Formulation of Pulpal and Periradicular Diagnoses1

Diagnosis Signs and Symptoms Radiographic Appearance Response to Pulp Tests2 Response Response Response (may be e'treme and(or lingering) Response to Periapical Tests3

Pulpal Diagnosis
Normal Pulp (NP)4 Reversible Pulpitis (RP) ymptomatic !rreversible Pulpitis ( !P)" None May have harp Pain harp Pain# but may have Deep# Dull# $na%ing Pain# pontaneous Pain# Referred Pain# or a Past &istory of Pain None# but may have a Past &istory of Pain No Response No Response No Response

)symptomatic !rreversible Pulpitis ()!P)" Pulp Necrosis (PN) Previously *reated (P*)+ Previously !nitiated *herapy (P!*)+

Response No Response No Response ,ith or ,ithout Response

Periradicular (Periapical) Diagnosis7

Normal )pical *issues (N)*)ymptomatic )pical Periodontitis ( )P)11 None (,N.)/ Pain No Periapical 0hanges 12 No ignificant 0hanges (may have %idened pdl) or 32 )pical Radiolucency )pical Radiolucency ,ith or ,ithout )pical Radiolucency ,ith or ,ithout )pical Radiolucency Radiopacity# may be framing a coe'istent radiolucency None (,N.) Painful Response

)symptomatic )pical Periodontitis ())P)11 )cute )pical )bscess ())))13 0hronic )pical )bscess (0)))14 0ondensing 6steitis (06)14

None (,N.) Swelling ,ith or ,ithout Pain Sinus Tract ,ithout Pain (usually) ,ith or ,ithout Pain

None (,N.) ,ith or ,ithout Painful Response 5sually No Response ,ith or ,ithout Response

From the ))7 0onsensus 0onference of Recommended Diagnostic *erminology8 Recommended *erms# 1+44 967 : ;olume 4"# Number 13# December 311/2 Previous terms used by the 5N0 Department of 7ndodontics %ere from a compilation of ,alton R7 and *orabine<ad M2 Diagnosis and *reatment Planning !n8 Principles and Practice of 7ndodontics# R7 ,alton and M *orbine<ad eds2# ,= aunders 0o2# 4rd edition# 3113# pp2 4/>?1 and *rope M and igurdsson )2 0linical Manifestations and Diagnosis !n8 7ssential 7ndodontology8 Prevention and *reatment of )pical Periodontitis# D 6rstavi@ and *R Pitt Ford eds2# =lac@%ell cience# 1//-# pp2 1"?>1?-2 3 Pulp *ests are sensitivity tests that include thermal (hot and cold) and electrical (7P*) stimulation and responses are categoriAed as None (>)# Responsive (B)# &yper>Responsive (BB)# or Not )pplicable (N))2 4 Periapical (Periradicular) *ests include percussion and palpation and are categoriAed as None (>)# Mild (B)# Moderate (BB) or evere (BBB)2 4 )lso referred to as &ealthy Pulp (&P) 5N0 311+2 " )lso referred to as !rreversible Pulpitis# ymptomatic or )symptomatic PulptitisC Note8 &yperplastic Pulpitis (Pulp Polyp) is a form of !rreversible Pulpitis2 + More a finding or observation# but used as a diagnostic term2 ? Radiolucencies and(or Radiopacities of Non>7ndodontic 6rigin that normally respond to Pulp *ests are not included2 6ther terms include Non>7ndodontic Pathosis or .esions of Non>7ndodontic 6rigin2 )lso referred to as &ealthy Periodontium# Normal Periodontium2 / ,N. D ,ithin Normal .imitsC usually includes none to mild signs# symptoms# or responses2 11 )lso referred to as )cute )pical Periodontitis# )cute Periradicular Periodontitis# ubacute Periradicular Periodontitis2 ,hen associated %ith an apical radiolucency# also termed )cute 7'acerbation of )cute )pical Periodontitis ()70)P) 5N0 311+2 11 )lso referred to as 0hronic )pical Periodontitis# 0hronic Periradicular Periodontitis2 13 )lso referred to as )pical Periodontitis %ith )bscess# )cute Periradicular )bscess2 14 )lso referred to as )pical Periodontitis %ith inus *ract# 0hronic Periradicular )bscess# uppurative Periradicular Periodontitis# uppurative )pical Periodontitis2 14 )lso referred to as clerotic )pical Periodontitis# 0ondensing )pical Periodontitis# Focal clerosing 6steomyelitis# Periradicular 6steosclerosis2