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Dental Visits - The Endodontic Examination Appointment

On most occasions, the endodontic examination and the endodontic consultation take place at the same visit. Most dentists prefer this. This section will look at each process separately.

What Is the Purpose of the Endodontic Examination?

The purpose of the endodontic examination is to determine the state of health of the pulpal tissues of a tooth or group of teeth. The dentist hopes to collect specific information to assist in diagnosis and treatment planning. During the examination portion of the visit, the dentist will:

• Review the patient's medical history and evaluate the patient's current medical status and in order to determine how it might influence the dental diagnosis and/or treatment plan.
• Review the patient's dental history and, in particular, its relationship to the specific reason for the visit, also called the "chief complaint."
• Perform a thorough clinical examination.
• Perform certain endodontic tooth tests to help establish an accurate diagnosis of the condition of the pulpal tissue.
• Perform a radiographic examination. Two or three different radiographic angles of the same area are often required to adequately visualize the various teeth, the root canal spaces within each tooth, and the surrounding bone and structures. Since a single radiograph is a two-dimensional picture of a three-dimensional object, two or more radiographs with different angulations can provide important additional information. Radiographs reveal many things that the dentist is unable to see with the clinical examination alone.

What Is the Purpose of the Endodontic Consultation?

The purpose of the endodontic consultation is to present a root canal treatment plan to the patient. Once the dentist has collected and evaluated all of the diagnostic information, the goals of the consultation visit are to:

• Share the examination findings and the resultant diagnosis with the patient.
• Discuss the prognosis.
• Discuss the treatment recommendations and any perceived complications.
• Discuss the treatment alternatives and their respective ramifications.
• Discuss the number and length of appointments necessary to complete the recommended treatment.
• Review the cost of the recommended treatment and the various treatment options.
• Answer questions that the patient may have regarding the diagnosis and various treatment options.

On occasion, the dentist may need to consult with other professionals or obtain additional information before all of the goals listed above can be accomplished.

By Clifford J. Ruddle, DDS, in collaboration with Philip M. Smith, DDS

A Root Canal Abscess

What Causes an Endodontic Abscess?

An endodontic abscess is caused by infected pulpal tissue. This acute disease process then spreads to the outside of the root and enters the bone and soft tissues around the tooth. An endodontic abscess is oftentimes accompanied by a cascade of symptoms. These symptoms may include:

• Pain to hot liquids, touch, or biting pressure.
• Pressure that partially pushes the tooth out of the socket, causing it to contact the opposing tooth first upon biting.
• A loose tooth resulting from infection and subsequent pressure that builds around the outside of the tooth.
• Swelling localized to the tissue around the tooth.
• Swelling that spreads from the gums around the tooth into the cheek, lips, or neck areas. These tissues can become swollen resulting in an exaggerated asymmetry of the face.

In cases of extreme dental infection, the eye can become swollen shut or breathing can become difficult as pressure builds against vital structures. In these instances of severe infection, hospitalization may become necessary.

What Is Involved in the Emergency Management of an Abscessed Tooth?

An endodontic abscess can be extremely painful and emergency treatment is directed towards promptly relieving the patient's pain and, if present, reducing the swelling as quickly as possible. Emergency management would usually include getting the area profoundly numb and then creating a small window through the biting surface of the tooth and into the pulpal space. By opening the tooth in this manner, the dentist can relieve the pressure that has built up inside the tooth and allow the infected area to drain. Usually, the only procedures that are performed at the emergency visit are the ones that are necessary to eliminate acute pain and control the infection. Subsequent care an endodontic abscess will be necessary when the patient is more comfortable and relaxed in order to properly complete root canal treatment. At the conclusion of the emergency visit, the patient may require medications for pain and/or infection control and these will be prescribed by the doctor if they are necessary.

By Clifford J. Ruddle, DDS, in collaboration with Philip M. Smith, DDS

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