DentaltownUK May 2017 - 70

The Art of Diagnosis
in Endodontics
Part 1: Obtaining a pain history
with Kushal Gadhia
BDS (Bris. 2005), MFDS (RCS
Eng.), MSc (Cons), FDS (Rest.
Dent). Consultant in
Restorative Dentistry,
Eastman Dental Hospital
Clinical Director at Centre Of
Dental Excellence. Specialist
in Periodontology,
Endodontics, Prosthodontics
Special Interest in Implant
Surgery

Introduction

Endodontics: What is the aim?

Diagnosis is an 'art of using scientific
knowledge to identify a disease process'. In
addition, it entails defining the aetiology
and differentiating the disease process
from other similar occurring conditions.
In dentistry, we're able to diagnose commonly occurring conditions routinely. Yet
we're occasionally faced with unusual presentations that can be easily misdiagnosed
and therefore mismanaged. It's my strong
belief that one can broaden their clinical
experience in improving the art of diagnosis by improving their understanding on
assimilating the findings of history taking,
clinical assessment, special tests and radiographs (where necessary) before making an
accurate diagnosis1. After all, the practice
of 'evidence-based dentistry' is built on
core foundations of scientific evidence,
patient needs and preferences, and the clinician's expertise and experience.
I hope this series of articles will help
practitioners in refining their knowledge
by taking a methodical approach in reaching a diagnosis. I summarise a combination
of "scientific" and "pragmatic" tips that I
have learnt and found useful over the past
few years to achieve this.

The endodontic specialty involves:
* Preservation of pulp health.
* Treatment and prevention of pulpal
pathoses and apical periodontitis.
To achieve this aim, we need to be
able to diagnose:
* Health versus disease.
* Conditions that can predispose
to endodontic pathoses.

Part 1: Obtaining a pain history
Part 2: Clinical examination,
special tests and radiographs
Part 3: Classification of endodontic
diagnosis
Part 4:
Cases with challenging diagnoses:
The unusual presentations

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MAY 2017 // dentaltownuk.com

Patients' presenting concerns
We often hear, 'The patient tells you the
diagnosis'. This hold true in most cases
where an accurate history is ascertained.
Table 1 summarises a series of questions in
a systematic and chronological order to
obtain an accurate pain diagnosis. I also
offer explanations for using these questions
and how these reflect to foundations in
dentine, pulp and periapical physiology.
Some of these questions have been modified from the acronym SOCRATES to
obtain a detailed pain history. Some of
these questions may not apply to all cases,
depending on the nature of the problem
(e.g., previously root filled tooth versus
vital tooth).
What you get depends on:
* What you ask
* How well you listen
* Time-busy practice and emergency
appointments?
Look:
* Does the patient look well/flushed/
distressed/anxious?
* Is the patient pointing to a specific
area or tooth?
* Is the patient jumping from place to
place with different symptoms?
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