2. Endodontic diagnosis. Do we really know the status of
thepulps??? Usuallyendodontic procedures areperformed secondarily
to the patientspresenting with symptoms. Accurately diagnose
endodontic diseaseno matter symptomatic or asymptomatic. 3. The
reality. LEO (a lesion of endodontic origin). Many pulpally
involved teeth do notshow Incipient radiolucency. accurately
diagnosis decrease therisk factors comes from oralinfection of
certain disease . 4. Etiology of pulpal breakdown. Pulp---a dynamic
tissue. Restricted capacity to heal---limited blood supply.
Magnitude and duration of injury. Progression from reversible
toirreversible and rapidly advancefrom ischemia, infarction
andpartial necrosis to completenecrosis. 5. The endodontic
examinaton. Three-step diagnostic process. Clinical Radiographic
Vital pulp testing. Symptom or not? LEO or not? 6. Clinical
examinaiton. Evaluate all aspects of the extraoral and intraoral
tissues. 7. Periodontal examination. 8. Intraoral hard
tissue---missing teeth, fractured teeth, dark teeth and
developmental anomalies. 9. Restorativesmarginal adaptation Caries,
cervical erosion, abrasion andabfraction. Mobility Palpation
(laterally and apically.) Percussion---attachment apparatus. Biting
test---fractures. Masticatory system. 10. Radiographic examination.
Following the clinical examination. Three different well-angulated,
andhigh quality images. the location and extent of caries
orrecurrent caries Pulp Crown and root relation. 11. Traumatic
episodes 12. For retreatment. 13. Lateral canalsperiodontitis 14.
Vital pulp testing. Vital pulp tests (VPT) to disclose thestatus of
the dental pulp. Contralateral opposing healthy suspicious.
Establishment of baseline. Pulpal inflammation confined to theroot
canal space. (proprioceptive n.fiber.) Thermal test, EPT, cavity
test. 15. Cavity test. Rarely used. Prove inclusive by clinical and
radiographic examination and pulp test. 16. Thermal test. Based on
pts CC.(cold) Refractory period. On the cervical aspect. Immediacy,
intensity, duration. 17. Cold test. Ice pencil. Reliable hand
signal. Ice stick. Isolated teeth. 18. Hot test. Acutely inflamed
or partially necroticpulp. Touch n heat, System B (hot pulp
testtip.) Wait several secs. Coffee first sip or after repeated
sip. Isolated teeth---closely to the feelingof food and liquid we
have. 19. Others Localized anesthesia. Do no harm while doing good.
20. Endo-perio interrelationship Anatomical communication
betweenpulp and PDL---dentinal tubules,lateral canals, apical
foramen. Similar microflora (anaerobic ) ---cross infection. 21.
Effect of pulpal disease on theperiodontium Endodontic infections
may causeperiodontium to have rapidinflammatory responses.
Inappropriately endodontic treatment. 22. Effect of periodontal
disease on thepulp. Periodontal involved tooth may haveatrophic
change on pulp. Periodontitis lateral canalsensitivity. 23.
Conclusion. Reliable information serves to improvediagnostics,
treatment planning and patientcommunication. The comprehensive
endodontic examinationincreases the possibility for patients to
receivemore timely care 24. Craniofacial pain (CFP) Pain in the
face and head. May be due to local pathology. Maybe referred to the
face and head fromadjacent area. Maybe of psychogenic origin.
Oro-facial pain. 25. VIP MEN Vascular CFP Intracranial CFP
Psychogenic CFP Musculoskeletal CFP Extracranial CFP Neurologic CFP
26. Vascular CFP throbbing, pulsatile, episode,recurrent ,
persistent and wide area. Associated with carotid pressure,posture.
Migraine Cluster headache Temporal arteritis. Chronic paroxysmal
hemicarnia. 27. Migraine. Adult: 75% female, child: 70% male. 18%
of women, 8% of men. Age at onset: 2~40 y/o ( 2:1 Neurologic
aura---40% Severe, intermittent, throbbing pain. Unilateral
Nocturnal Photophobia 29. Cluster headache. Periodic migrainous
neuralgia. Intensity: severe paroxysmal, explosive pain. Frequency:
up to 8 per day. Duration: 15~180 mins. Cluster cycles: pain-free
interval (week-month) Nocturnal. Unilateral, orbital,
supra-orbital, temporalarea (posterior maxilla, dental pain?) Male:
80% Age: 20~50 (36) y/o no familyhistory. 30. Temporal arteritis
(Giant cell arteritis) Giant cell granulomatous reaction ofartery.
Prevalent: over 50 y/o Dull or throbbing pain over temporalarea.
weakness and pain in the jaw andtongue---jaw claudication.
Diagnosis : biopsy, ESR x :corticosteroid. 31. Intracranial CFP
Headache, numbness, weakness. Tumor, trauma or hemorrhage. Symptom
of trigeminal neuralgia. 32. Psychogenic CFP May evoke physical
pain. Chronic, multiple, bilateral, migratorypain. Unexpected
response to treatment. 50 % of pain of psychogenic origin
isexperienced in the face and head. Atypical facial pain/atypical
odontalgia. Oral dysaesthesia Hypochondriasis. 33. Atypical
odontalgia Women (Menopause.) Like pulpal pain. Maxillary premolar
or molar. Aching or burning, even throbbing pain.
Etiology---neurovascular cause,psychogenic origin or
deafferentation. Tricyclic. 34. Musculoskeletal CFP Charater: dull
(sharp), localized pain. Associated with function of jaws. Types:
TMD Muscle contraction(tension) headache. 35. Extracranial CFP
Localized and acute pain. Diagnosis, treatment and improve. Types:
Odontigenic ENT Eyes Salivary glands Lymph nodes bone 36.
Neurologic CFP Paroxysmal, electrisic, free betweenepisodes,
intermittent. short duration. Types: Trigeminal neuralgia
Glossopharyngeal neuralgia. Deafferentation pain Systemic disease
37. Trigeminal neuralgia. Severe paroxysmal pain Unilateral (96%);
r>l Mild superficialstimulation provokes pain. V2 and V3, no
neurologic deficits No dentoalveolar cause found Local anesthesia
of trigger zonetemporrarily arrests pain. 38. Conclusion. 39. Thank
you!!!
