Pulpal and Periapical Diagnostic Terminology and Treatment Considerations
This chapter presents a revision of diagnostic terminology developed by the American Association of Endodontists and indicates both the previous and most current terms and definitions. The clarification is useful to the practitioner as dentists and public
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Pulpal and Periapical Diagnostic Terminology and Treatment Considerations
4.1
Synthesis of Information
The final pulpal and periapical diagnosis is based on a synthesis of information collected from the patient’s history of the chief complaint, dental and medical histories, radiographs, sensibility, and clinical tests. The process is challenging since no single test can be considered definitive. The clinician should have a keen ear capable of interpreting subtle clues in the patient’s narrative and be able to put the clues together with other diagnostic information. At the same time, the clinician must recognize false leads that can result in misdiagnosis and treating the wrong tooth or providing treatment that is not necessary. Tests provide information, but the critical part of the diagnostic process is the ability of the clinician to synthesize information into a rational meaningful complete picture.
4.2
Terminology
There is more than one set of terms used to describe pulp and periapical pathosis. Terminology varies among different organizations to describe the pulp and periapical tissues. Variation in terminology can cause confusion during communication with other dentists (as can different dental numbering systems). It must be understood that inflamed pulp tissue is in a dynamic state and may have more than one condition existing in the tissue at the same time. For example, underlying deep caries there may be an area of acute inflammation adjacent to chronic inflammation and/or necrosis all of which is in flux. These states may coexist asymptomatically for a long period of time or degenerate rapidly to total necrosis with or without pain. It has been clearly demonstrated that clinical symptoms do not correlate well with histologic findings [7, 9]. The dynamic state of the tissue can produce confusing results during sensibility testing. For example, a root canal may contain necrotic tissue but still have some neural tissue capable of conducting an impulse. In such cases a positive response to P.A. Rosenberg, Endodontic Pain, DOI 10.1007/978-3-642-54701-0_4, © Springer-Verlag Berlin Heidelberg 2014
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Pulpal and Periapical Diagnostic Terminology and Treatment Considerations
testing with cold or electric could mislead the clinician into a diagnosis of a normal responsive pulp. Similarly in a multi-rooted tooth, one root may contain responsive pulp tissue, while the other is completely necrotic. In that case, pulp testing would not indicate the presence of pulp necrosis. The American Association of Endodontists (AAE) recently published (2012) a revised list of pulp and periapical diagnostic terms and definitions (Table 4.1). The terminology is useful in categorizing cases and their treatment. There are other pulp classifications, but the AAE provides the most recent revision available. There is no universal agreement concerning the validity of this terminology.
4.3
Neuroplasticity
A major development in the field of pain physiology was the discovery of neuroplasticity in the late twentieth cent
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