Certainty every step of the way

28 January 2023

Mark Allen explains ways to test for pulpitis.

In dentistry, an accurate diagnosis is the basis for any treatment you offer your patients. The ability to accurately diagnose the source of pain, by carrying out the right assessments and recording results with certainty will give you and your patients confidence to go through with treatment. When it comes to endodontic therapy, many patients will be hesitant when they hear the words “root canal”. As such, it is important that the treatment plan is based on accurate evidence, so that you can explain why this treatment is right for them and how it will improve their quality of life going forward.

Correct assessment is vital for this. If you make an incorrect diagnosis early on, you may choose to manage the pain in the wrong way. This might mean that you perform endodontic treatment when it is not indicated, or provide no treatment or another procedure when root canal treatment was needed in this case. With any tests you conduct to detect pulpitis, it is important that each result is interpreted and scrutinised carefully to avoid incorrect results. This is because false results may lead to incorrect diagnosis and, therefore, treatment which is unnecessary or inappropriate for the patient.

Getting an accurate result

Diagnosing dental pulp diseases can be problematic due to the practitioner’s inability to access and test the pulp directly when it is encased within the dentine. This means that some information required for diagnosis must be obtained indirectly based on patient response to stimuli placed externally to the tooth. Pulp tests are used to determine the status of the pulp, whether alive, dead, or showing signs of irreversible pulpitis. Pulp tests can be considered relatively non-invasive, user-friendly, and affordable. By quantifying patient pain responses, we can ascertain whether pulpitis or pulp necrosis is likely. The ability to correlate the words mild, moderate, and severe with a numbered scale from one to 10, with one being no pain or least painful and 10 meaning the most severe, offers less ambiguity, and more accuracy when narrowing down the source of pain.

When conducting sensitivity tests, for example, electric and temperature, ask patients to rate their level of pain and discomfort. Electrical pulp testing is useful when determining if the pulp is still alive, or if the pulpitis has progressed to necrosis. The patient will be able to feel the stimulation if the pulp is alive, but if the pulp is dead, they will feel nothing. Similarly, when using temperature tests, be it hot or cold, sensitivity which is longer lasting indicates irreversible pulpitis, and no feeling suggests necrosis. An additional test for irreversible pulpitis involves tapping gently on the affected tooth, if this causes pain, it signals irreversible pulpitis.

The use of imaging proves to be a successful method for endodontic diagnosis. It provides the practitioner with information about the tooth, including the number of canals, size of pulp chamber, the direction of curvature, as well as any fractures and the extent of dental caries. Diagnostic radiographs can also help to predict the risk of complications, and show root fractures and periapical lesions. Where possible, sensitivity tests should be used alongside imaging for accurate diagnosis, providing you with the certainty you need to recommend the best course of treatment.

Treat patients with certainty

Once you have a diagnosis of pulpitis, and endodontic treatment is required, it is essential that this sense of certainty is carried through to the treatment stage of the process. Patients may be worried about complications, especially since root canals are generally considered painful. You should be sure you are using equipment which is reliable, to reduce the risk of complications, for example, file breakage during treatment.

It is also essential to ensure you have a clear plan for canal preparation, ensuring you are able to predict outcomes and accurately navigate the root canals. The CanalPro Jeni from Coltene is the ideal helping hand for endodontic treatments. Its autonomous navigation system allows you to negotiate root canals with precision, and the certainty that you need to perform outstanding care. The CanalPro Jeni uses complex algorithms to adapt the file movement within milliseconds for optimal accuracy, and navigate the root canal system by itself. The system also prompts you with a beep when it’s time to irrigate, and gives another audible signal which its recommended to change the file.

Provide your patients with treatment that is predictable, using equipment which is reliable. Establishing an appropriate diagnosis is essential for providing your patients with the best possible care, and creates the basis for your treatment planning for each case. Getting these first steps right is key, and continuing this sense of accuracy and predictability throughout the entire treatment process will ensure outcomes are successful, and patients will receive suitable treatment.

For more information visit www.coltene.com