OHSU

Diagnosis and Clinical Tests 2009

Objectives and Goals

  • Classify pulp and periapical diseases and their clinical features.
  • Discuss the importance and limitations of and procedures for the clinical examination of the soft tissues and periodontium as related to the endodontic examination.
  • Discuss the importance and limitations of and procedures for the clinical pulp and periapical tests involved in the endodontic examination.

Ingle's Endodontics, ed 6; Ingle JI, Bakland LK & Baumgartner JC  eds. BC Decker, 2008.  p. 520 - 553.

1969

*Van Hassel HJ, Harrington GW.  Localization of pulpal sensation. Oral Surg 28:753-760. 1969. 

1976

*Fulling HJ, Andreasen JO.  Influence of maturation status and tooth type of permanent teeth upon electrometric and thermal pulp testing.  Scand J Dent Res 84:286-290. 1976.

1977

*White JH, Cooley RL.  A quantitative evaluation of thermal pulp testing.  J Endodon 3:453-457. 1977.

1980

*Trowbridge HO, Franks M, Korostoff E, Emling R.  Sensory response to thermal stimulation in human teeth.  J Endodon 6:405-412. 1980.

1981

*Augsburger RA, Peters DD.  In vitro effects of ice, skin refrigerant, and   CO2 snow on intrapulpal temperature.  J Endodon 7:110-116. 1981.

1982

Abou-Rass M. The stressed pulp condition: An endodontic restorative diagnosticconcept. J Pros Dent 1982; 48:264-267.

1983

*Peters DD, Lorton L, Mader CL, Augsburger RA, Ingram TA.  Evaluation of the effects of carbon dioxide used as a pulpal test.  I. In vitro effect on human enamel.  J Endodon 9:219-227. 1983.

1986

*Fuss Z, Trowbridge H, Bender IB, Rickoff B, Sorin S.  Assessment of reliability of electrical and thermal pulp testing agents. J Endodon 12:301-305. 1986.

1988

*Rickoff B, Trowbridge H, Baker J, Fuss Z, Bender IB.  Effects of thermal vitality tests on human dental pulp.  J Endodon 14:482-485. 1988.

1989

*Bender IB, Landau MA, Fonsecca S, Trowbridge,HO.  The optimum placement site of the electrode in electronic pulp testing of the 12 anterior teeth.  J Amer Dent Assoc 118:305-310. 1989.

1994

Peters DD, Baumgartner JC, Lorton L.  Adult pulpal diagnosis I.  Evaluation of the positive and negative responses to cold and electrical pulp tests. J Endodon 20:506-511. 1994.

1996

Turp JC, Gobetti JP.  The cracked tooth syndrome: an elusive diagnosis. JADA 127:1502-1507. 1996.

1998

Marshall JG, Morgan LA. Endodontic Diagnosis and treatment planning. Clark'Clinical Dentistry 1998;4:1-19.

2001

Amir F, Guttman J, Witherspoon D. Calcific metamorphosis: A challenge in endodontic diagnosis and treatment. Quint Int 32:447. June, 2001.

Aesaert G. Management of vertical root fractures. Endo Prac 4:32. October, 2001.

2002

Jones VR, Rivera EM,Walton RE. Comparison of carbon dioxide versus refrigerant spray to determine pulpal responsiveness. J Endod 28:531. July, 2002.

Vier FV & Figueiredo JAP. Prevelence of different periapical lesions associated with the presence and extension of apical external root resorption. Int Endo J 35:710. 2002.

2006

Wilson BL, Broberg C, Baumgartner JC, Harris C, Kron J. Safety of electronic apex locators and pulp testors in patients with implanted cardiac pacemakers or cardioverter/defibrillators. J Endod 32:847. September, 2006.

Optional

Reiss HL, Furedi A. Significance of the pulp test as revealed in a microscopic study of the pulps of 130 teeth. Dental Cosmos 1933;75:272-281.

Stephan RM. Correlation of clinical tests with microscopic pathology of the dental pulp. J Dent Res 11937;6;267-278.

Herbert WE. A correlation between nervous accommodation, symptomatology and histological condition of the pulps of 52 teeth. Brit Dent J 1945;78:161-173.

Vargas F, Vivaldi L. Correlation between nervous accommodaation, symptomatology and histology of normal and pathologic tooth pulp: Its application to electrodiagnosis. J Dent Res 1959;38:866-880.

Mitchell DF, Tarplee RE. Painful pulpitis - a clinical and microscopic study. Oral Surg 1960;13:1360-1370.

Degering CI. Physiologic evaluation of dental-pulp testing methods. J Dent Res 1962;41:695.

Seltzer S, Bender IB, Zionitz M. The dynamics of pulp inflammation: correlations between diagnostic data and actual histologic findings in the pulp. Oral Surg 1963;16:846-977.

Dachi SF. The relationship of pulpitis and hyperemia to thermal sensitivity. Oral Surg 1965;19:776-785.

Reynolds RL. The determination of pulp vitality by means of thermal and electrical stimuli. Oral Surg 1966;22:231.

Dachi SF et al. Standardization of a test for dental sensitivity to cold. Oral Surg 1967;24:687.

Mumford JM. Pain perception thrshold on stimulating human teeth and the histological condition of the pulp. Brit Dent J 1967;123:427.

Lundy T, Stanley HR. Correlation of pulpal histopathology amd clinical symtoms in human teeth subjected to experimental irritation. Oral Surg 1969;27:187.

*Mumford JM, Newton AV. Zone of excitation when electrically stimulated human teeth. Arch Oral Biol 1969;14:1383-1388.

Johnson RH, Dachi SF, Haley JV. Pulpal hyperemia - a correlation of clinical and histologic data from 706 teeth. J Am Dent Ass 1970;81:108.

Mullaney TP, Howell RM, Petrich JD. Resistance of nerve fibers to pulpal necrosis. Oral Surg 1970;30:690.

Baume LJ. Diagnosis of diseases of the pulp. Oral Surg 1970;29:102-116.

Hasler JF, Mitchell DF. Painless pulpitis. J Am Dent Ass 1970;81:671.

Chilton NW et al. Pulpal response iof bilateral intact teeth. Oral Surg 1972;33:797.

Garfunkel A, Ulmansky M. Dental pulp pathosis: Clinicopathologic correlations based on 109 cases. Oral Surg 1973;35:110-117.

*Bhaskar SN, Rappaport HM. Dental vitality tests and pulp status. J Am Dent Ass 1973;86:409.

England MC, Pellis EG, Michanowicz AE. Histopathologic study of the effect of pulpal disease upon nerve fibers of the human dental pulp. Oral Surg 1974;38:783.

Matthews B, Searle BN, Adams D, Linden R. Thresholds of vital and non-vital teeth to stimulation with electric pulp tester. Brit Dent J 1974;137:352-355.

*Wooley LH, Woodworth J, Dobbs JL.  A preliminary  evaluation of the effects of electrical pulp testers on dogs with artificial pacemakers. J Am Dent Ass 89:1099-1101. 1974.

*Michaelson RE, Seidberg BH, Guttuso J.  An in vivo evaluation of interface media used with the electric pulp tester. J Amer Dent Ass 91:118-121. 1975.

Cunningham J et al. Pain perception to electrical stimulation of the periapical tissues in human subjects and the possible influence of disease. Arch Oral Biol 1976;21:95.

Cooley RL. An alternative to electric pulptesting. Quint Int 1977;12:1573.

*Ehrmann EH.  Pulp testers and pulp testing with particular reference to the use of dry ice.  Austral Dent J  22:272-279. 1977.

Cooley RL et al. Thermal pulp testing Gen Dent 1978;58:??.

*Klein HJ. Pulp responses to an electric pulp stimulator in the developing permanent anterior dentition. J Dent Child 1978:23-26.

Marshall FJ.  Planning endodontic treatment.  Dent Clin No Amer 23:495-518. 1979.  Read p. 495-510 only!

Dummer PMH, Hicks R, Huws D. Clinical signs and symptoms in pulpdisease. Int Endo J 1980;1:27-36.

*Cooley RL, Robison SF.  Variables associated with electric pulp testing.  Oral Surg 50:66-73. 1980.

*Peters DD, Augsburger RA.  In vitro cold transference of bases and restorations.  J Amer Dent Assoc 102:642-646. 1981.

Abou-Rass M. The diagnostic problem. Alpha Omegan 1982;75:35-56.

*Cecic PA, Hartwell GR, Bellizzi R.  Cold as a diagnostic aid in cases of irreversible pulpitis.  Oral Surg 56:647-650. 1983.

*Kitamura T, Takahashi T, Horiuchi H.  Electrical characteristics and clinical application of a new automatic pulp tester.  Quint Int 1:45-53. 1983.

Plasschaert AJM. The treatment of vital pulps I. Diagnosis and etiology. Int Endo J 1983;16:108.

Forman PC. Ultraviolet light as an aid to endodontic diagnosis. Int Endo J 1983;16:121.

Hyman JJ, Doblecki W.  Computerized endodontic diagnosis.  J Am Dent Ass 107:755-758.  1983.

Ingram TA et al. Evaluation of the effects of carbon dioxide used with a pulpal test. I: In vivo effect on human enamel and pulpal tissues. J Endodon 1983;9:296.

Cooley RL et al. Evaluation of a digital pulp tester. Oral Surg 1984;58:437.

Mendoza MM, Reader A, Meyers WJ, Forman DW. An ultrastructural investigation of the human apical pulp in irreversible pulpitis I. Nerves. J Endodon 1987;13:267-276.

Mendoza MM, Reader A, Meyers WJ, Marquard JV. An ultrastructural investigation of the human apical pulp in irreversible pulpitis II. Vaculature and connective tissue. J Endodon 1987;13:318-327.

*Lado EA, Richmond AF, Marks RG.  Reliability and validity of a digital pulp tester as a test standard for measuring sensory perception.  J Endodon 14:352-356. 1988.

Anderson RW, Pantera EA.  Influence of a barrier technique on electric pulp testing.  J Endodon 14:179-180.  1988.

Wilder-Smith PEEB.  A new method for the non-invasive measurement of pulpal blood flow.  Int Endo J  21:307-312. 1988.

*Olgart L, Gazelius B, Lindh-Stromberg U.  Laser Doppler flowometry in assessing vitality in luxated permanent teeth.  Int Endo J  21:300-306. 1988.

Pogrel MA, Yen CK, Taylor RC.  Studies in tooth crown temperature gradients with the use of infrared thermography.  Oral Surg 67:583-587. 1989.

Moody AB, Browne RM, Robinson PP. A comparison of monopolar and bipolar electrical stimuli and thermal stimuli in determining the vitality of human teeth. Arch Oral Biol 1989;34:701-705.

Pantera EA, Anderson RW, Pantera CT.  Reliability of electric pulp testing after pulpal testing with dichlorodifluoromethane. J Endodon 19:312-314. 1993.

Brown RS, Hinderstein B, Reynolds DC, Corio RL.  Using anesthetic localization to diagnose oral and dental pain.  JADA 126:633-641. 1995.

Tidwell E, Witherspoon DE, Gutman JL, Vreland DL, Sweet PM. Thermal sensitivity of endodontically treated teeth. Int Endo J 1999;32:138-145.

Petersson K, Soderstrom C, Kiani-Anaraki M, Levy G. Evaluation of the ability of thermal and electrical tests to register pulp vitality. Endodon Dent Traum 1999;15:127-131.

Selden HS. Diagnostic thermal pulp testing: a technique. J Endod 26:623. October, 2000.

Kells BE, Kennedy JG, Biagioni PA, Lamey PJ. Computerized infrared thermographic imaging and pulpal blood flow: Part 1. A protocol for thermal imagine of human teeth. Int Endo J 33:442. 2000.

Kells BE, Kennedy JG, Biagioni PA, Lamey PJ. Computerized infrared thermographic imaging and pulpal blood flow: Part 2. Rewarming of healthy human teeth following a controlled cold stimulus. Int Endo J 33:448. 2000.

Kerezoudis NP, Donta-Bakoyianni C, Siskos G. The lateral periodontal cyst: aetiology, clinical significance and diagnosis. Endod Dent Traumatol 16:144. 2000.

Goodis HE, Winthrop V, White JM. Pulpal responses to cooling tooth temperatures. J Endod 26:263. May, 2000.

Yanpiset K, Vongsavan N, Sigrudsson A, Trope M. Efficacy of laser dopler flowmetry for diagnosis of revascularization of reimplanted immature dog teeth. Dent Traum 17:63. 2001.

Bahcall J and Barss J. Fiberoptic endoscope usage for intracanal visualization. J Endodon 27:128. February, 2001.

Liewehr F. An inexpensive device for transillumination. J Endodon 27:130. February, 2001.

Petka K. The 14 warning signs. Endo Prac 4:18. October, 2001.

McCaul LK, McHugh S, Saunders P. The influence of specialty training and experience on decision making in endodontic diagnosis and treatment planning. Int Endo J 34:594. 2001.

Roberts S, West LA, Liewehr FR, Rueggeberg FA, Sharpe DE, Potter BJ. Impact of dental devices on cochlear implants. J Endod 28:40. January, 2002.

Slaton CC, Loushine RJ, Weller RN, Parker MH, Kimbrough WF, Pashley DH. Identification of resected root-end dentinal cracks: A comparative study of visual magnification. J Endod 29:519. August, 2003.

Gupta R & HasselgrenG. Prevalence of odontogenic sinus tracts in patients referred for endodontic therapy. J Endod 29: 798. December, 2003.

Boykin MJ, Gilbert GH, Tilashalski KR, Shelton BJ. Incidence of endontic treatment: A 48-month prospective study. J Endod 29:806. December, 2003.

Strobel H, Gojer G, Norer B, Emshoff R. Assessing revascularization of avulsed permanent masillary incisors by laser Dopler flowmetry. J Am Dent Ass 134:1597. December, 2003.

Polat S, Er Ka, Akpinar KE, Polat NT. The sources of laser Doppler blood-flowsignals recorded from vital and root canal treated teeth. Arch Oral Bio 49:53. Janruary, 2004.

Akpinar KE, Er K, Polat S, Polat NT. Effect of gingival on laser Doppler pulpal blood flow measurements. J Endod 30:138. March, 2004.

Smith E, Dickson M, Evans AL, Smith D, Murray CA. An evaluation of the use of tooth temperature to assess human pulp vitality. Int Endo J 37:374. June, 2004.

Miller SO, Johnson JD, Allemang JD, Strother JM. Cold testing through full-coverage restorations. J Endod 30:695. October, 2004.

Wright HM, Loushine RJ, Weller N, Kimbrough WF, Waller J, Pashley DH. Identification of resected root-end dentinal cracks: A comparative study of transillumination and dyes. J Endod 30:712. October, 2004.

Mounce R. Know when to say "when" in Endodontics Smoke on the water. Dent Today 23:102. October, 2004.

Emshoff R, Emshoff I, Moschen I, Strobl H. Diagnostic characteristics of pulpal blood flow levels associated with adverse outcomes of luxated permanent maxillary incisors.

Campbell KM, Casas MJ, Kenny DJ, Chau T. Diagnosis of ankylosis in permanent incisors by expert ratings, Periotest and digital sound wave analysis. Dent Traumatol 21:206. 2005.

Nam KC, Ahn SH, Cho JH, Kim DW, Lee SJ. Reduction of excessive electrical stimulus during electric pulp testing. Int Endo J 38:544. 2005.

Polat S, Küşat E, Polat NT. Penetration depth of laser Doppler flowmetry beam in teeth. OOOO&E 100:125. July, 2005.

Simon JHS, Encisco R, Malfaz J, Roges R, Bailey-Perry M, Patel A. Differential diagnosis of large periapical lesions using Cone-beam Computed Tomography measurements and biopsy. J Endod 32d:833. September, 2006.

Rajendran N & Sundaresan B. Efficacy of ultrasonic and color power Doppler as a monitoring tool in the healing of endodontic periapical lesions. J Endod 33:181. February, 2007.

Gopikrishna V, Tinagupta K, Kandaswamy D. Evaluation of efficacy of a new custom-made pulse oximeter dental probe in comparison with the electrical and thermal tests for assessing pulp vitality. J Endod 33:411, April, 2007.

Gopikrishna V, Tinagupta K, Kandaswamy D. Comparison of electrical, thermal, and pulse omixmetry methods for assessing pulp vitality in recently traumatized teeth. J Endod 33:531. May, 2007.

Khan AA, McCreary B, Owatz C, Schindler WG, Schwartz SA, Keiser K, Hargreaves KM. The development of a diagnostic instrument for the measurement of mechanical allodynia. J Endod 33:663. June, 2007.

Lin J, Chandler N, Purton D, Monteith B. Appropriate electrode placement site for electric pulp testing first molar teeth. J Endod 33:1296. November, 2007.

Krell KV & Rivera EM. A six year evaluation of cracked teeth diagnosed with reversible pulpitis: Treatment and Prognosis. J Endod 33:1405. December, 2007.

Linsuwanont P, Palamara JE, Messer HH. Thermal transfer in extracted incisors during thermal pulp sensitivity testing. Int Endo J 41:204. 2008.

Bigras BR, Johnson BR, BeGole EA, Wenckus CS. Differences in clinical decision making: a comparison between specialists and general dentists. OOOO&E 106:139. July, 2008.

Jafarzadeh H, Udoye C, Kinoshita J. The application of tooth temperature measurement in endodontic diagnosis: a review. J Endod 34:1435. December, 2008.

Jararzadeh H & Rosenberg PA. Pulse oximetry: Review of a potential aid in endodontic diagnosis. J Endod 35:329. March, 2009.

Zadik Y. Barodontalgia. J Endod 35:481. April, 2009.  

*ABE Review Articles