Welcome to Julian Webber's blog where he muses on a range of topics including some of his most interesting cases,
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Shining a light on diagnosis by Trevor Lamb


I frequently find myself being asked for a second opinion. The patient comes to see me saying their dentist believes the problem with their tooth is sensitivity. But the patient suspects that the nagging discomfort is in fact a more deep-rooted problem – forgive the pun – and they wind up in my chair.

Today, dentists take a minimally invasive approach. They don’t want to open up a tooth or even carry out an x-ray unless it is necessary, which is of course correct. The trouble is, that the “minimally invasive”, “wait and see” approach does not always provide a solution.  Very often, the patient with toothache finds the absence of a clear diagnosis and a solution  frustrating because it does not signal an end to the problem.


I have several tests I undertake depending on the state of the tooth and the suspected problem. First I use the aspirator to blow cold air. This helps me zone in on a tooth or teeth that are symptom producing.  Then I percuss gently, tapping with the back of a mirror handle to see if I get a reaction. I might test all the teeth in the quadrant to make sure the patient is correctly identifying the source of the discomfort.


If the tooth has a minimum restoration and I suspect a crack, I use an LED light. Healthy teeth transmit light whereas a fracture line stops the light. For a tooth which is heavily restored, I use a bite stick or Tooth Slooth.


This is followed by cold and hot testing of the pulp of the affected tooth.  The final and definitive test is the electric pulp tester. From the above tests a preliminary  diagnosis of the pulp status can be made – reversible pulpitis or irreversible pulpitis.  Finally a radiograph is taken.


To the dentist in practice, wanting to deal with a worried and frustrated patient, I would always recommend a Tooth Slooth and/or  LED light investigation followed by an electric pulp test. By this time, the patient is reassured and happy that the cause of their toothache has been fully investigated and a solution may be on the horizon.


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