November 22, 2014
The pulp vitality test helps to ascertain the condition of the pulp. The pulp is the soft inside of the tooth that contains connective tissue, nerves and blood vessels. Often patients report pain and sensitivity in a particular tooth. Other than radiography, the dentist uses vitality tests to isolate the affected tooth and to understand the extent of the condition. It is used to decide the course of further treatment. It is also carried out before any restoration is attempted to rule out pulpal disease.
Vitality testing can take several forms and is based on the main complaint of the patient. It consists of applying hot, cold or electrical stimulation to the teeth. Another means for testing are the cavity tests, though they are used sparingly.
Pulp vitality testing procedure
Generally testing begins with thermal testing and if there are no complaints regarding thermal sensitivity, then the tooth is checked for response to cold stimulation. The dentist may use an ice pencil or a cold spray cotton pellet. If the patient complains of pain on eating or drinking something hot, then a hot stimulus is applied for vitality testing. Irrigating the area with hot water with the help of a syringe is one method or heated gutta percha may be used to check the response of the dental pulp.
Another method for pulp vitality testing is the use of an electric stimulus with the help of an electric pulp tester. A special paste is used as a conductor of the electric current. The probe is touched to the tooth being tested and the initial current is very low. This current is increased very gradually till it elicits a response. The intensity at which there is a response is noted.
Normal procedure is to start testing from the opposite part from the point of pain. This helps both, the dentist and the patient, to understand the patient’s normal response to stimulation. It also has the added benefit of relaxing the patient who may be nervous in anticipation of pain or discomfort.
The patient is asked to indicate his response through a hand signal and may also be asked to rate the intensity of the pain. The dentist takes different aspects of the response into consideration to make the diagnosis. These include the reaction time, the intensity level as well as how long the sensation lasts.
Sharp pain on cold stimulation is an indication of pulpitis or inflammation that is reversible and does not require treatment. Discomfort or pain that lingers even after the stimulus has been removed is a cause for concern and indicates irreversible pulpitis. This needs to be treated as, if it is left untouched, will lead to pulp necrosis. This may eventually take the form of a dental abscess oracute apical periodontitis. However, chronic periapical periodontitis may not elicit a response altogether. Treatment may require root canal treatment or extraction of the tooth depending on the condition of the pulp. If the patient has taken any painkiller even 12 hours prior to the test, then sensitivity may be greatly suppressed.