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Tooth/Pulp Testing

*Tooth and pulp testing can be done during almost any appointment to address pain or discomfort being felt by your patient. Anytime you test a tooth, make sure to fill out an "Endodontic Testing Form" under the "Forms" tab in the EHR.*

Things to remember:

  • Anytime you are testing a tooth, you need to have "control" teeth. Choose teeth adjacent to or across the arch from the tooth in question.

  • **Always start your testing on the control teeth.

  • Be gentle.

  • Give clear instructions to your patient to avoid having to re-test a tooth and causing more discomfort for your patient.

Palpation

The palpation test is done by feeling the buccal or lingual gingiva apical to a tooth with the pad of the finger or with a cotton swab. It is used to aid in your periradicular diagnoses. Responses should be recorded as the following:

  • (-) Negative/no response

  • (+) Positive response (severity of positive response can be differentiated by adding more + signs)

Percussion

Materials Needed:

  • Basic cassette

The percussion test done by tapping on the incisal edge of a tooth with the end of a mirror. Positive responses indicate inflammation of the periodontal ligament. It is used to aid in your periradicular diagnoses. Responses should be recorded as the following:

  • (-) Negative/no response

  • (+) Positive response (severity of positive response can be differentiated by adding more + signs)

Cold Test

Materials Needed:

  • Basic cassette

  • #2 cotton pellets (on the cart)

  • Endo Ice (on the cart or in each bay area)

The cold test is used to detect the vitality of the tooth in question and can be used on teeth with full coverage crowns. Instruct the patient to raise their hand when they feel pain/discomfort and to keep it up until the sensation has subsided to help you determine if the pain was exaggerated and/or lingering.

To perform a cold test:

  1. Dry the tooth to be tested

  2. Hold a #2 cotton pellet with cotton pliers

  3. Spray Endo Ice on the cotton pellet until fully saturated

  4. Touch the cotton pellet to the facial surface of the tooth

  5. Remove the cotton pellet as soon as the patient raises their hand

Responses should be recorded as the following:

  • N- normal response

  • E- exaggerated

  • EL- exaggerated and lingering

  • NR- no response (should perform EPT next)

EPT

Materials Needed:

  • EPT with tips (from dispensary)

  • Toothpaste

Electronic Pulp Testing (EPT) is used to detect the vitality of the tooth in question and cannot be reliably used on teeth with full coverage crowns. To perform an EPT:

  1. Check out an EPT from the dispensary

  2. Insert one of the tips into the handle

  3. Set the rate using the dial

  4. Dry the tooth and apply toothpaste to the tooth surface and to the tip of the EPT

  5. Hold the plastic part of the handle

  6. Instruct your patient to hold the metal part of the handle and to let go as soon as they feel a sensation in the tooth that is being tested (the EPT will send a current through their tooth that will start and increase automatically from the time the tooth is touched until the current is broken by the patient letting go of the handle)

  7. Touch the EPT tip to the tooth

  8. Record the number on the EPT in your note

Bite test (Tooth Slooth)

Materials Needed:

  • Tooth Slooth (from dispensary)

The bite test is used to detect cracked teeth or cusps. Check out a Tooth Slooth from the dispensary. Have the patient bite on the flat end while using the pointy end to direct the force of the patient's bite to a particular part of the tooth in question (usually a cusp). Sensitivity while biting can indicate a cracked tooth.

Transillumination

Materials Needed:

  • Transilluminator (from dispensary)

Transillumination is used to detect crown fractures and cracks. You can check out a transilluminator from the dispensary. To use it, turn it on and touch it to different surfaces of the tooth in question. If a crack or fracture is present, it can be detected by only portions of the tooth being illuminated while the rest of the tooth remains dark and is made more obvious by a hard line separating the two areas as opposed to the light just diffusing throughout the tooth. Observations should be recorded in your notes.

For more information on diagnosing, see Pulpal Diagnosis (Definitions)

Additional Resources:

Pulpal Diagnosis Flow Charts: