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

70

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?


http://www.dentaltownuk.com

Table of Contents for the Digital Edition of DentaltownUK May 2017

On Dentaltown.com
Mike Gow Editorial
Meet the Team
Howard Speaks
Dental Aid Network
Titanium vs. Zirconia Implants
NASDAL Goodwill
Golden Nuggets
Orthodontist Case Study
Poll—Pediatric Dentistry
Technology: The True Foundation of Your Practice
Continuing Education
Timeout: Chris Barrow
Progressive Bites
Walt Disney's Hollywood Smiles
Dental Imaging: Elaine Halley
MANAGING SYSTEMIC DISORDER: STEPHEN HUDSON
The Art of Diagnosis in Endodontics
MESSAGE BOARD: 2nd Distal Root on 36
Social Media Fails
Operation Smile
THROUGH THE KEYHOLE: SURGERY— HOME AND AWAY
Lifestyle Section
History of Dentistry
Student Section
Wish List
DentaltownUK May 2017 - 1
DentaltownUK May 2017 - 2
DentaltownUK May 2017 - 3
DentaltownUK May 2017 - 4
DentaltownUK May 2017 - On Dentaltown.com
DentaltownUK May 2017 - Mike Gow Editorial
DentaltownUK May 2017 - 7
DentaltownUK May 2017 - 8
DentaltownUK May 2017 - 9
DentaltownUK May 2017 - Meet the Team
DentaltownUK May 2017 - 11
DentaltownUK May 2017 - Howard Speaks
DentaltownUK May 2017 - 13
DentaltownUK May 2017 - Dental Aid Network
DentaltownUK May 2017 - 15
DentaltownUK May 2017 - 16
DentaltownUK May 2017 - 17
DentaltownUK May 2017 - 18
DentaltownUK May 2017 - 19
DentaltownUK May 2017 - 20
DentaltownUK May 2017 - 21
DentaltownUK May 2017 - Titanium vs. Zirconia Implants
DentaltownUK May 2017 - 23
DentaltownUK May 2017 - 24
DentaltownUK May 2017 - NASDAL Goodwill
DentaltownUK May 2017 - 26
DentaltownUK May 2017 - Golden Nuggets
DentaltownUK May 2017 - 28
DentaltownUK May 2017 - 29
DentaltownUK May 2017 - 30
DentaltownUK May 2017 - Orthodontist Case Study
DentaltownUK May 2017 - 32
DentaltownUK May 2017 - 33
DentaltownUK May 2017 - Poll—Pediatric Dentistry
DentaltownUK May 2017 - 35
DentaltownUK May 2017 - Technology: The True Foundation of Your Practice
DentaltownUK May 2017 - 37
DentaltownUK May 2017 - 38
DentaltownUK May 2017 - 39
DentaltownUK May 2017 - 40
DentaltownUK May 2017 - 41
DentaltownUK May 2017 - Continuing Education
DentaltownUK May 2017 - 43
DentaltownUK May 2017 - 44
DentaltownUK May 2017 - 45
DentaltownUK May 2017 - Timeout: Chris Barrow
DentaltownUK May 2017 - 47
DentaltownUK May 2017 - Progressive Bites
DentaltownUK May 2017 - 49
DentaltownUK May 2017 - 50
DentaltownUK May 2017 - 51
DentaltownUK May 2017 - 52
DentaltownUK May 2017 - 53
DentaltownUK May 2017 - Walt Disney's Hollywood Smiles
DentaltownUK May 2017 - 55
DentaltownUK May 2017 - 56
DentaltownUK May 2017 - 57
DentaltownUK May 2017 - 58
DentaltownUK May 2017 - 59
DentaltownUK May 2017 - 60
DentaltownUK May 2017 - 61
DentaltownUK May 2017 - Dental Imaging: Elaine Halley
DentaltownUK May 2017 - 63
DentaltownUK May 2017 - 64
DentaltownUK May 2017 - 65
DentaltownUK May 2017 - 66
DentaltownUK May 2017 - 67
DentaltownUK May 2017 - MANAGING SYSTEMIC DISORDER: STEPHEN HUDSON
DentaltownUK May 2017 - 69
DentaltownUK May 2017 - The Art of Diagnosis in Endodontics
DentaltownUK May 2017 - 71
DentaltownUK May 2017 - 72
DentaltownUK May 2017 - 73
DentaltownUK May 2017 - MESSAGE BOARD: 2nd Distal Root on 36
DentaltownUK May 2017 - 75
DentaltownUK May 2017 - Social Media Fails
DentaltownUK May 2017 - 77
DentaltownUK May 2017 - Operation Smile
DentaltownUK May 2017 - 79
DentaltownUK May 2017 - 80
DentaltownUK May 2017 - 81
DentaltownUK May 2017 - THROUGH THE KEYHOLE: SURGERY— HOME AND AWAY
DentaltownUK May 2017 - 83
DentaltownUK May 2017 - Lifestyle Section
DentaltownUK May 2017 - 85
DentaltownUK May 2017 - 86
DentaltownUK May 2017 - 87
DentaltownUK May 2017 - 88
DentaltownUK May 2017 - 89
DentaltownUK May 2017 - 90
DentaltownUK May 2017 - 91
DentaltownUK May 2017 - 92
DentaltownUK May 2017 - 93
DentaltownUK May 2017 - 94
DentaltownUK May 2017 - History of Dentistry
DentaltownUK May 2017 - Student Section
DentaltownUK May 2017 - 97
DentaltownUK May 2017 - 98
DentaltownUK May 2017 - 99
DentaltownUK May 2017 - 100
DentaltownUK May 2017 - 101
DentaltownUK May 2017 - 102
DentaltownUK May 2017 - 103
DentaltownUK May 2017 - Wish List
DentaltownUK May 2017 - 105
DentaltownUK May 2017 - 106
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