Clinical manifestations and diagnosis

Correct pulpal diagnosis is the key to all endodontic treatments. It is paramount to have established a clinical diagnosis of the pulp and the periapical tissue prior cutting access into the pulp chamber or to do any other treatment to a tooth. Clinical signs and symptoms, diagnostic tests in addition to a comprehensive knowledge of the reaction of the pulp to caries, operative manipulations, trauma, and periodontal disease, enable us to establish an empirical pulp diagnosis only. The history of symptoms for the diagnosis of reversible pulpitis will mainly reveal provoked pain or sensation, and the tooth will only bother the patient when the tooth is exposed to a hot and/or cold or other excitatory stimuli. Like pulpal inflammation, the periapical inflammation can be symptom-free and only diagnosed in a chronic phase on a periapical radiograph. Determining the endodontic diagnosis prior to any invasive endodontic, or even any dental, procedure is paramount.