Endodontic diagnosis represents a multidimensional challenge. It should be thought of as a process leading to an answer rather than just a question and answer. During the process the dentist collects data including the chief complaint, medical and dental histories, radiographs, and clinical tests. This is followed by synthesis of findings leading to an evidence-based diagnosis.
Early in the process the clinician must categorize patient’s symptoms as being of odontogenic or non-odontogenic origin. If it is non-odontogenic a referral is often made to another health-care practitioner with expertise in that area. If the problem is odontogenic, the dentist has another question to resolve: “Should I treat the patient or should I refer the patient to a specialist?” This chapter discusses some of the issues and guidelines associated with that question.
The patient’s medical and dental histories and description of the onset of symptoms provide information that may have a bearing on the diagnosis and treatment plan. Specific medical problems including diabetes, liver disease, and alcoholism should be discussed in terms of their impact on treatment.
Reading this chapter will enable a clinician to recognize some of the key words used by patients and how they indicate non-odontogenic or odontogenic causes of pain. Important clinical findings including stomas and the use of local anesthetic as a diagnostic tool are also reviewed. Sample patient–dentist dialogues are presented demonstrating the importance of that conversation.
