Necrosis: Differential Diagnosis

Differential diagnosis of pulp necrosis is not as problematic as is pulpitis. However, in some clinical situations diagnosis of pulp necrosis is not easily made. Pulp testing is an important tool in diagnosing necrosis, therefore most difficulties are related to pulp testing.

Teeth with obliterated canals often respond poorly to pulp testing. Large restorations may also hamper pulp testing, but crowns in particular typically make it difficult to evaluate the vitality of the pulp. Carbon dioxide ice sticks can be used in pulp testing of teeth with crowns and prolonged contact with ice sticks may also help in some cases. Several teeth should always be tested for comparison and cross-reference whenever possible.

Pulp testing provides information of nerve activity in the pulp. Temporary loss of sensibility after injury results in a negative response to pulp testing for a few days to several months even though blood circulation continues normally and the tooth is vital. Therefore, caution must always be employed when testing teeth after trauma.

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