pain
2. Continuous or intermittent pain
3. Cold stimuli response
   1. lingering pain

      Nota:

      • The pain remains when withdrawing the pellet for 10, 15, 20 or more seconds
4. Bending over or laying down exacerbates the pain

1. No clinical response

1. Tenderness to percussion (PDL)
2. Thickening of the PDL

   Nota:

   • PDL: periodontal ligament
3. Apical disease

1. No pain on percussion or palpation

   Nota:

   • - Percussion: tapping on teeth with a mirror handle - Palpation: feeling on gums around apex of the root

1. Painful percussion
2. Intense, throbbing pain

1. Sometimes occlusal adjustment is enough
2. If the tooth is necrotic, endodontic treatment is necessary to prevent progression

1. Radicular cyst or periapical granuloma

1. Sometimes you can insert a guttapercha through the sinus tract and expose a periapical radiograph and find the path and source