Current Therapy in Endodontics

Priyanka Jain, Priyanka Jain

• Publisher: Wiley-Blackwell
• Year: 2016
• ISBN:
  9781119067740
• Edition: 1
• Topic: Medicine
• Subtopic: Dentistry

Dentistry has been undergoing enormous changes, and the field of endodontics has certainly been at the forefront. Recent advances in technology, materials, and equipment have changed the way endodontics is practiced today, thereby facilitating treatments with greater efficiency, precision, and success, ultimately leading to better outcomes. Current Therapy in Endodontics encompasses the recent discoveries and applications for this field in one clinically relevant volume.

• Evidence-based presentation of recent advances in the field of endodontics
• Objective comparison of materials and instruments on the market
• Tables present key data and instruction for quick viewing and comprehension

Chapter 1
Diagnosis

Reza Farshey^1,2

¹ Private practice, Chevy Chase, Maryland, USA

² Clinical Assistant Professor, University of Maryland School of Dentistry

Dentistry has always been a fusion of science and art. Science provides the foundation for dentists to deliver optimal care. Evidence‐based practice has successfully worked its way from medicine into dentistry. Every treatment decision that is made is at least partly influenced by the scientific support for its rationale. However, the science behind diagnosis relies on advancements in diagnostic equipment and armamentaria. The most consistent marker for an accurate diagnosis remains the clinician's ability to correctly process the diagnostic findings.

When patients are asked to grade the level of pain in an inflamed tooth after a painful stimulus is applied, it is foolish to assume a uniform and consistent response will be obtained from all patients. The International Association for the Study of Pain defines pain as an unpleasant sensory and/or emotional experience associated with actual or potential tissue damage [1]. Obviously, the physiologic condition of the tooth plays a major factor in pain perception, but the emotional aspect of this experience can modulate the pain levels among different patients. Factors such as past experiences, temperament, culture, gender, age, and overall pain tolerance can affect the responses. Recognizing this nuance is the trait of a good diagnostician. This is the art of diagnosis.

This chapter explores the various components that make up the examination process. A systematic approach to diagnosis is presented in order to gather the information thoroughly. A few clinical tips are offered to help clinicians with some of the confusing scenarios encountered during an examination.

Chief complaint

The chief complaint (CC) identifies the reason for the patient's visit. The information used to construct the CC is derived during the interview portion of the examination. This represents the very first interaction between the patient and the clinician. It is best to use the patient's own words when constructing the CC, rather than writing down a factual, objective sentence based on the initial interaction with a patient. For example, a chief complaint that reads I have pain in my lower right back tooth after I bit down on an olive pit is more complete than one that states pain in the lower right tooth or evaluate lower right tooth. Documenting the patient's own words often provides valuable information that can help steer the clinician toward an accurate diagnosis. It also allows the clinician to become familiar with the patient. Does the patient's demeanor suggest a high level of anxiety? Does the patient possess clarity of communication, or is the patient very vague and ambiguous when describing the purpose of his or her visit? Clinicians often overlook the significance of this last point. A patient lacking clarity of communication can make diagnosis more challenging for the clinician. Lastly, a well‐documented CC allows the clinician to separate a coincidental finding or a coincidental diagnosis from the diagnosis that addresses the patient's CC.

Medical history

Every patient who presents for evaluation or treatment should complete a thorough medical history form. The patient, or guardian if the patient is a minor, should sign and date the form. Prior to examining the patient, the clinician is responsible for reviewing the medical history with the patient, highlighting any medical conditions, a list of current medications, and any drug allergies. The clinician should initial the form to indicate that a review of the medical history has been completed. The medical history forms should be reviewed with the patient at every subsequent appointment and should be updated once a year to reflect any changes to the patient's medical history.

Many medical conditions require the clinician to modify a proposed dental treatment. Modifications to treatment can include shortening the appointment time, postponing elective treatment to a later date, or prescribing a course of antibiotics, just to name a few. Having a basic understanding of various medical conditions is paramount to providing appropriate care to patients with intricate medical conditions. The list of the medical conditions requiring a modification in dental treatment is vast. However, many textbooks and references are available to guide the clinician on how best to provide dental car...

Table of contents

• Cover
• Table of Contents
• Dedication
• List of figures
• List of tables
• Contributors
• Foreword
• Preface
• Acknowledgements
• Chapter 1: Diagnosis
• Chapter 2: Imaging technologies
• Chapter 3: Rotary instruments
• Chapter 4: Determination of working length
• Chapter 5: Root canal filling
• Chapter 6: Treatment planning of pulpless teeth
• Chapter 7: Dental traumatic injuries
• Chapter 8: Visualization in endodontics
• Chapter 9: Endodontic microsurgery
• Chapter 10: Lasers
• Chapter 11: Dental pulp regeneration
• Chapter 12: Teledentistry
• Quiz answers
• Index
• End User License Agreement