Diagnostics in conservative dentistry
TD2 OC:
| Pathology | Diagnosis | Treatment |
| Pulpo-dentin damage (dental caries) | Pain only provoked (sugar, hot, cold, acid) Disappears when stimuli stop Pulp vitality preserved | Capping according to the level of damageOperative field.Opening of the cavity (diamond ball bur mounted on a turbine).Dental curettage (ball bur mounted on a blue contra-angle supplemented by manual curettage).Cleaning of the cavity (disinfection).Provide trimming all around the tooth (renew the cotton roll).Capping: if it is parapulpal, use calcium hydroxide then zinc oxide eugenol.If it is dentinal, put ZOE directly.Close the cavity hermetically and clean well.Restoration after 4 weeks for simple dentinal capping and 4 to 9 months for parapulpal capping. |
| Reversible pulpitis | ||
| Pulp hyperemia | Accidentally exposed pulp (iatrogenic fault) Absence of spontaneous pain Pain provoked Pain provoked persists for a few seconds after the stimuli stop ( does not trigger a new painful attack even if it continues ) | Etiological treatment: caries (capping), break-in, erosion, amelogenesis imperfecta, dentinogenesis imperfecta. |
| Irreversible pulpitis | ||
| Acute superficial serous pulpitis | Provoked and spontaneous discontinuous pain with total disappearance of pain between attacks Pulp vitality preserved Patient can determine the causative tooth Responds favorably to analgesics | Styling if not pulpectomy |
| Acute partial serous pulpitis | Provoked and spontaneous discontinuous pain with complete disappearance of pain between attacks Pulp vitality preserved Patient can determine the causative tooth Responds favorably to analgesics | Pulpotomy: temporary treatment for temporary teeth to achieve closure of the apex. If pulpotomy is chosen as definitive treatment, calcification or degeneration or internal resorptions may occur. Pulpectomy: anesthesia, surgical fields, access cavity, shaping and preparation of the canal, then obturation of the canal |
| Acute total serous pulpitis (red) | Provoked and spontaneous discontinuous pain with total disappearance of pain between attacks Pulp vitality preserved Patient unable to determine the causative tooth Responds favorably to analgesics | |
| Acute suppurative pulpitis (yellow) | Violent pain, exacerbated by heat and calmed by cold (each body in contact with a high temperature undergoes an expansion causing pressure on the nerve endings, or a low temperature undergoes a retraction and then dissipation of the edema) The pulp appears as a yellow point when the cavity is opened | Immobilize the tooth between thumb and index finger and open the cavity (transcanal drainage) = emergency treatment. Leave the tooth open and covered with a cotton ball or close with calcium hydroxide, leaving a small opening for pus drainage. Root canal treatment and filling after all traces of pus have disappeared. |
| Chronic pulpitis | Asymptomatic (minimal pain) Absence of spontaneous pain (present in the past then cooled) Pulp polyp : the diagnosis is obvious, when you touch there is bleeding that is not in a sheet, you look for the origin, if it comes from the center of the tooth (from the pulp chamber) = chronic hypertrophic or hyperplastic pulpitis Differential diagnosis = when the pulp is alive = dental caries When the pulp is mortified = chronic periodontitis => vitality test and periapical lesion | |
| Chronic open pulpitis | Communication with the external environment | Directly pulpectomy (bio-depulpation) |
| Chronic closed pulpitis | No communication with the oral environment | We try a juxta-pulp styling, if that doesn’t work we do a pulpectomy |
| Pulp gangrene | Mortification (necrobiosis) + anachoresis if not gangrene immediately Small widening of the periodontal space Variations in tooth color (physical sign) Differential diagnosis with chronic pulpitis and caries is done by vitality test and with chronic LIPOE by overflow of germs from the foramen Fetid odor from the pulp chamber It can be open or closed, dry or moist (aerobic or anaerobic bacteria) | Trimming-Disinfection (we no longer speak of pulp removal) Inter-session medication with calcium hydroxide with chimney Root canal obturation Restoration |
| Apical periodontitis (LIPOE) | Can be acute or chronicNegative vitality testResistant to analgesicsContinuous spontaneous pain of varying intensityPeriapical, latero-radicular or furcation radiolucent imageRubs or swellingsWhen it is acute, percussion should not be performed (very painful)Soft tartar bits all around the toothSometimes the tooth is eroded | Premedicate or open the cavity to relieve pain by immobilizing the tooth between thumb and index finger Calcium hydroxide medication Trimming and disinfection |
Case 1:
A 62-year-old patient who presents a loss of substance on the occluso-distal face of the 46, presents violent spontaneous pain, the tooth is a little mobile, painful arch at the back of the vestibule
- Diagnosis: there are 2 diagnoses: acute apical periodontitis to be confirmed with X-ray and septum syndrome (from the moment there is a collapse of a proximal dental wall)
- Justification: spontaneous pain, mobility of the tooth, the curvature at the bottom of the vestibule (we can do the ping-pong test)
- Treatment plan: periodontal curettage and clearing of the interdental space and reproducing the contact point if necessary, paring, disinfection and obturation
Case 2:
A 9-year-old patient who presents a more or less voluminous loss of substance on the 75, the pain is caused by sugar and presents a small discomfort when he brushes the tooth with his tongue
- Diagnosis: dental caries to be confirmed by vitality tests, the child’s semiology is never certain
- Differential diagnosis: partial gangrene (clinical silence)
- Treatment plan: in case of dental caries, curettage and filling with a dressing, in case of gangrene, curettage, access cavity then canal preparation, the filling depends on the degree of rhizalization
Case 3:
A 12-week pregnant woman presents with pain radiating to the right ear, intraoral examination reveals the presence of a severely decayed and mobile tooth: 47, 46 and 48 are decayed, with a grayish dischromia at the level of 46. The patient took Paracetamol but it was not satisfactory.
- Diagnosis: 46: pulp gangrene (change in color), 47: acute apical periodontitis (decay, mobility, resistant to analgesic treatment), 48: dental caries
- Treatment plan: open 47, curettage and debride disinfection, finish shaping and put in place calcium hydroxide, obturation requires LT=radio, to be postponed until after delivery
48: if it is a simple caries cavity, we do a cap
46: Vitality test, treated the same as 47
Diagnostics in conservative dentistry
TD2 OC:
| Pathology | Diagnosis | Treatment |
| Pulpo-dentin damage (dental caries) | Pain only provoked (sugar, hot, cold, acid) Disappears when stimuli stop Pulp vitality preserved | Capping according to the level of damageOperative field.Opening of the cavity (diamond ball bur mounted on a turbine).Dental curettage (ball bur mounted on a blue contra-angle supplemented by manual curettage).Cleaning of the cavity (disinfection).Provide trimming all around the tooth (renew the cotton roll).Capping: if it is parapulpal, use calcium hydroxide then zinc oxide eugenol.If it is dentinal, put ZOE directly.Close the cavity hermetically and clean well.Restoration after 4 weeks for simple dentinal capping and 4 to 9 months for parapulpal capping. |
| Reversible pulpitis | ||
| Pulp hyperemia | Accidentally exposed pulp (iatrogenic fault) Absence of spontaneous pain Pain provoked Pain provoked persists for a few seconds after the stimuli stop ( does not trigger a new painful attack even if it continues ) | Etiological treatment: caries (capping), break-in, erosion, amelogenesis imperfecta, dentinogenesis imperfecta. |
| Irreversible pulpitis | ||
| Acute superficial serous pulpitis | Provoked and spontaneous discontinuous pain with total disappearance of pain between attacks Pulp vitality preserved Patient can determine the causative tooth Responds favorably to analgesics | Styling if not pulpectomy |
| Acute partial serous pulpitis | Provoked and spontaneous discontinuous pain with complete disappearance of pain between attacks Pulp vitality preserved Patient can determine the causative tooth Responds favorably to analgesics | Pulpotomy: temporary treatment for temporary teeth to achieve closure of the apex. If pulpotomy is chosen as definitive treatment, calcification or degeneration or internal resorptions may occur. Pulpectomy: anesthesia, surgical fields, access cavity, shaping and preparation of the canal, then obturation of the canal |
| Acute total serous pulpitis (red) | Provoked and spontaneous discontinuous pain with total disappearance of pain between attacks Pulp vitality preserved Patient unable to determine the causative tooth Responds favorably to analgesics | |
| Acute suppurative pulpitis (yellow) | Violent pain, exacerbated by heat and calmed by cold (each body in contact with a high temperature undergoes an expansion causing pressure on the nerve endings, or a low temperature undergoes a retraction and then dissipation of the edema) The pulp appears as a yellow point when the cavity is opened | Immobilize the tooth between thumb and index finger and open the cavity (transcanal drainage) = emergency treatment. Leave the tooth open and covered with a cotton ball or close with calcium hydroxide, leaving a small opening for pus drainage. Root canal treatment and filling after all traces of pus have disappeared. |
| Periodontitis | Rebellious to analgesics Continuous spontaneous pain of varying intensity | |
Diagnostics in conservative dentistry
Dental crowns are used to restore the shape and function of a damaged tooth.
Bruxism, or teeth grinding, can cause premature wear and often requires wearing a retainer at night.
Dental abscesses are painful infections that require prompt treatment to avoid complications. Gum grafting is a surgical procedure that can treat gum recession. Dentists use composite materials for fillings because they match the natural color of the teeth.
A diet high in sugar increases the risk of developing tooth decay.
Pediatric dental care is essential to establish good hygiene habits from an early age.