The 4R Operational Diagnosis (4ROD) is a protocol for the clinical data collection and biologic assessment of the dental diagnostic findings of the patient signs, symptoms, Dentin, Endodontium, and Periodontium of a tooth of interest.

Using the 4ROD protocol generates eight sets of diagnostic findings which the clinician can evaluate to reach a definitive diagnosis by the end of the dental appointment. The sets of diagnostic findings are:

1. Patient Pain Profile questionnaire (PPP)
2. Dental history
3. Social and Medical history
4. Diagnostic imaging PA or/and BW of the tooth of interest.
5. Pulpal health status findings
6. Periodontal health status findings
7. Tooth structure status findings
8. Restorative dentistry findings

The R1.(Report findings); the Patient Pain Profile (PPP) is the highlight of the 4ROD protocol. PPP is assessed using the standard criteria of pain profile: Onset, Quality, Quantity, Duration, and Subsidence.

The R2.(Radiographic findings); focuses on the use of PA and BW radiographs as the most practical and accurate intra-oral radiology. R2 utilizes the 10 Areas of Diagnostic Interest protocol developed by the author to systematize the radiographic interpretation of Periapical Radiographs.

The R3. (Response testing); eliminated the use of Electric, Heat, Percussion, Bite, and Palpation tests as endodontic tests. R3 streamlined the pulpal response testing into Cold Pulp Test, and Fistula tracking, and Periodontal testing into the standard PI, BOP, PD, CAL, MMI tests.

The R4 Restorative and tooth structure findings focuses on visual and clinical examination of the tooth and gingiva Warning Signs.

Educational Objectives

The content of unit two is organized to accomplish the following objectives:

1. Use the eight diagnostic reports generated from the use of the 4R Operational Diagnosis (4RROD) in endodontics related periodontic and restorative dentistry treatments
2. List the 10 Areas of Diagnostic Interest (ADI)
3. Describe the Best Practices in the Diagnostics of Endodontics, Periodontics, and Restorative Dentistry

The dental school teaching considers Tooth resorption a "rare phenomenon" that affects the internal, external, or apical surfaces of teeth. The causes are physiologic, idiopathic, pathologic, or following orthodontic treatment. The Differential Diagnosis and treatment of the different types of root resorptions depends on the characteristics of the radiographic image of the resorption defect. 

 The current knowledge of root resorption is entirely different. Root resorption is no longer considered a rare phenomenon. Root resorption is a common iatrogenic, pathologic complication of substandard dental patient care. According to Tsesis et al., 2008, 71.2% of root resorption is of Endodontic etiology, followed by 14.6% of Orthodontic-etiology and 10.2% of Oral pathology etiology. Therefore, because the causes are known, most root resorption problems are preventable.

The author presents key academic concepts and suggestions on what should the patient be told when in the dental hygiene process of care, a dental hygienist encounters  a root resorption situation.  

The content of unit 4 empowers practicing dental hygienists with the academic knowledge and diagnostic skills to exercise their role as the primary providers of evidence-based preventive oral healthcare information and at the same time, assist and collaborate with dentists in the diagnostic aspects of patient care. 

Educational Objectives

Unit 4 content has been organized to achieve the following objectives:

1. Describe the current knowledge of root resorption in modern dentistry.
2. Diagnose root resorption problems with the 4R operational diagnosis protocol.  
3. Describe the author's classification of the problem- based root resorption
4. Outline what the dental hygienist should tell the Patient about the different types of root resorption 

75% of dentoalveolar infections are of Endodontic and Periodontic origin. These infections are biologically interrelated, pathologically slow-paced, and usually, progress unchecked because of their asymptomatic nature. Fortunately, the etiology of dentoalveolar diseases is well known and, therefore, preventable. The causes are bacterial coronal and apical microleakage, developmental tooth anomalies, and tooth alignment abnormalities.

A Warning Sign is a diagnostic clinical or radiographic finding of change of an established clinical or radiographic norm detected during the examination of the Patient's mouth, gingiva, or teeth. Diagnostically, the Warning Signs manifest as  changes in tooth or gingiva; anatomy, color, structure, texture and/or radiographic appearance. Pathologically, the changes are an indication of underlying pulp, periapical, or periodontal pathology. Conceptually a Warning Sign should be considered as "The Tip of the Iceberg." 

Educational Objectives

Unit 6 content has been organized to achieve the following objectives:

1. Define coronal and radicular micro-leakage and discuss its relevance to endodontic and restorative treatment outcomes.
2. Describe the concept of dental warning signs, and it's a clinical application to the dental hygiene process of care
3. Categorize the most common warning signs of tooth and gingiva encountered in clinical and radiographic examinations.