Diagnosing Pulpal and Periapical Conditions
Pulpal Diagnosis:
Normal Pulp: A clinical diagnostic category in which the pulp is symptom-free and normally responsive to pulp testing.
Reversible Pulpitis: A clinical diagnosis based on subjective and objective findings indicating that the inflammation should resolve and the pulp return to normal.
Symptomatic Irreversible Pulpitis: A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing. May also experience lingering thermal pain, spontaneous pain or referred pain.
Asymptomatic Irreversible Pulpitis: A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing. Has no clinical symptoms, but there is evidence of pulp inflammation with caries or trauma.
Pulp Necrosis: A clinical diagnostic category indicating death of dental pulp. The pulp is usually nonresponsive to pulp testing.
Previously Treated: A clinical diagnostic category indicating that the tooth has been endodontically treated and the canals are obturated with various filling materials other than intracanal medicaments.
Previously Initiated Therapy: A clinical diagnostic category indicating that the tooth has been previously treated by partial endodontic therapy (pulpotomy, pulpectomy).
Apical Diagnosis:
Normal Apical Tissues: Teeth with normal periradicular tissues that are not sensitive to percussion or palpation testing. The lamina dura surrounding the root is intact and the periodontal ligament space is uniform.
Symptomatic Apical Periodontitis: Inflammation, usually of the apical periodontium, producing clinical symptoms including a painful response to biting and/or percussion or palpation. It might or might not be associated with an apical radiolucent area.
Asymptomatic Apical Periodontitis: Inflammation and destruction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area, and does not produce clinical symptoms.
Acute Apical Abscess: An inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation, and swelling of associated tissues.
Chronic Apical Abscess: An inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little or no discomfort, and the intermittent discharge of pus through an associated sinus tract.
Condensing Osteitis: Diffuse radiopaque lesion representing a localized bony reaction to a low-grade inflammatory stimulus, usually seen at apex of tooth.