Guidance to Achieve Clinical Pulpal Diagnosis and Operative Decisions

Abstract

Determining the accurate status of the pulp of primary and young permanent teeth is a challenging task for any provider treating children and young adults. The younger the child, the more difficult to obtain objective and clear information since children are considered “poor historians.” Multiple diagnostic tests are available, but limitations for their use exist, especially when treating pre-cooperative and patients with special needs. The utilization of adequate behavior guidance techniques is paramount to the gathering of critical information such as response to clinical tests and radiographic images. Since the histopathological status of the pulp is impossible to obtain, the collection of all test results and radiographs will likely lead to a preoperative diagnosis. The final diagnosis is only obtained when treatment is performed. The decision of being conservative or more aggressive on the operative approach is very personal and depends on experience and correct interpretation of the information collected. The goal of this chapter is to provide the clinician with knowledge of currently available tests and evidence-based recommendations to achieve pulpal diagnosis. In addition, the current terminology for pulpal and periapical pathology for young permanent teeth is also described.