Operative dentistry aje qualtrough, jd satterthwaite la morrow, pa brunton

DIAGNOSIS AND ASSESSMENT
A problem in endodontics is that both the healthy and the damaged
pulp are in an enclosed environment (the pulp chamber), hence can-
not be directly subjected to diagnostic testing. A further complicating
factor is that pain is notoriously subjective and if severe, it may be
difficult to identify the causative tooth with certainty. More than one
tooth may be involved, so it is essential that the clinical signs and
symptoms and the diagnostic tests and radiographs are interpreted
carefully and related to the provisional diagnosis.
In determining endodontic requirements, the clinician must decide
whether or not there is any pulpal or periapical pathology. This
means differentiating between those teeth that are normal, reversibly
inflamed, irreversibly inflamed and necrotic. Periapically, it must 
be determined whether teeth are normal, root treated and normal, or
have apical pathology.
Clinical manifestations
The most common clinical manifestation of pulp disease is that of
pain. The nature and duration of pain is related to the type and stage
of the disease process and may vary from a transient discomfort to
throbbing incessant pain. Other diagnostic signs include extra-oral
swelling, intra-oral swelling, sinus formation, tooth mobility, peri-
odontal pocketing, tooth discoloration, tooth fracture and caries.
Assessment of pulp vitality
It is understood that in a non-vital tooth there is an absence of both
neural and vascular supplies. However, almost all conventional pulp
tests employ assessment of the neural supply.
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Principles of endodontics


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Endodontic treatment should not be undertaken on the basis of 
pulpal status alone. The patient’s medical history, the overall 
treatment plan and the periodontal status must also be taken into con-
sideration. There are also contraindications to endodontics. These
may be divided into general aspects such as factors in the medical 
history of relevance, poor access, poor oral hygiene and local factors,
for example the tooth being unrestorable, the periodontal support
being poor, the presence of advanced resorptive defects and complex
root morphology.