Dental Problems

Pulp Testing Methods

DenturesPulp testing is one of the effective ones to follow before the treatment for a root canal therapy or any tooth filling. There are various pulp testing methods which are useful to know the health of the pulp tissue. Later, after the testing it is helpful to know the follow a tooth filling to get back the healthy tooth. Different conventional and newer pulp testing methods are discussed below in this article. Let us examine them.

Conventional pulp testing methods:

  1. Thermal (cold or heat) method:

    • Technique or material:

      ethyl chloride, ice, air, blast, hot water, heated gutta percha (used for location of symptomatic tooth)

    • Symptom or interpretation:

      • Lingering pain: irreversible pulpitis
      • Hypersensitivity or subsiding pain: Reversible pulpitis.
  2. Electric method:

    • Technique or material:

      instrument such as odontometer.

    • Symptom or interpretation:

      • Higher current required (nonvital or chronic inflammation)
      • Lower current required (acute pulpitis) unreliable in children, recently traumatized teeth and multirooted teeth.
  3. Percussion:

      • Technique:

        Vertical

        Symptoms of interpretation:

        Apical periodontitis (irreversible pulpitis, if due to caries)

    .

  4. Techinique:

    Lateral

    Symptoms or interpretation:

    Lateral periodontal space inflammation

  5. Radiograph:

    • Technique:

      IOPA

    • Symptom or interpretation:

      • Furcation involvement
      • Thickening of the PDi space: indicated periapical infection (usually accompanied with irreversible pulpitis).

Newer pulp testing methods:

  • Laser Doppler Flowmetery:

    • The laer droppler flowmeter, developed in the 1970s to measure the velocity of red blood cells in capillaries, is a noninvasive, objective, painless alternative to traditional neural-stimulation methods, and therefore a promoising test for young children.
    • The flowmeter produced regular signal fluctuations for vital teeth.
    • Nonvital teeth showed no such synchronous signal but produced irregular fluctuations or very sleep spike traces that were attributed to a movement artifact. This instrument has demonstrated its value for ongoing assessment of post-traumatized permanent incisors.
  • Pulse oximetry in evaluation of vitality:

    • Since pulp vitality is purely a function of vascular health, a vital pulp with an intact vasculature may test nonvital of only its neural component is injured as in a recently traumatized tooth. For electric and thermal testing to be effective, the pulp must have a sufficient number of mature neurons. However, both primary and immature permanent teeth may not exhibit full alpha myelinated axon innervations until 4-5 years after eruption.
    • This reduced number of pain receptors makes them less responsive to stimuli. Considering all these limitations, present pulp testing with thermal and electric methods cannot be considered reliable vitality tests for children.
    • A direct measurement of pulp circulation is the only real measure of pulp vitality. Pulp oximetry is a completely objective test, requiring no subjective response from the patient, that directly measures blood oxygen saturation levels. To determine oxygen saturation, the pulse oximeter measures and compares amplitudes of the ratios of transmitted infra-red with red light. This ratio varies with relative fractions of oxygen saturated to oxygen saturation. These characteristics infer that the pulse oximeter is also capable of evaluating the blood vasculature status within a tooth and therefore pulp vitality.
    • The dependence on a pulsatile blood flow appears to be a disadvantage of the use of the pulse oximeter.
  • Dual wavelength spectrometry:

    This measures blood oxygenation change within the capillary bed of dental tissue and thus not dependent on a pulsatile blood flow.

  • Higherprobeye camera:

    This is used in detecting temperature change as small as 0.1 degree centigrade hence been used to measure pulp vitality experimentally.

The above article discusses briefly about the conventional and newer pulp testing methods.

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