Dental Problems

Diagnostic Procedures for Pediatric Endodontics

Dental CavityPediatric endodontics deals with the management of pulpally involved teeth in kids. The pulp therapy in kids is sitll a subject of controversy mainly due to the lack of efficacious medicaments and skill, which requires a lot of patientce on the part of operator in handling this group of patients. The diagnostic procedures for pediatric endodontics are discussed below in this article. Read on to know more.

Diagnostic Procedures for Pediatric Endodontics

Before initiating treatment, one must first assemble all the information regarding signs, symptoms and history. This information is then combined with results from the clinical examination and test to obtain the diagnosis.

A diagnostician must have a working knowledge of examination procedures -percussion, palpation, probing and pulp testing: a knowledge of pathosis, its radiographic and clinical manifestation: an awareness of the various modalities of treatment: and above all, a questioning mind.

A methodical and disciplined approach, along with a good measure of patience, will help establish an accurate diagnosis.

History:

  • Recollecting is the first step towards establishing a diagnosis.
  • A complete history will not determine treatment but may influence modification in endodontic treatment modalities, especially if there have been any change in the patient’s health status.

Detailed history of pain:

  • Kids are not good historians. Their symptoms are often misleading because of their apprehension and parent involvement.
  • It is not uncommon to see a child with a large carious lesion in the primary tooth with no complaint of pain due to fear.
  • Therefore, a detailed history of the pain should be evaluated with very simple, subjective questions like the ones mentioned below:
    1. Do you have any discomfort on eating ice cream or drinking hot soup?
    2. What happens when you eat anything sweet like a candy bar?
    3. Does you tooth bother you at the night when you go to sleep?
    4. How long does the pain last?
    5. Does your tooth jump when you hit it with tooth brush or spoon?
    6. How often do you get this pain?

    The above questions are an attempt to see if the tooth is influenced by any thermal, chemical stimuli or percussion. Spontaneous pain at night indicates trouble. These questions may give a clue as to whether a tooth is mildly inflamed, chronically inflamed or necrotic.

External examination:

  • The child must be examined for localized swelling, changes in color or bruises, abrasions, cuts or scars and similar signs of disease, trauma or previous treatment.
  • The extra oral examination includes the face, lips and neck, which may need to be palpated if the patient reports soreness.
  • Enlarged lymph nodes are of importance in denoting the spread of inflammation.

Intraoral examination:

  • Examination of oral vestibules, buccal and lingual mucosa, palatal soft tissues for localized swelling and sinus tract or color changes is carried out.
  • Finally, as part of the general inspection, carious lesions, discolorations and other obvious abnormalities associated with the teeth should be noted.

Coronal evaluation:

  • Coronal evaluation is done by using a mouth mirror and explorer and possibly a fiber optic light source.
  • The dentist carefully and thoroughly examines the suspected tooth or teeth for caries, defective restoration, discoloration, enamel loss or defects that allow direct passage of stimuli to the pulp.
  • Vertical and horizontal fractures are located by transillumination.

Pulpal evaluation:

  • The clinical condition of the pulp can be evaluated by thermal stimuli, percussion, palpation and vitality tests.
  • The various method of pulpal evaluation, provide information which be used with the child’s history and radiograph to establish diagnosis.

The above article discusses briefly about the diagnostic procedures for pediatric endodontics.

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