A patient attends your surgery
with the following complaint
Dentine Hypersensitivity
„
& Reversible Pulpitis
“My tooth is sensitive to cold on the
bottom rightright-hand side. It feels like its up
the back but it’
it’s hard to tell which one.
Sometimes it feels like it’
it’s up the top but I
really think that it’
it’s down the bottom”
bottom”
What do you
do/say next?
History of symptoms–
What do you ask?
„
„
„
„
„
Previous patient of
your surgery?
Recent dental
treatment?
When did the
problem start?
How long present?
Any trauma?
„
„
„
How intense?
Persistent or short lived?
Elicited by?
„
„
Only cold
No:
„
„
„
„
„
History of recent dental
treatment?
„
„
„
„
„
Hot
Sweet
Chewing
No spontaneous ache?
Keeps you awake at
night?
Over-heating
Recent or past dental treatment in the region?
PostPost-operative symptoms (ever since
treatment?)
Possible forms of iatrogenic damage?
„
„
„
„
OverOver-heating
OverOver-drying
Mechanical pulp exposure
OverOver-etching
Inadequate pulp protection (linings, bases)
How do each of these stimuli cause the current
symptoms?
Over-drying
1
„
„
„
„
Mechanical pulp
exposure
Over-etching
dentine
Inadequate pulp protection
Now What?
Thermal protection
Chemical protection
Encourage dentine repair
Linings
„
„
„
„
Glass Ionomer
Calcium Hydroxide
ZincZinc-oxide/eugenol
Bases
„Visual
„
inspection
Cause may be immediately obvious
What might you be
looking for?
Cervical
abrasion/erosion
Bruxism
„ BruxoBruxo-facets
„ Generalized?
„ Attrition
„ Localized?
„ Generalized?
„ Localized
to the
region of
reported
symptoms?
„ How
deep?
„ Surface area
involved?
2
Obvious caries
Leaking restorations
„ Where?
„How
big?
„Where?
„More than
one?
„ How
bad?
Trauma
Obvious crack
„ Obvious
„One
or
several
teeth?
Biting on a hard object
So what else do you need to
know?
„
„
„
„
If no visual clues?
Radiograph
Do you always need one?
Yes under the following circumstances
„
„
„
if no obvious cause for the symptoms can be
seen clinically
multiple possible causes
If more than one tooth is suspect
broken teeth
or
restorations?
„ History of
some trauma
to region?
„ What
sort?
Radiograph
„ What
view?
„ Initially
„ What
a BiteBite-wing
are you looking for?
3
Leaking margin of
restoration?
Significant caries?
„
How deep
radiographically?
radiographically?
decay front
clinically, is
always deeper
than apparent
radiographically
How does this
appear on a
radiograph?
„ Recurrent caries
associated with
leaking
restoration?
„
„ The
Probably already an exposure
So you have done a visual
and a radiograph
„ Found
„ Pulp
Test
„ Locate and isolate
a culprit?
„ Yes?
„ How
„
to confirm?
„
„No
obvious culprit
yet?
„
„
Describe the procedure.
„
„
„
Isolate teeth
„
„
Inform and educate patient
Why?
Why?
Which teeth do you test first and
subsequently
„
Why
What test would you perform first based on
the patients present symptoms?
Why?
What other test might be useful to distinguish
between reversible and irreversible?
Why?
What result are you hoping
to achieve?
How would you perform the first
test?
„
What next?
„
„
Based on the patient’
patient’s history, how would
you expect the patient to describe the
sensation of the test to you?
What do you do if you get no result?
„
„
„
What is a possible explanation for this?
What do you do if you get an equivocal
result?
What do you do if several teeth respond
abnormally?
4
Is it worthwhile to do other
tests?
„
„
„
„
Does this relate back to the patients
presenting complaint?
Depending on what the patient has told
you what other tests would you perform?
Describe these
What are we trying to establish with all
these tests?
Assume you have established
cervical abrasion as the cause
„ How
does this exert its effect?
„ How would you explain this to
the patient?
„ How do you treat this problem?
„ How do you explain this
treatment to the patient?
Assume you have established a
leaking restoration as the cause
How does this exert its effect?
„ How do you explain this to the
patient?
„ How do you go about treating this
problem?
„ How do you explain this treatment
to the patient?
„
Assume you have established
bruxism as the cause
How does this exert its effect?
„ How do you describe this to the
patient?
„ What do you do to address this
problem?
„ How do you explain this treatment
to the patient?
„
Assume you have established
caries as the cause
„ How
does this exert its effect?
do you explain this to the
patient?
„ How do you address this
problem?
„ How do you explain this
treatment to the patient?
„ How
Assume you have established a
crack as the cause
„ How
does this exert its effect?
„ How do you explain this to the
patient?
„ How do you treat such a
problem?
„ How do you explain this
treatment to the patient?
5
Assume that you have established
trauma as the cause
„ How
does this exert its effect?
„ How do you explain this to the
patient?
„ How do you treat such a
problem?
„ How do you explain this
treatment to the patient?
Written and Compiled by
Lea Foster
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