VITALITY TEST AND

PERIODONTIUM TEST

O.R.GANESAMURTHI B.D.S M.Sc.D ENDO

UNIVERSITY OF THE EAST

MANILA

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INTRODUCTIONThere are several ways to obtain information about the condition of a tooth’s pulp and supporting structures. Probably no one test is sufficient in it self; the result of several test often have to be obtained to have enough information to support a likely diagnosis or perhaps a list of differential diagnoses.

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THERMAL PULP TEST One of the most symptoms associated with

the symptomatic inflamed pulp is pain elicited by thermal stimulation.

When pulp responds abnormally to thermal stimulation, either in an exaggerated manner or not at all, is that it is not in a state of good health.

The rationale for innervation of any bodily structure is to provide a warning of damage that is occurring or impending.

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The pain is proportionate to the stimulation; consequently even teeth with intact enamel will react to extreme cold, such as ice or carbon dioxide snow.

When the teeth react to stimuli that do not normally produced pain, such as tap water, the probability is that dentin has been exposed by caries, that the tooth has fractured, or that faulty restoration, abrassion or attachment loss cause by periodontal disease. 4

When the CC is pain to a thermal stimulus the clinician must distinguish between thermal testing to isolate the offending tooth by reproducing the patients symptoms and attempting to determine if the suspected tooth has a vital or non vital pulp.

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COLD TEST Cold test may be used in differentiating

between reversible or irreversible pulpitis and in identifying teeth with a necrotic pulp.

When cold is used to differentiate between reversible or irreversible pulpitis, one must have to determine if the effect of the stimulus application produces a lingering effect or if it subsides immediately after the removal of the stimulus from the tooth.

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In testing if the pain lingers, that is taken as evidence for irreversible pulpitis.

and if pain is subside immediately after stimulus removal most probably the diagnosis is hypersensitivity or reversible pulpitis.

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PULP NECROSIS VS. VITAL PULP Cold as test for pulp vitality is probably not

entirely reliable since teeth with calcified pulp spaces may have vital pulp, but cold stimuli may not be able to excite the nerve endings owing to the insulating effect of tertiary dentin .

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VARIOUS METHODS FOR COLD TEST

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HEAT TEST As with cold test, there are some methods

for heat testing teeth have been suggested.

Hot testing can be made with a heated gutta percha or a hot water bath. ( heated gutta percha is more convenient to clinicians, but the hot water bath yield the most accurate patient response.)

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ELECTRIC PULP TEST Electric pulp tester uses electric excitation

to stimulate A delta fibers within the pulp.

A positive response to EPT does not provide any information about the health or integrity of the pulp it simply indicates that there are vital sensory fibers present within the pulp.

Often, irreversible inflamed pulp is responsive to EPT because it still contains vital and functional nerve fibers that can produce a toothache.

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EPT provides only a responsive or non responsive result that correlates, in many cases, with vital or non vital pulp status, therefore attempting to interpret the numerical values produced by EPT is not recommended.

EPT does not provide any information on the vascular supply of the pulp which is the true determinant of pulp vitality.

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Teeth that temporarily or permanently lose their sensory function will be non responsive to EPT however they will have intact vasculature.

To achieve consistent result with EPT one must follow a standard procedure.

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TECHNIQUE FOR EPT Dry the tooth to be tested by 2x2 gauze and

isolate with a cotton roll. Cover the tip of the electrode with toothpaste or

similar electrical conductor. If the tooth has a proximal metallic restoration it

is necessary to used a rubber dam to prevent electrical conduction to adjacent teeth.

Clinician should explained the patient about the sensation of heat or tingling felt during testing.

The patient should place a finger on the handle of the testing device to serve a “switch”.

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then the electrode is place on the dry enamel of the tooth being tested on the middle 3rd of the facial surface of the crown.

Current flow should increased slowly to allow the patient time to respond before the attendant tingling sensation becomes painful.

Each tooth should be tested at least two or three times and an average should be recorded.

For multi rooted teeth may need to be tested by placing the electrode on more than one location.

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PALPATION Palpation testing is using a digital pressure

to check any tenderness in the oral tissue overlying suspected teeth.

Sensitivity indicates that inflammation in the periodontal ligament surrounding the affected tooth has spread to the periodontium overlying the jaw bone.

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In this manner an incipient swelling may be detected before it is clinically evident by rolling the index finger over the mucosa and pressing it against the underlying bone.

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PERCUSSION Tenderness noted upon percussing a tooth

indicates some degree of inflammation in the periodontal ligament.

It may be cause by: Occlusion Trauma Sinusitis Periodontal disease Extension of pulpal disease on the periodontal

ligament26

Percussion is not a test for pulp vitality.

Before testing the clinician should communicate the purpose of the test to the patient and explained how the patient should indicate any tenderness (eg. Raising a hand)

Testing should begin with gentle tapping It should be in randomly tap teeth in

suspected quadrant, beginning with one that is not suspected so the patient is aware of normal sensation

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If the patient is unable to discern a difference in sensation with digital percussion, the blunt end of the mouth mirror can be used.

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MOBILITY Tooth mobility indicates the integrity of the

attachment apparatus (whether inflammation of the periodontal ligament exists.)

The clinician should use 2 mouth mirror handles to apply alternating lateral forces in a facial lingual direction to observe the degree of mobility of the tooth.

Degree of depressability within its alveolus should also be tested (by pressing the tooth to its socket and any vertical movement should be noted)

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All movement is subjected to individual differences 1st degree mobility is barely perceptible

horizontal movement 2nd degree no more than 1 mm horizontal

movement 3rd degree greater than 1 mm horizontal

movement and or vertical depressability.

The pressure exerted by the purulent exudates of an acute periradicular abscess may cause considerable mobility but it resolves quickly once drainage for exudates is established. 30

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PERIODONTAL EXAM A far more sensitive is to use a blunt,

calibrated probe to explore the attachment level in the gingival sulcus around each tooth.

All surface of the roots should be probed along with any furcas, findings should be recorded.

Probing must be performed throughout the mouth as with the periodontal screening and recording technique to appreciate the patients overall condition. 32

Wide gently sloping craters around multiple teeth characterized periodontal disease.

In some case a sinus tract can drained pus from the apex of a tooth with a necrotic pulp to the oral cavity through periodontal ligament.

It is useful for diagnostic confirmation to place a gutta percha in the sulcular defect and expose a radiograph film to confirm the depth and the direction of the periodontal pocket, to distinguish a periodontal from endodontic etiology. 33

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PULPAL DIAGNOSIS

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REFERENCES: Pathways of the pulp 9th edition by: S. Cohen and R.C.

Burns Pages 1-29 Endodontics Ingle Bakland 5th ed. Dentistry, chapter

6 http://www.acteongroup.com/prod_escl_list.aspx?id_m

enu=37 http://images.google.com.ph/images?hl=en&um=1&q

=tooth+palpation&sa=N&start=20&ndsp=20 http://books.google.com.ph/books?

id=aV1kEf7mlckC&pg=PA669&lpg=PA669&dq=percussion+of+teeth&source=bl&ots=TJmHLNKuTV&sig=17y48zbjIUzd6DDTICEtjV9rOlM&hl=en&ei=kt-nSqf_HY2WkAXAx7SFCQ&sa=X&oi=book_result&ct=result&resnum=10#v=onepage&q=percussion%20of%20teeth&f=false

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