As with all dental treatment, a detailed treatment plan can only be drawn up when a correct and accurate diagnosis has been made. It is essential that a full medical, dental and demographic history be obtained, together with a thorough extra-oral and intra-oral examination. This part considers the classification of diseases of the dental pulp, together with various diagnostic aids to help in determining which condition is present, and the appropriate therapy.
The importance of correct diagnosis and treatment planning must not be underestimated. There are many causes of facial pain and the differential diagnosis can be both difficult and demanding. All the relevant information must be collected; this includes a case history and the results of both a clinical examination and diagnostic tests. The practitioner should be fully conversant with the prognosis for different endodontic clinical situations, discussed in Part 12. Only at this stage can the cause of the problem be determined, a diagnosis made, the appropriate treatments discussed with the patient and informed or valid consent obtained.
CASE HISTORY
CASE HISTORY
The purpose of a case history is to discover whether the patient has any general or local condition that might alter the normal course of treatment. As with all courses of treatment, a comprehensive demographic, medical and previous dental history should be recorded. In addition, a description of the patient’s symptoms in his or her own words and a history of relevant dental treatment should be noted.
Medical history
There are no medical conditions which specifically contra-indicate endodontic treatment, but there are several which require special care. The most relevant conditions are allergies, bleeding tendencies, cardiac disease, immune defects or patients taking drugs acting on the endocrine or CNS system. If there is any doubt about the state of health of a patient, his/her general medical
practitioner should be consulted before any endodontic treatment is commenced. This also applies if the patient is on medication, such as corticosteroids or an anticoagulant. An example of the particulars required on a patient’s folder is illustrated in Table 1. Antibiotic cover has been recommended for certain medical conditions, depending upon the complexity of the procedure and the degree of bacteraemia expected, but the type of antibiotic and the dosage are under continual review and dental practitioners should be aware of current opinion. The latest available edition of the Dental Practitioners’ Formulary should be consulted for the current recommended antibiotic regime. However, when treating patients who may be considered predisposed to endocarditis, it may be advisable to liaise with the patient’s cardiac specialist or general medical practitioner. Not all patients with cardiac lesions require antibiotic prophylaxis, and such regimes are not generally supported by the literature. However, if it is agreed that the patient is at risk, they would normally be prescribed the appropriate prophylactic antibiotic regime, and should be advised to report even a minor febrile illness which occurs up to 2 months following root canal treatment. Prior to endodontic surgery, it is useful to prescribe aqueous chlorhexidine (2%) mouthwash