Between working in my endodontic practice and running E-School: Everyday Endo Made Easy, I field a LOT of questions, day-in and day-out, from dental professionals. But lately I keep getting the same question from the lovely dentists who read my blog, subscribe to my informational emails, follow me on social media, and enroll in E-School. And that question is: Sonia, how do I improve my endodontic diagnosis? 

It makes sense. As medical professionals, our diagnosis is the number one most important key to managing or eliminating our patients’ pain. Diagnosis drives who we refer to or how we treat the patients, ourselves. It even influences how we anesthetize patients during procedures and what medications we prescribe them later. 

It’s a big deal! 

And the consequences of a misdiagnosis can mean our patients lose trust in us. So the stakes are pretty darn high.

Luckily, I’ve got a pretty streamlined process for upping your diagnosis game with one single test. Let’s dive in.

How to Improve Endodontic Diagnosis – Step 1: Let’s Talk Cold Tests

My friends, you can never underestimate the importance of the cold test. Unfortunately, however, in my career I’ve come across more and more patients and dentists alike who treat the old endo ice test as if it is optional

In fact, it is mandatory in order to achieve an accurate diagnosis. 

Whether you are doing a treatment yourself or referring your patient out to a specialist, the cold test can help you do two things. It can help you A) Figure out which tooth you actually need to treat and for what, or B) Help you determine which specialist you need to send your patient to. 

These decisions have a huge impact on your patient—because naturally, they don’t want to waste their time and money on treatments or specialist visits that don’t yield results—and also have a huge impact on you!

Building trust with your patients and allowing them to feel real confidence in you requires that you cover all your bases, and diagnose them as accurately as possible so you can expedite their healing.

Cold Test. Every Time!

Improving your endodontic diagnosis means doing a cold test. Yes, every time! 

Whether you’re treating a new patient or an emergency patient, there are few things that will give you the information you need quickly. The cold test is one of those things! 

You cannot rely on the radiograph alone to guide your diagnosis. This is a common error I see lots of folks make and it can lead to a misdiagnosis. 

Take, for example, a patient who is presenting a radiographic lucency, so we assume that the tooth is necrotic. But that radiograph isn’t the end-all-be-all. By performing a cold test with endo ice, we can quite quickly determine the accuracy of that assumption. I can’t tell you how many times a tooth presented like this in a radiograph, but was, in fact, vital. 

Or what if you failed to perform a cold test before putting on a crown, only to find out that the tooth is necrotic after the cement has been applied? That’s a big ol’ oof.

Skipping an ice test can lead to some major missteps—don’t let that happen to you!

Step 2: Skip the Cotton Swab

Want to improve the efficacy of your cold tests? Please, please, please don’t use a cotton swab as you perform them! 

Why? A cotton swab simply cannot get cold enough (and hold on to that temperature) to perform the test accurately. If you’re using cotton swabs to get the job done, chances are you are finding a lot more necrotic teeth than are actually there. 

Instead, I suggest using a cotton pellet on a pair of college pliers (get the step by step in this endo quick tip blog!). And make sure you really saturate the cotton with your endo ice spray! Using this method allows for outcomes that paint a more accurate picture of what’s going on with the tooth in question. 

Step 3: Prep Your Patient

Listen. It’s a simple fact that comes with the territory of doing endodontics. The cold test is, well, uncomfortable for your patient. 

But that’s no reason to forego it altogether. 

Just be honest with your patient. Let them know what to expect and reassure them the entirety of the test should last no more than a minute. 

Also take this opportunity to provide a little education. Let your patient know you are performing the test to accurately diagnose and treat the tooth that is causing them problems. When people understand the necessity of the procedure, they are far less likely to resist it. 

Step 4: Cold Test in Two Quadrants

Want to make double sure you’re improving your endodontic diagnosis and getting the most accurate read on the situation possible? 

Then, you don’t just need to perform the cold test in the area from which the pain is originating. You need to perform a cold test in two quadrants. Why? Because you need to establish a baseline of what a normal response looks like for that specific patient sitting in front of you. 

In order to gauge that baseline, I like to test a clinically similar tooth in a different quadrant. 

For example, if tooth #3 is the tooth in question and it has a crown, I’ll find another first molar with a crown and use it as a “control tooth” to get an understanding of what’s normal for that patient. Because everyone is different! That’s part of the beauty and the challenge of endo.

Nailing Your Diagnosis

Drawing the right conclusions—from a combination of radiographs, observation, and procedures like a diagnostic cold test—is what ultimately guides your treatment. That’s why being as thorough as possible is of the utmost importance. No one wants to deal with a misdiagnosis! 

Getting our patients out of pain and keeping them that way requires that we flex all our endo skills to diagnose, refer, or treat in the most appropriate and effective manner. 

When you’re able to nail your diagnosis, you nail everything else that follows. And as a result, you build trust with your patient, who will likely remain loyal to you and your practice (and probably rave about your endo skills to all their friends!). 

If you feel less than confident when it comes to endo diagnosis, subscribe to my email list to get endo tips and tricks delivered to your inbox every week. As a subscriber, you’ll get $300 off E-School with Coaching!

What are your endo diagnosis struggles? Drop me a line in the comments and I’ll do my best to address them in future blogs!

– Sonia