When one discusses clinical endodontic techniques, it often tends to involve a drill, an endodontic file, or an obturator. But a noninvasive procedure that must not be overlooked, and that which precedes the aforementioned, is that of diagnosing and treatment planning the case at hand.
In this article, the author will review diagnostic techniques in the form of very important fundamental questions that should be asked, along with clinical criteria to consider, prior to every potential endodontic case.
What Is the Origin of the Pain?
While a patient may have oral pain and point to the teeth, the clinician needs to determine if the pain is of an endodontic origin. Perhaps the pain is due to nonendodontic sources such as dentin hypersensitivity, occlusal trauma such as clenching/grinding, or is sinus-related. So, even if the patient points to his or her teeth, the clinician must always keep an open mind when diagnosing the symptoms. One cannot assume it is always endo-related.
Criteria to Consider
Pardon the obvious statement, but endo should be performed only if the clinician is certain that the pain is of an endodontic origin. Such pain should meet the fundamental criteria for pain of pulpal, or apical, origin. This, at least in part, includes symptoms such as lingering pain to hot or cold, no response to pulp tests (with exceptions), and cases with apical pathology (Figure A in the Table). One of the simplest but most important techniques to should use in order to diagnose the pulpal state is a cold test with Endo-Ice (Hygenic) (Figures 1 and 2). To determine common signs of pain of neuromuscular or parafunction origin, one should perform and evaluate the following: palpate for tender or tense masticatory muscles (Figure 3) and look for occlusal wear facets (Figure B in the Table) or nonlocalized pain that either wakes the patient up at night or is present upon waking up in the morning.