Modern concepts in endodontics. Part 1. Diagnosis

Diagnosis is the basic procedure from which further endodontic treatment decisions flow. Although we still use diagnostic tools which differ little from those of 50 years ago, our understanding and interpretation of their results has been slowly changing. As an example, we now believe that the painful responses to hot and cold occur via different a delta and C fibre pathways, involving changes in intra pulpal pressure and neuropeptides such as VIP and SP. As treatment planning is becoming more sophisticated and treatment modalities and options are expanding, correct endodontic diagnosis is even more important in the new age of rising patient expectations and ever-increasing legal complexities. Endodontists are frequently called upon to deal with difficult diagnostic situations, or manage situations of misdiagnosis where treatment has been initiated but the original chief complaint mysteriously persists. In the future, new exciting techniques such as pulse oximetry or laser doppler analysis may be clinically available as endodontic diagnostic aids. This paper will try and cover some of the broader concepts involved in correctly diagnosing a patient's chief complaint.