Endo + Khaled

When should you do pulp testing? (3)

1. If pt has symptoms (swelling, pain, drainage)

2. During comp exam (teeth with big restorations, extensive caries, periapical lesions)

3. Before staring restorative tx on deep caries

What is palpation? What does it look for?

Press on tooth → looks for tissue inflammation at apex

What is percussion? What does it look for?

Tap vertically on the occlusal surface → tests inflammation of PDL

What is bite testing? What does it look for?

Pt bites on teeth or cotton roll → tests for cracked teeth / vertical root fracture

What is mobility? What does it look for?

Attempt to move teeth with fingers → test for periodontal disease, trauma, periapical abscess

Where do you put the cotton roll for cold testing?

Mid facial of tooth

Is cold testing more specific or sensitive? What about electrical pulp testing?

What does each mean in relation to necrosis of pulp?

Cold: more specific → easier to detect if a tooth has normal vital pulp

Electric: more sensitive → easier to detect if tooth has necrosis of pulp

Which pulp testing technique works through crowns?

Cold test ONLY

In cold testing, what does it mean if you have short pain, long pain, or no pain?

Short pain = normal pulp

Long pain / Intense pain= irreversible pulp damage

No pain = necrosis of pulp

What is recommended radiographically to look at periapical lesions?

Anterior = 2 PA

Posterior = 2 PA + 1 BW

What does an endo lesion look like radiographically?

Option 1: Break or widening of the lamina dura

Option 2: Radiolucent area at the apex of the root → look like bone loss

Option 3: no radiographic change even in the presence of diseased bone

What do you need to do before doing an RCT?

Determine tooth restorability

Finalize tx plan

Assess periodontal support

What info is needed before issuing a pulpal and periradicular diagnosis?

Pulp testing, periapical testing, and soft tissue exam

What is the difference between a referral and a consultation?

Referral: when pt is treated by a dental colleague

Consultation: pt evaluated by colleague, but YOU do the tx (most common is with PCP)

What reports need to be filed in order to refer the pt?

Initial report: state reason for referral + pt consent

Follow-up report: preliminary diagnosis + anticipated tx (after 1st apt)

Final report: Occasional progress reports if tx is extended

Who does liability rest with if a referral pt has a problem?

Liability rests with the person who provided the care

• (regardless of what information a consultation told you)