Dental pulp testing is a useful and essential diagnostic aid in endodontics. Pulp sensibility tests include thermal and electric tests, which extrapolate pulp health from sensory response. Accurate assessment of the health of the dental pulp is very important for successful endodontic treatment. Laser Doppler flowmetry and pulp oximetry are few examples of vitality tests.
Cold spray is applied and held on a tooth for 5-10 seconds. If the pain lingers for more than 10 seconds after the tip is removed this is considered evidence of irreversible pulpitis.
Softened or heated Gutta-percha is apllied on the tooth to deliver heat to the pulp. These methods may produce sufficient heat to stimulate the C fibers and produce pain that lingers.
This test may serve as a last option in testing for pulp vitality. It is only considered when the results of all other tests have proved inconclusive. The test cavity is made by drilling through the enamel-dentine junction of an unanesthetized tooth at slow speed with good isolation. This may be achieved under rubber dam with a small round diamond bur with adequate coolant. The patient is asked to respond if any painful sensation is felt during the drilling procedure. If the patient feels pain once the bur contacts the sound dentin, the procedure is terminated, and the cavity is restored.
Electrical Pulp Test
The electric pulp tester (EPT) is widely used to differentiate between lesions of endodontic origin and those not seen on radiographs. This device is designed to deliver an electric current to stimulate the closest delta fibers. The EPT indicates the neural transmission and presence of vital nerve fibers but does not measure the health or integrity of the pulp. Recently traumatized teeth that may temporarily lose their sensory function have no response to the device even though teeth has blood supply(false-negative) whereas teeth that are partly necrotic may give a response, even though they lack a blood supply (false-positive).
When dental symptoms are poorly localized or referred, an accurate diagnosis is extremely difficult. Sometimes, patients may not even able to specify whether the symptoms are from upper or lower arch. In such cases, anesthetic test may be helpful. The technique is done by either infiltration or an intraligamentary injection, the most posterior tooth in the area suspected of causing the pain is anaesthetized. If pain persists once the tooth has been fully anesthetized, the tooth immediately next to it is then anaesthetized, and the procedure is done until the pain disappears.
Place your finger at the edge of the tooth and gently press it inwards. If patient feels pain then periapical region is inflamed. If no pain it indicates healthy pulp. More accurate results can be obtained from radiographs and combination of other tests.
This test helps if patient complains pain on biting or having food. . Ask the patient to bite on a hard object (cotton roll, tooth pick or tooth sloth) on the suspected tooth and tooth on opposite side. Patient will report of pain on biting if the pulp is damaged upto the periodontal ligament or if there is any vertical fracture.
Place your index finger and place it in the periapical area. If patient reports pain then periapical region is inflamed. If no pain it’s intact. More accurate results can be obtained from radiographs and combination of other tests.
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