The Role of Additional Methods in the Diagnostic Process
The capabilities of traditional dental diagnostics are limited, so to objectify the clinical picture, the physician resorts to technically advanced instrumental studies. Analysis and synthesis of all obtained facts allow building a logical-didactic framework. With its help, the specialist can competently substantiate the final diagnosis, develop patient treatment and rehabilitation tactics, and outline prevention pathways.
All methods used during a dental appointment are strictly divided into two broad categories:
- Basic methods: are based on direct contact with the patient. They include ascertaining complaints, taking a history (anamnesis morbi and anamnesis vitae), as well as a physical examination (visual assessment, palpation, percussion, probing).
- Additional methods: are employed to clarify the nature of the pathological process, the depth of tissue involvement, and for differential diagnosis.
Classification of Additional Methods
According to the classification, specialized instrumental and laboratory studies in dentistry include:
- Thermal diagnostics: assessment of the tooth's reaction to temperature stimuli. Helps differentiate carious and inflammatory pulp lesions.
- Radiological (imaging) method: essential for visualizing hidden cavities, assessing the condition of root canals, periodontium, and jaw bone tissue.
- Electric pulp testing (EPT): determining the excitability threshold of pulp nerve receptors using an electric current.
- Laboratory methods: include cytological, histological, and bacteriological analyses. Used when specific infections or oncological processes are suspected, or for precise pathogen identification.
- Special methods: other highly targeted tests required depending on the clinical situation.
Documentation and Diagnostic Timeline
All results of additional examinations, along with history taking and examination data, must be recorded in the "Development of the Present Illness" section of the dental patient's medical record (form No. 043/u). This record is a critical legal and scientific document.
Only after the examination is fully completed does the physician fill out the "Diagnosis" section. The timeframe is regulated:
- In outpatient settings (polyclinic) — within the first 1–2 days.
- In inpatient settings — within the first 1–3 days.
- In emergency (urgent) cases — within the first hours.
- In complex diagnostic situations (if not life-threatening), the definitive diagnosis is formulated exclusively after receiving the results of all prescribed additional examination methods.
Compliance Issues and Refusal of Examinations
Diagnostic success largely depends on the interaction between the patient and the physician (medical deontology). The patient may become the source of an iatrogenic situation and disrupt the treatment process.
At the stage of deciding on management tactics, a serious problem arises in the form of poor compliance — specifically, when the patient refuses additional examination methods or consultations with related specialists. Such behavior, along with "imposing" their own opinion on the physician or concealing anamnesic data, deprives the specialist of the opportunity to obtain an objective picture of the disease and make a correct diagnosis.
Briefly: answers to topical questions
What types of X-ray examinations are used in dentistry?
Dentistry utilizes intraoral and extraoral types of X-ray examinations, as well as tomographic methods.
- Contact intraoral radiography — includes periapical, interproximal, occlusal, and long-cone radiography.
- Extraoral radiography — examination of the skull bones, sinuses, and temporomandibular joint.
- Orthopantomography and panoramic radiography — obtaining an overview image of the teeth and jaws.
- Tomography and zonography — sectional imaging for pathologies of the jaws, nasal cavity, and orbit.
- X-ray computed tomography — obtaining 2D and 3D cross-sectional images of the head.
- Visiography — a digital method with high precision in assessing bone tissue structure.
- Electroradiography — used for emergency image acquisition.
What current values in EPT correspond to intact pulp, caries, and pulpitis?
Threshold current values during electric pulp testing vary depending on the physiological state of the dental pulp and the presence of an inflammatory process.
| Tooth condition | Current value (µA) |
|---|---|
| Intact pulp (healthy teeth) | 2–6 |
| Initial caries | 2–6 (sensitivity unchanged) |
| Moderate and deep caries | 20–40 (decreased excitability) |
| Pulpitis (pulp inflammation) | 10–100 (onset of inflammation — 20–25) |
What temperature stimuli are used during dental thermal diagnostics?
During thermal diagnostics (thermometry) to assess the reaction of dental tissues, hot and cold temperature stimuli are used. The stimuli include:
- Water — cold water or water heated to 60–70 °C applied to the tooth using a cotton pellet.
- Gutta-percha — used in a heated state.
- Dental instrument — applied in a heated state.
Exposure to these stimuli allows for the differential diagnosis of uncomplicated caries, pulpitis, and periodontitis based on the nature of the pain response (transient, prolonged, or absent).
For quick memorization of laboratory methods in dentistry, use the mnemonic CHB: Cytological, Histological, Bacteriological.
Class and exam questions
Where are the results of X-rays and EPT recorded?
The results of laboratory and instrumental studies are entered into the patient's medical record (form No. 043/u) under the "Development of the Present Illness" section.
Why might a patient hinder diagnostics?
The patient may consciously or unconsciously provide false information, conceal concomitant diseases, or directly refuse to undergo additional examination methods, making it impossible to substantiate the diagnosis.
What else to study on this topic
- Patient's Medical Record (Accounting Form No. 043/u) and Guidelines for Filling It Out
- Basic Examination Methods (History Taking, External and Intraoral Examination)
- Tooth Notation Systems (Two-Digit and Square-Digit Dental Formulas)
- Medical deontology and prevention of iatrogenic diseases
- Palpation of lymph nodes and exit points of the branches of the trigeminal nerve
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Other topics of section "Chapter 16. Methodology of dental patient examination"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.