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When To Refer

When to Refer
by Katherine A. Thomson, DDS, MS

Diagnosis and case difficulty assessment in endodontics

Diagnosis and case difficulty assessment form the cornerstone of referrals. While evaluating tooth pain, general practitioners are often faced with vague symptoms and inconclusive test results. There are times when practitioners start endodontic treatment on teeth only to find out during the treatment that the case should have been referred to an endodontist. How does one make the decision to treat or refer? Which cases are treated is dependent on the general practitioner's experience with both diagnosis and treatment modalities. Patients and practices are best served when a clear referral algorithm is set.

Diagnosis

Diagnosing teeth suffering from pulpal and periapical disease is as much an art as it is a science. Symptoms of pulpal disease can range from absent to excruciating, spontaneous pain. Painless pulpitis leading to pulp necrosis occurs in 40% to 60% of cases. Moreover, periapical disease can present with a wide range of subjective and objective symptoms, including pain on percussion, swelling, or radiographic evidence in the form of periapical radiolucencies that are consistent with bone loss. Sometimes, these radiolucencies can only be visualized with 3-dimensional radiography or cone-beam computed tomography (CBCT). Recognizing the need for root canal therapy in these cases requires systematic and thorough diagnostic testing. The cold test, percussion, palpation, periodontal probing, bite test, and mobility test make up the foundation of endodontic testing. The results are interpreted to reach a diagnosis for the pulp and periapical tissues based on the latest American Association of Endodontics (AAE) classification of pulp and periapical conditions.

Read full article on Inside Dentistry.