DentaltownUK May 2017 - 72

Table 1: A list of questions that will help you obtain a detailed history from the patient.
QUESTION

CLINICAL RELEVANCE

Are you experiencing any
symptoms today?

This helps ascertain:
* If the patient requires management of their acute symptoms at this visit.
* If the current symptoms differ to symptoms experienced previously (asked later)
Obtain a thorough history of the symptoms they are experiencing whilst they are seated in the dental chair.
Some of the questions below can be used as an aid to facilitate this discussion.

When did you first experience
symptoms from this tooth/region?

This establishes a 'timeline' of events, from when the symptoms first started.
* Obtain a history of the symptoms first experienced and whether these events differ from the current symptoms.
This also allows one to draw a picture of the progression of symptoms from onset to present time and correlate
this to changes within the pulp and or peri-apical tissues.

When was the initial root canal
treatment carried out and why?
When was the tooth restored with a
crown/onlay/bridge? (If the tooth is
previously root treated +/- crowned)

This provides a history of treatment undertaken on the specific tooth in question.
A brief history on why root canal treatment was previously undertaken, if the patient is able to recall this
(e.g., caries, fracture, deep restoration, incidental finding).
The timing of the cementation of the coronal restoration will help ascertain if there was a possible delay
and breach in providing a coronal seal.

Has the crown/onlay/bridge ever
de-cemented/de-bonded since it was
first fitted? (If the tooth has an existing
extra coronal restoration)

To ascertain:
* If there was a possible breach in the coronal seal
* The likely difficulties in removing the extra coronal restoration during root canal treatment

Is it a specific tooth /area that hurts?

Describe the symptoms
you experience.

This establishes the site of the pain experienced. Is this localised to a tooth/sexant/quadrant? Pulpitic pain is usually
difficult to localise to a specific tooth. Patients would generally point to an 'area' as opposed to a specific tooth. Pain
involving peri-apical tissues is usually well localised to a tooth, due to the involvement of the periodontal ligament fibers.
Allow the patient to give their version of symptoms. This establishes the character of the pain.
Certain words to look out for: sharp, shooting, dull, ache, discomfort, tender, swelling, pressure, constant,
throbbing, pulsating, tooth feels raised.
Is the pain short lived or lingering in nature? How long to the symptoms persist?
These words helps determine, at a histologic level, the involvement of acute (A-delta fibers) or chronic nature
(C-fibers) of the pain experienced and whether this could be reversible or irreversible.

Does the pain radiate to adjacent areas?

This may either indicate referred pain, spread of infection or pain of non-odontogenic origin.

Is the pain particularly worse
at any time of the day or night?

Pain can present with diurnal variations. On occasions, pulpitic pain can mimic symptoms of non-odontogenic pain.
Parafunctional habits, clenching or grinding resulting in the involvement of the muscles of mastication
may need to be excluded as the aetiology.

What happens when
you have a hot drink?

This causes movement of fluid within the dentinal tubules in an Inward direction, triggering the nerve complexes
within the pulp-dentine junction and resulting in pain. In reversible pulpitis, where there is clinical evidence of recession,
dentine exposure or a crack, this is a short-lived symptom which resolves within seconds of removal of stimulus.
In irreversible pulpitis, (where the pulp is histologically inflamed) application of heat to the tooth will
cause exacerbation of the symptoms. There is no room for the swelling within the pulp chamber to expand.
The symptoms will persist for a few minutes to hours on removal of the symptoms.
Note: Irreversible pulpitis has varying presentations. If the pulp was necrotic or part necrotic, application of hot
may not always elicit any symptoms.

What happens when
you have a cold drink?

This causes movement of fluid within the dentinal tubules in an Outward direction, triggering the nerve complexes
within the pulp-dentine junction and resulting in pain. In reversible pulpitis, where there is clinical evidence of recession,
dentine exposure or a crack, this is a short-lived symptom which resolves within seconds of removal of stimulus.
In irreversible pulpitis, (where the pulp is histologically inflamed) application of a cold stimulus will provide relief
to the patients symptoms.
Where the pulp is partly healthy (other parts being either necrotic or inflamed), application of a cold stimulus
will result in persistent pain for a few minutes to hours on removal of the symptoms
Note: Irreversible pulpitis has varying presentations. If the pulp was necrotic or part necrotic, application of hot
may not always elicit any symptoms.

Are the symptoms alleviated
by use of analgesics?

The use of non-steroidal anti-inflammatory drugs can help with reduction in inflammation within the pulp
and therefore with short term symptomatic control.

Are you able to chew or bite
onthe teeth in the area?
Is your sleep disturbed? Do you experience
symptoms spontaneously without any
stimuli (hot/cold/biting on the tooth)

This question can be directed to ascertain if there is presence of a crack in the tooth or whether the
inflammation has spread beyond the pulp into the peri radicular areas.
This is a common presentation in patients with pulpitis where spontaneous pain involving the A-d fibers can
stimulate.

How severe would you rate your pain
on a scale of 0-10, 10 being the worst

Ascertain severity of pain experienced.

Other questions, if relevant:
* Have you experienced any bad taste?
* Have you experienced any swelling
(gum boil)?

This may reflect previous or current discharging sinus and suppuration.

References:
The American Association of Endodontists (AAE) guidelines on Diagnosis published in 2013 (www.aae.org). Examination procedures required to make an endodontic diagnosis (8)

MAY 2017 // dentaltownuk.com

http://www.aae.org http://www.dentaltownuk.com

Table of Contents for the Digital Edition of DentaltownUK May 2017