Amy Dukoff
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 IAGNOSIS
IS ESSENTIAL before initiating root canal therapy. A separate appointment
is often needed to diagnosis accurately. If the patient’s need is
odontogenic, the patent will be grateful that the right tooth is treated
so that his symptoms are dissipated. If it is not odontogenic, the
proper referral or treatment is needed.
The patient’s symptoms and the patient’s description
of what he or she thinks has happened to the tooth are important, of course.
However, after a patient explains why he feels it is a specific tooth,
the patient may pinpoint another tooth. A complete diagnosis is needed
for an understanding of the patient’s chief complaint; that diagnosis includes
objective findings of clinical and radiographic examination and clinical
tests. Clinical findings are not limited to pulp vitality tests,
intra-oral or extra-oral exam. One must also evaluate for TMD ( tempromandibular
disorder). Furthermore, evaluating for bruxism, clenching, and abnormal
habits can lead to additional clues to conditions that might affect the
patient’s symptoms. Finally, radiographic examination and evaluation
are required. All the pieces are put together in order to make an
accurate diagnosis.
Radiographic evaluation is very dependent on your
subjective evaluation and observation. Certain findings are indisputable,
such as the number of teeth, restorations present, and gross findings—a
radiolucency or grossly short obturation of the root canal space, for example.
Some observations may be considered subjective. For example, the
obturation in a premolar maybe “thin” to one practitioner yet acceptable
to another. Also, canal in the mesial buccal root of a first molar
that seems well obturated to one practitioner may reveal a missed MB2 to
another practitioner. In many cases, calcified bodies in the pulp
chamber can be a sign of pulpal changes and necrosis to some practitioners.
Other practitioners may view these changes as normal since there maybe
no periapical pathology found. Radiographs are a wonderful aid.
However, their interpretations are subjective to the practitioner’s eyes.
The consultation visit is extremely important.
A good mutual understanding of the treatment and proper diagnosis is important
in attaining a successful outcome.
May-June 2001
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A
good mutual understanding of the treatment and proper diagnosis is important
in attaining a successful outcome.
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