10 Alternatively, a micro-EPT that is thin (like an explorer tip) can also be used. A fine tip of an explorer or file can be used to contact tooth structure cervical to the crown margin, and the EPT probe tip contacts the instrument (Figure 2). 9 If a full coverage restoration is present, a bridging technique can be utilized. The latter has the benefit of having the patient in charge of the test by letting go of the handle if a sensation is felt. An electric pulp tester tip and contact medium placed on sound tooth structure.ĭepending on the EPT used to complete the electrical circuit, a lip clip is placed on the patient, or the patient will holds the metal handle. However, placement of the tip on sound tooth structure anywhere on the clinical crown will yield an accurate result (Figure 1). 7 According to Bender et al, 8 the optimal placement of the tip is on the incisal third for anterior teeth. The probe tip is coated with a contact medium, such as petroleum jelly, topical anesthetic or toothpaste. One should not dry the tooth with an air syringe because if the tooth is very sensitive, as in cases of pulpitis, it will cause the patient unnecessary pain. It is recommended to dry the tooth with gauze and place a cotton roll in the vestibule to isolate. Performing the electric test accurately requires a well-dried and isolated tooth. While the current is flowing through the tooth, viable A-delta nociceptive fibers will be stimulated, resulting in a tingling or “zinging” sensation to the patient. This monopolar device flows high-frequency electrical current from the probe tip through the tooth. The electric test is performed with an electric pulp tester (EPT). This allows the patient and clinician to understand what a normal response is, so when the offending tooth is tested, an abnormal response can be differentiated from a normal response or lack of response. It is prudent to first test a control tooth, or teeth, and the suspect tooth last. Each has their strengths, weaknesses and common errors. These tests include electric, cold and heat tests. Traditional pulp tests assess the neural response of the pulp, either directly or indirectly. While some methods are able to accomplish this (such as pulse oximetry or laser doppler flowmetry), their use is neither widespread nor practical in dentistry. Pulp tests involve methods used to determine the vitality of the pulp ideally, this would be accomplished by detecting a vascular supply to the pulp. 4Įndodontic testing is divided into two main components, pulp sensibility and periapical tests. If no treatment is performed, the pulp will move from an inflamed to a necrotic state. Depending on when a patient seeks treatment along this timeline, there will be a specific set of diagnoses. Even though these broad categories exist, endodontic disease is a progression of a single disease - one that progresses in a coronal to apical direction over time. While myriad pulpal and periapical diagnoses exist for cases, they can generally be separated into three broad categories: the pulp tissue is either normal, inflamed or infected. This article will focus on the objective pulpal sensibility and periapical tests. Extraoral and intraoral examinations, along with periodontal and radiographic assessments, are also part of the overall diagnostic process. When performed on the offending tooth, the objective tests discussed in this article should replicate the patient’s chief complaint. The patient’s chief complaint, if there is one, should also be documented. 1–3Ī thorough medical and dental history should be taken before examining the patient. Endodontic cases diagnosed with pulpal necrosis and an associated periapical radiolucency have roughly a 10% decreased success rate compared to cases of pulpitis or necrotic cases that do not yet have a periapical radiolucency. Furthermore, the type of diagnosis can affect the success rate. In endodontics, an accurate diagnosis is imperative to identify the offending tooth that is causing the patient’s symptoms and/or disease. Proper and accurate diagnosis is paramount for successful treatment in medicine and dentistry.
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