Diagnosis and Treatment Planning
Build the database before the plan
Treatment planning is a sequence of disciplined data gathering, not a hunch about a tooth. Start with the chief complaint in the patient's own words, then expand into a history of the present illness (onset, location, duration, character, aggravating and relieving factors, timing, severity), medical and medication history, allergies, and social history including tobacco and alcohol. The medical history is not paperwork: it determines whether you need a physician consult (anticoagulants, bisphosphonates, poorly controlled diabetes, cardiac conditions) and which drugs and anesthetics are safe.
Examination and testing
Complete an extraoral exam (lymph nodes, TMJ, asymmetry, soft tissue) and an intraoral exam, then periodontal charting with probing depths, bleeding on probing, mobility, furcation and mucogingival assessment. Select radiographs by explicit diagnostic need and ALARA, not by habit. Use pulp sensibility testing (cold, electric) always with a contralateral control, plus percussion, palpation, transillumination, and caries risk assessment. Convert findings into a written problem list, then a differential diagnosis for each problem.
Sequencing
Urgent care first, then disease control (caries removal, scaling and root planing, needed endodontics, extractions of hopeless teeth), then definitive and reconstructive care, then maintenance. Re-evaluate periodontal and caries status before committing to expensive irreversible work.
Traps
Calling a tooth necrotic because it does not respond - recently traumatized teeth can be transiently unresponsive. Mistaking the mental foramen or incisive canal for a periapical lesion. Planning implants before periodontal stability or medical clearance. Prescribing a full-mouth series for every patient.
Rule of thumb: no irreversible treatment until the diagnosis is documented and active disease is controlled; when the diagnosis is uncertain, treat the symptom, not the guess. Worked example: sharp cold pain lasting a few seconds in a tooth with deep caries and no periapical change is reversible pulpitis - remove caries, protect the pulp, restore. Pain that lingers well after the stimulus or occurs spontaneously points to irreversible pulpitis and endodontic treatment.