Testing Pulp Vitality
Vitality testing is a critical part of the endodontic diagnosis to determine the overall health of the dental pulp, in addition to the standard dental examination with exposed radiographs. Thermal testing by stimulating the nerve endings of the pulp with a cold spray is a highly effective way to test for tooth vitality.
In addition to this, it can also help localise specific tooth pain, help differentiate between odontogenic and non-odontogenic pain as well as helping to establish the dental pulp health prior to undertaking prosthodontic treatment.
The results of this test will indicate the vitality of the tooth before starting an endodontic procedure.
How to test for Tooth Vitality:
Step 1:
Isolate the area that needs to be tested with Cotton Rolls to prevent saliva from interfering with the test. Dry the tooth with cotton gauze.
Step 2:
Spray Cold Spray on to a cotton pellet until it is drenched. Fluffy cotton pellets are more effective than using cotton buds as they will retain more moisture.
Step 3:
Place cotton pellet onto tooth surface and ask the patient to raise their hand when they start to feel the cold sensation. Start by placing the cotton pellet on one or two teeth that are adjacent to establish a normal response. Place on the cervical region of the tooth for between 5 to 10 seconds, or until the patient responds.
How to interpret the results:
There are four main ways to interpret the results of the vitality test:
- Healthy Pulp – If the patient elicits a response that is similar to nearby or adjacent teeth, this indicates that the pulp is healthy;
- Reversable Pulpitis – The patient has a mild or sharp pain that disappears once the cold stimulus is removed from the tooth surface. Pulp vitality can be maintained if the tooth is treated, usually by restorative work;
- Irreversible Pulpitis – If the patient experiences severe and lingering pain for more than 10 seconds, even once the stimulus is removed, this indicates that further endodontic procedure or in some cases an extraction may be required, though this would only be as a last resort;
- Non Vital Pulp – If the patient has no response at all to the cold stimulus, the tooth can be considered non vital and immediate endodontic work is required. It is common to then have a crown or veneer fitted after the endodontic work is completed. In some cases, extraction may be the only option.
A cost effective and simple way to test for tooth vitality, a cold spray should be a staple of every practice. It is an essential part of the endodontic workflow and can significantly improve diagnosis and treatment.