Authors: Seltzer S.
Title: Classification of pulpal pathosis.
Journal: Oral Surg Oral Med Oral Pathol
Date: Aug 1972
Citation: 34(2):269-87
Category: Diagnosis and Case Selection
Evidence-based Ranking: 5
Purpose/Objectives: To discuss past methods of classifying pulpal pathosis as compared to new recommendations Materials & Methods: This is a philosophical paper that discusses how pulpal disease has been classified in the past and how the author feels this should be modified. He states that in the past, clinical and histolopathologic nomenclature has been intertwined, resulting in misleading terms and diagnoses. The author suggests that a discussion of classification of pulpal pathosis must be based on etiology, histopathology and symptoms. Etiology - changes in pulp may be due to aging, dental tissue manipulation, disease processes and trauma. Histopathology - the author lists the following as representing the entire spectrum of histopathologic diagnosis of pulp pathosis: atrophic pulp, transitional stage, acute partial pulpitis, chronic partial pulpitis, chronic total pulpitis, and total pulp necrosis. Symptomatology – the author states that there is no clinical sign or symptom which designates the histopathologic status of the pulp with certainty. The use of as many tests as possible are needed to try to obtain a correct diagnosis. The author discusses “classification based on pain” and “classification for therapeutic purposes”. Pain is the most common symptom of a diseases pulp and usually indicates tissue damage. The author discusses characteristics of pulpal pain, intensity (severity) and duration of pain, spontaneity of pain, thermally induced pain, electrically induced pain and the history of prior pain. Under “classification for therapeutic purposes” the author states that clinical judgment, based on the patients’ history, signs and symptoms directs pulpal therapy. It is impossible to know the exact histologic status of the pulp and the practitioner must make a decision as to whether the tooth is treatable by medication (pulp capping) or if root canal treatment is warranted. Reviewer’s Comments: This paper gives a very thorough description of factors that need to be considered when determining a pulpal diagnosis.