Centro de Con♡cimiento         

1. Pulpal Diagnoses (The "Nerve" Status)

• Normal Pulp: Asymptomatic; responds normally to vitality tests.

• Reversible Pulpitis: Pain to stimuli (like cold) that resolves immediately upon removal.

• Symptomatic Irreversible Pulpitis: Vital pulp that cannot heal; characterized by lingering pain to thermal stimuli, spontaneous pain, or referred pain.

• Asymptomatic Irreversible Pulpitis: Vital pulp that cannot heal, but currently has no clinical symptoms (usually due to deep caries or trauma).

• Pulp Necrosis: The pulp is dead; non-responsive to vitality testing.

• Previously Treated: The tooth has had a prior root canal or endodontic therapy.

• Previously Initiated Therapy: A partial endodontic treatment has been started (e.g., pulpotomy or pulpectomy).

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2. Periapical Diagnoses (The "Bone/Apex" Status)

• Normal Apical Tissues: Not sensitive to percussion or palpation; lamina dura is intact.

• Symptomatic Apical Periodontitis: Painful response to biting or percussion. May or may not have a radiographic apical lucency.

• Asymptomatic Apical Periodontitis: Inflammation and destruction of apical periodontium (radiolucency present) but no clinical symptoms.

• Chronic Apical Abscess: Inflammatory reaction to pulpal infection; characterized by gradual onset and a sinus tract (stoma). Usually painless.

• Acute Apical Abscess: Inflammatory reaction to pulpal necrosis; characterized by rapid onset, spontaneous pain, swelling, and often systemic fever or malaise.

• Condensing Osteitis: Diffuse radiopaque lesion representing a localized bony reaction to a low-grade inflammatory stimulus.

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3. Structural & Surgical Diagnoses (The "Condition" of the Tooth)

• Non-Restorable Caries: Decay has progressed to a point where the tooth cannot be functionally restored (e.g., subgingival or into the furcation).

• Vertical Root Fracture (VRF): A fracture beginning on the root surface; usually necessitates extraction.

• Cracked Tooth Syndrome: An incomplete fracture of a vital posterior tooth that may or may not involve the pulp.

• Severe Periodontitis: Class III mobility or bone loss exceeding 70% with furcation involvement.

• Internal/External Resorption: Pathological loss of tooth structure originating from the pulp or PDL.

• Impacted: (Specific to 3rd molars) Classified as Soft Tissue, Partial Bony, or Complete Bony Impaction.

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4. Prognosis:                                                            Action/Plan

Good│Stable                                                                        Routine Maintenance 

Fair│Monitor/Early Intervention                                  S&RP / Local Delivery Antimicrobials 

Poor/Guarded │High Risk                                              Surgical Consult / Periodontal Surgery 

Questionable│Low Predictability                                  Consider Extraction vs. Heroic Dentistry 

Hopeless│Non-Functional/Infection Risk                 Extraction & Grafting / Implant Site Prep 

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Example » Diagnosis #19: Pulpal Necrosis with Symptomatic Apical Periodontitis; Non-restorable due to Vertical Root Fracture. Prognosis: Hopeless.

Common Terms:

Vitality

Vital, Non-Vital, Necrotic

Response

Lingering, Non-Lingering, Spontaneous

Apical

Percussion (+/-), Palpation (+/-), Swelling (+/-)

Integrity

Fractured, Non-Restorable, Perforated

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Periodontal DDX │

American Academy of Periodontology  »

Periodontal DDx (AAP Staging/Grading)

Instead of just "Gingivitis" vs "Periodontitis," use the Stage/Grade system to justify your surgical treatment plans (like implants or grafting).

• Periodontal Health: Pink, firm, no bleeding, no attachment loss.

• Gingivitis: Biofilm-induced inflammation without clinical attachment loss (CAL).

• Periodontitis (The "Surgical" Tiers):

  • Stage I/II (Mild-Moderate): Horizontal bone loss, Probing Depths (PD) 5 mm. Usually manageable with ScRP.

  • Stage III (Severe): Vertical bone loss, PD 6 mm, furcation Grade II or III. surgical consult 

  • Stage IV (Advanced/Potential Tooth Loss):Significant tooth loose, masticatory dysfunction, complex rehab, 

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DDX                                                   Visual/Clinical                                              Action

Plaque-Induced Gingivitis                  Bleeding, No Bone Loss                              Prophy / OHI 

Stage III/IV Perio                                Deep pockets, Vertical defects                   Surgical Intervention         

Endo-Perio Lesion                              Deep pocket + Non-vital pulp                     Endo first, then Re-eva  

Vertical Root Fracture                         Isolated deep pocket, hx or Rct                  Extraction (Hopeless) 

Nerotizing Periodontal Disease          Punched out" papillae, extreme pain          Antibiotics + Debridement 

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Furcation Involvement Classification (Glickman)

Grade I — Incipient / Early

• Early furcation involvement

• Slight bone loss in the furcation area

• Pocket extends into furcation slightly

• Minimal horizontal penetration

Grade II — Partial Furcation

• Partial horizontal bone loss

• Furcation can be entered with an explorer/probe

• Cul-de-sac involvement

• Does not extend completely through the tooth

Grade III — Through-and-Through

• Complete horizontal furcation involvement

• Probe can pass entirely through the furcation

• Furcation often covered by soft tissue clinically

Grade IV — Visible Through-and-Through

• Same osseous destruction as Grade III

• Gingival recession exposes the furcation clinically

• Furcation is visibly open and accessible