By doing research, the dentist tries to come to the right diagnosis. This is done on the basis of:
- Anamnesis. The patient is asked to describe the pain, when the pain is present and where.
- Intraoral examination:
– The teeth are checked for caries and fractures.
– The cover fold is palpated.
– Thermal sensitivity test: the sensitivity of the pulp is tested by applying cold (chloroethyl) or heat pickles (warm gutta-percha).
– Electronic pulp tester: this tests the vitality of the pulp.
– Percussion test: by gently tapping an element with the back of a metal instrument, it is tested whether an element is knock-sensitive.
- X-ray picture. Apical inflammations are visible on a solo recording of the relevant element through a dark spot around the root point. A gutta percha point can also be inserted into the fistula. This is visible on the X-ray and shows where the fistula has its origin.
- Test drilling. Without anesthesia, a small cavity is drilled into the element to test the vitality.
- Test stunning. By selective anesthesia, the origin of the pain can be located.
Sometimes, despite these diagnostic tools, it is not possible to determine where the cause of the pain is. Then it is necessary to wait until there is more clarity.
When a root canal treatment is indicated, the DETI score is determined. DETI stands for Dutch Endodontic Treatment Index. With this, it is determined on the basis of a number of questions whether it will be an uncomplicated (DETI score A) or a complicated (DETI score B) endodontic treatment. With a DETI score B, the difficulty level is then estimated by filling in the CEB (Endodontic Treatment Classification). This is a more extensive questionnaire than with the DETI score. Based on the classification (I, II or III), the dentist can decide whether to perform the root canal treatment himself or whether the patient can be better referred to an endodontist.