Pulpal diagnoses

By Dr.Swathi Pai on Tuesday, April 29, 2008 with 0 comments

Normal Pulp. A normal pulp will produce a positive response to the electric pulp tester (EPT). When evaluated by thermal testing, the normal pulp produces a normal response that is mild and subsides immediately when the stimulus is removed. Percussion and palpation testing produce a non-sensitive response. Radiographs demonstrate an intact lamina dura and uniform periodontal ligament (PDL) space (i.e. within normal limits).

Reversible Pulpitis. Caries, cracks, restorative procedures or trauma may cause a pulp to become inflamed. The patient complains of an exaggerated response to thermal stimulus but once the stimulus is removed, the discomfort does not linger. EPT results are positive. Percussion and palpation testing produce a non-sensitive response. Radiographically, the lamina dura and PDL space are within normal limits.

Irreversible Pulpitis. If the inflammatory process progresses, irreversible pulpitis can develop. Patients may have a history of spontaneous pain and complain of an exaggerated response to hot or cold that lingers after the stimulus is removed. EPT results are positive. The involved tooth will usually present with an extensive restoration and/or caries. Percussion and palpation testing may or may not produce sensitive results. Radiographically, the PDL space may be within normal limits or widened.

In certain cases of irreversible pulpitis, the patient may arrive at the dental clinic with a glass of cold/ice water. In these cases, cold actually alleviates the patient’s pain, and thus, can be used as a diagnostic test. Cooling of the dentin and the resultant contraction of the fluid in the tubules relieves the pressure on pulpal nerve fibers caused by edema from pulpal inflammation.

Irreversible pulpitis can present as an asymptomatic condition. Internal resorption and hyperplastic pulpitis (pulp polyp) are examples of asymptomatic irreversible pulpitis.

Pulpal Necrosis. Necrosis is a histologic term that denotes death of the pulp. Teeth with total pulpal necrosis are generally asymptomatic unless the periradicular tissues become involved. The pulp will not respond to the EPT and this result should be reported as no response (NR) over 80, if using a digital EPT. The pulp will not respond to thermal tests. The dental record entry for this pulpal diagnosis should be necrotic pulp.

Pulpless Tooth. This pulpal diagnosis is used when root canal therapy has been either initiated or completed. For example, a tooth with previous pulpotomy/pulpectomy/root canal debridement or previous root canal therapy should be recorded in the dental record as a pulpless tooth.

Category: Conservative and Endodontics Notes



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