Clinical classification of Pulpal and periapical Diseases

No spontaneous symptoms

Pulp test (+)

Rx (-)

• Normal pulp

• Reversible pulpitis

• Symptomatic Irreversible pulpitis

• Asymptomatic Irreversible pulpitis

• Pulp necrosis

Causes: caries, exposed dentin, recent dental treatment and defective restorations

Tx – removal of the irritant

Dentin sensitivity – exposed dentin, w/o pulp pathosis

- Sharp, quickly reversible pain (thermal and other stimuli)

- Cervical area

• Normal pulp

• Reversible pulpitis

• Symptomatic Irreversible pulpitis

• Asymptomatic Irreversible pulpitis

• Pulp necrosis

Intermittent or spontaneous pain

Thermal (+) cold –heightened and prolonged episodes of pain after removal of the stimulus

Rx –periradicular bone is normal; thickening of the pdl

Causes: deep restoration, caries, pulp exposure, direct or indirect insult to the pulp

Untreated: necrosis

• Normal pulp

• Reversible pulpitis

• Symptomatic Irreversible pulpitis

• Asymptomatic Irreversible pulpitis

• Pulp necrosis

Intermittent or spontaneous pain

Thermal (+) cold –heightened and prolonged episodes of pain after removal of the stimulus

Rx –periradicular bone is normal; thickening of the pdl

Causes: deep restoration, caries, pulp exposure, direct or indirect insult to the pulp

Untreated: necrosis

• Normal pulp

• Reversible pulpitis

• Symptomatic Irreversible pulpitis

• Asymptomatic Irreversible pulpitis

• Pulp necrosis

Deep caries

No Pain

Untreated – symptomatic or necrotic

RCT -asap

• Normal pulp

• Reversible pulpitis

• Symptomatic Irreversible pulpitis

• Asymptomatic Irreversible pulpitis

• Pulp necrosis

Pulp blood supply and nerves are non-existent and non-functional

Asymptomatic

EPT (-)

Cold (-); Hot (+) [Positive in remnants of fluid or gases extending up to the periradicular tissues]

Partial or complete

Percussion (+)

Rx –thickening of the pdl space to the appearance of a periapical radiolucent lesion

• Normal pulp

• Reversible pulpitis

• Symptomatic Irreversible pulpitis

• Asymptomatic Irreversible pulpitis

• Pulp necrosis

Pt is asymptomatic and the tooth responds normally to percussion and palpation

Rx –intact lamina dura and pdl space around all root apices

• Normal apical tissues

• Symptomatic apical periodontitis

• Asymptomatic apical periodontitis

• Acute apical abscess

• Chronic apical abscess

Percussion (+) -acute painful response

May or may not respond to vitality test

Rx –widened pdl space; may or may not have apical radiolucency

• Normal apical tissues

• Symptomatic apical periodontitis

• Asymptomatic apical periodontitis

• Acute apical abscess

• Chronic apical abscess

No clinical symptoms

There is radiolucency but clinical symptoms not appears

Vitality tests (-)

Rx (+)

“it feels different”

• Normal apical tissues

• Symptomatic apical periodontitis

• Asymptomatic apical periodontitis

• Acute apical abscess

• Chronic apical abscess

Acutely painful to biting, palpation and percussion

Vitality tests (-)

Mobility (+) Due to the abcess

Rx –widened pdl space to an apical radiolucency

Swelling may be present intraorally and facial tissue is swelling

Palpation (+) –lymph nodes (cervical and submandibular)

• Normal apical tissues

• Symptomatic apical periodontitis

• Asymptomatic apical periodontitis

• Acute apical abscess

• Chronic apical abscess