Diagnosis and Treatment Plan of Common Oral Lesions

Diagnosis
Noncavitated caries
(Initial caries)
Arrested caries
Cavitated caries
(Dentin involvement)
Reversible pulpitis
(Deep cavitated caries)

Symptomatic Irreversible
pulpitis*
(Caries exposed pulp nonvital
tooth)
Asymptomatic Irreversible
pulpitis*
(Caries exposed pulp - nonvital
tooth)
Pulp necrosis **
(Caries exposed pulp - nonvital
tooth)
Symptomatic apical
periodontitis
(Apical lesion) *,**
Asymptomatic apical
periodontitis
(Apical lesion) *,**
Acute apical abscess **
(Apical lesion Phoenix abscess)

Sign and Symptoms

No any symptoms
Present white spot lesions
No any symptoms
Present brown spot lesions
No any symptoms
Usually present cavity
Food retention or impaction
Sensitive when drinking cold water or
having sweet diet
Usually present cavity
Food retention or impaction
Sensitive to all stimuli, especially hot water
Spontaneous sharp pain, sometimes linger
pain
Usually present cavity
Food retention or impaction
Negative to all stimuli
No spontaneous sharp pain
Usually present cavity
Food retention or impaction
No any symptoms
Usually present large cavity
Food retention or impaction
Pain when chewing
No gingival swelling

Examination & Investigation

Treatment
Negative to all stimuli except
Fluoride application
vitality test
Negative to all stimuli except
Fluoride application
vitality test
Positive to exploration (sometimes) Filling
Positive to air blow (sometimes)

No pain when chewing (Feel weird)

No gingival swelling

Sensitive to percussion
Negative to palpation

Pain when chewing or touching

Gingival swelling without sinus tract
opening

Positive to percussion
Positive to palpation

Positive to exploration
Positive to Vitality test (Vital tooth)

Filling

Positive to all stimuli

1.
2.

Negative to all stimuli except

Vitality test but irregular response

Negative to all stimuli

Positive to percussion
Negative to palpation

Root canal treatment and

Restoration (filling or crown)
Extraction

Medication
In case of pain
1. Ibuprofen 400 mg 1X3
In case of apical abscess
1. Amoxicillin 500 mg 1X3

Diagnosis
Chronic apical abscess **
(Apical lesion)
Gingivitis
Periodontitis

Gingival abscess

Sign and Symptoms

Pain when chewing (sometimes)
History of gingival swelling (sometimes)
Present sinus tract opening
Present of plaque and calculus: bad breath
Bleeding when brushing
Present of plaque and calculus: bad breath
Bleeding when brushing
Tooth mobility
Gingival recession
Gingival swelling with pus discharge
History of impaction of foreign bodies

Periodontal abscess

Gingival swelling with pus discharge

History of periodontitis
History of recent periodontal treatment

Pericoronal abscess

Gingival swelling with pus discharge

adjacent to impacted tooth

Examination
1. Exploration
2. Air blow
3. Percussion
4. Palpation
5. Vitality test
a. Thermal test: cold and Hot
b. Electric pulp test

Examination & Investigation

Sensitive to percussion

Treatment

Red gingival margin

Edematous gingival contour
Bluish red / red gingival margin
Edematous gingival contour
Tooth mobility
Bone loss (Radiograph)
No tooth mobility
Positive to palpation
Present of foreign bodies
Tooth mobility
Present periodontal pocket
Positive to palpation
Bone loss (Radiograph)

Scaling and root planing

Impacted tooth

Stimuli
1. Air
2. Food concentration
3. Radiographs
4. Thermal
5. Scrubbing / touching
6. Chewing

1. Scaling and root planning

2. Periodontal surgery
3. Extraction
Systemic medication (If indicated)
Scaling and root planing + Topical
medication
Scaling and root planing + Topical/
Systemic medication
Topical medication
1. 0.12% chlorhexidine mouthwash
Systemic medication (7-10 days)
Single medication
Amoxicillin 500 mg 1X3
OR
Clindamycin 300 mg 1X3
Combined medication
Amoxicillin 500 mg 1X3
+
Metronidazole 250 mg 1X3
1. Gingivectomy
2. Surgical remove