Pulpal effects of water and air coolants
used in high-speed cavity preparations
Stephen F. Dachi, DM D, M SD
R. Winston Stigers, DM D, Lexingt on, Ky.
Th e comparat ive hi st ol ogic changes in t he pulps
of teet h prepared wit h an air coolant and a water
coolant were not ed in a series of 100 teet h in which
Class V cavit ies were made. Exami nat i ons revealed
t hat i nf lammat ory change wit h bot h t ypes of cool­
ant s were absent or ext remely m il d. Th e mild
changes produced had li t t le cl i ni cal signi f icance.
Since the introduction of ultrahigh-speed cutting
instruments for tooth preparation in restorative
dentistry, the use of coolants for pulp protection
has been a subject of controversy. A number of
histologic studies have offered evidence that a
water coolant is needed to prevent or minimize
such changes as the aspiration of odontoblasts in
to dentinal tubuli, odontoblastic destruction in
regions below and beyond the cut tubules, hyper
emia, inflammatory cell infiltration, and pulpal
necrosis. Swerdlow1 and Stanley2 were among
the first to report extensive investigations on the
pulpal effects of various cutting procedures. They
emphasized the damage created with air coolants,
such as the production of bum lesions or cellular
damage beyond the cavity floor. The possibility
that the use of air coolants may inhibit secondary
dentin formation has been presented.3 Stein,4
among others, has shown evidence that the use of
an air coolant produces heat damage in the dentin
of the cavity floor.
. The use of air as a coolant has advantages to
the clinician over a water-spray coolant and,
therefore, has been used extensively over the past
several years. Two studies, consisting primarily of
clinical observations, have been reported recently
by Schuchard and Watkins5 and by Bouschor and
Matthews.6 These studies indicate that in a large
series of teeth that were prepared with the use of
an air coolant only and studied over a period of
years, no clinical symptoms of pulpal damage
such as sensitivity or pain became manifest. These
findings are supported by reports that cavity prepa
ration, even with the use of an air coolant only, re
sults in slight temperature changes in the pulp.7»8
Evidence that the loss of odontoblasts as a result
of an air blast may stimulate the formation of ir
regular dentin was presented by Brannstrom9 in
1960.
Although there is agreement that cellular
changes do appear to be more pronounced in the
pulps of teeth prepared with an air coolant com
pared with a water coolant, the controversy seems
to concern the clinical significance of the histologic
changes noted and whether the aspiration of odon
toblasts, hyperemia, or mild inflammation repre
sents irreversible, change. Morrant and Kramer10
studied the histologic changes in the pulp of a
series of teeth prepared with various coolants and
failed to note any instance of pulpal necrosis al
though the greater incidence o f the milder changes
mentioned previously in cavities prepared dry was
confirmed. A large series of extracted teeth cur
rently being examined in our laboratory seems to
lend further proof that cavity preparation does
not represent an important cause of pulpal death.
For example, of 225 teeth with amalgam restora
tions placed more than 10 years before the extrac
tions, which were carried out for periodontal or
prosthetic indications, the incidence of necrotic
pulps in the absence o f recurrent caries was four.
This evidence seems to indicate that with a rela
tively nonirritating restorative material, cavity
preparation itself, which in this series of teeth was
carried out under a variety of circumstances, rarely
leads to tooth loss or painful symptoms.
The controversy also concerns the contention of
many clinicians that conservative, gentle handling
95
of hard tissues is the primary requisite for pulpal
protection and that under experimental condi
tions more trauma results from cavity preparation
than the careful clinician produces at chairside.
It was with this second aspect in mind that the
present investigation was carried out. The objec
tive of the study was to compare pulpal reactions
from cavity preparations done with an air coolant
and a water coolant, when the latter were per
formed in pairs of teeth in the same patient under
otherwise identical conditions, with the same
handpiece, by the same operator, and with opera
tive technics intended to be conservative and
gentle to hard tissues.
Materials and methods
A series of 100 teeth, obtained from 16 patients
who volunteered for the study from the U.S. Vet
erans Administration Hospital and Eastern State
Hospital in Lexington, Ky., was used for the study.
The patients included 12 men and four women
who ranged in age from 32 to 77 years, with a
mean age of 48 years. The teeth were to be ex
tracted for periodontal or prosthetic reasons. All
teeth were free of caries or restorations. The teeth
were used in pairs of comparable size, according
to three groups: maxillary incisors, mandibular
incisors, or premolars and canines.
Class V cavities were prepared in the tooth pairs
at the same appointment, one with an air coolant,
the other with an air-water spray. A Weber AT-
200 ultrahigh-speed handpiece was used. The
handpiece operated at a free-run speed of 250,000
rpm, with 40 psi of air pressure, and a water spray,
30 ml./min. Two carbide burs, a no. 33.5 and a
no. 35 inverted cone, were used. The cavities were
prepared to varying depths, with some of the prep
arations extremely close to the pulp, whereas
others were of intermediate depth or beyond the
dentinoenamel junction. Pairs of teeth within the
same patient were prepared to be equal in depth.
The cavities were prepared without the use of a
rubber dam, with an intermittent grinding technic,
and according to a standard outline. The average
time required to complete a cavity preparation
was about 4 minutes. A zinc oxide and eugenol
cement was used for obturation since it is a rela
tively nonirritating material.
The experiment required randomly distributed
tooth and coolant selection over which the oper
ator had no control. Seven days after the proce
dure, the teeth were extracted with the patient un
96 ■ JADA, Vol. 76, Jan. 1968
der local anesthesia. After extraction, the apical
half of each root was resected to allow better fixa
tion, and the teeth were placed in 10 percent neu
tral, buffered formalin. The specimens then were
prepared for histologic examination at a thickness
o f 8/i and stained with hematoxylin and eosin.
Three consecutive sections of every six serial sec
tions were stained. In this manner, about 50 speci
mens per tooth were examined. The histologic ma
terial was coded, and the examiner was unaware
of the procedure that had been used in a particu
lar tooth.
Histologic examination consisted of determin
ing and recording the extent and severity of the in
flammatory reaction subjacent to the cavity floor,
the degree of pulpal hyperemia, the amount and
extent of odontoblastic destruction and aspiration,
and the remaining depth o f the pulpal floor. The
pulpal reactions were recorded subjacent to the
deepest part of the cavity, and the inflammatory
infiltrate was classified as mild, moderate, or
severe. A mild reaction consisted of the presence
of scattered lymphocytes and plasma cells in a nar
row zone below the cut dentinal tubules. A reac
tion was recorded as moderate when inflammatory
cells were moderately abundant but limited to a
narrow zone below the cavity floor. A severe reac
tion was considered to be one with a dense cellu
lar infiltrate that contained neutrophilic leuko
cytes or that extended beyond the narrow sub
odontoblastic zone of the pulp or both.
Results
The histologic findings from the study are sum
marized in Table 1. The inflammatory changes
noted with both types o f coolants were minimum.
For example, there was no cellular inflammatory
infiltrate in 58 of 86 specimens examined. Of the
remaining 28 specimens, 21 had only a minimum
scattering of inflammatory cells. No statistically
significant differences could be detected between
the groups that were water cooled and those that
were air cooled. Some differences were noted with
respect to odontoblasts. Odontoblastic aspiration
was somewhat more frequent in the specimens
that were air cooled, and the destruction of the
odontoblastic layer beneath the cut dentinal tu
bules was twice as frequent in the specimens that
were air cooled as in the specimens that were wa
ter cooled. Odontoblastic destruction beyond the
cut dentinal tubules, the so-called burn lesion,
was seen only in one specimen that was air cooled.
Table 1 ■ H isto lo g ic changes.*
D e s tru c tio n o f
o d o n to b la s tic la y e r
In fla m m a to ry A s p ira te d
H y p e re m ia in filtr a te o d o n to b la s ts Lim ited B e yo n d
C a v ity d e p th t o cu t cut
C o o la n t (m > None M ild M o d e r a te None M ild M o d e ra te Absent Present None tub u le s tubules

A ir - w a t e r s p ray <500 1 5 9 9 4 2 12 3 5 10
5 0 0 -1 ,0 0 0 4 7 8 16 3 16 3 16 3
> 1 ,0 0 0 2 5 3 8 2 9 1 9 1

T o ta ls 7 17 20 33 9 2 37 7 30 14 0

A ir o n ly <500 1 2 11 9 3 2 6 6 2 10 1
5 0 0 -1 ,0 0 0 4 7 9 13 5 2 16 4 7 13
^ 1,000 1 2 4 3 4 1 4 3 2 5

T o ta ls 6 11 24 25 12 5 26 13 11 28 1

*T h e to t a l num bers in e a c h g r o u p d o n o t a d d up t o 5 0 since so m e specim ens c o u ld n o t b e used f o r h is to lo g ic e x a m in a tio n b e ca u se o f te c h n ic a l fa c to rs .

T h e four criteria referred to previously were com parison. T h ere was no com parison possible
used to com pare reactions in tooth pairs w ithin in 13 instances. Exam ples o f the histologic fea
the sam e patient. O nly pairs o f teeth in which cav tures noted in this study are shown in Figures 1
ity depth in the two m em bers was w ithin 300 ¡i o f and 2.
each other w ere included in this evaluation. In T able 2 sum m arizes the m easurem ents o f re
21 o f the 37 pairs, the teeth p repared with a w ater m aining dentin betw een th e cavity floor and the
coolant had som ew hat m ilder reactions than their pulp. T he mean cavity depth o f all teeth prepared
air-cooled counterparts. In 15 instances, no dif w ith the w ater coolant was 717/t and th a t o f the
ferences could be discerned. In one instance, the specim ens prepared w ith the air coolant was 736/i.
air-cooled m em ber o f the p air was favored in the

Fig. 2 ■ Pulpal region subjacent to cavity floor of contra­

Fig. 1 ■ Pulpal region subjacent to cavity floor with re­ lateral tooth shown in Figure 1. Remaining dentin depth
maining dentinal depth of 550p. Cavity was prepared with was 625/i,and air was used as coolant. Note partial destruc­
water coolant. Note compressed odontoblastic layer and tion of odontoblastic layer and hyperemia with inflamma­
absence of inflammatory infiltrate. Specimen is from 46- tory cells scattered in narrow subodontoblastic zone. Most
year-old man. of pulp shown, however, is free of inflammation.

Dachi—Stigers: EFFECT OF COOLANTS WITH HIGH-SPEED DRILL ■ 97

Table 2 ■ Remaining dentin thickness at cavity floor.
N o . o f specimens M ean dentin thickness (/<)
C a vity depth W a te r A ir W a te r
co ole d co oled co ole d
(/a)
<500
500-1,000
15
19
14
20
275
745
>1 ,0 0 0 10 7 1,325
A il teeth 44 41 717
Discussion
The results of this study support the contention
that cavity preparation with an air coolant under
the conditions of this experiment does not pro
duce significant pulpal damage. Although the air-
coolant procedure does create more odontoblastic
destruction, it is the opinion of the authors that
such changes are mild and probably are not of
clinical significance. Furthermore, as mentioned
previously,4 this destruction may have the bene
ficial effect of stimulating irregular dentin forma
tion. Since inflammatory changes were minimal
and odontoblastic destruction was confined to the
region of cut dentinal tubules, there is reason to
assume that regeneration and healing would have
occurred. This assumption is supported by the
aforementioned - clinical observations. The ob
servations also are consistent with those of Brann-
strom,11 who found that loss of odontoblasts does
not give rise to inflammation.
All of the changes noted in all teeth, regardless
of cavity depth or coolant used, were much milder
than those found in any previous studies in our
laboratory. The cavities in this study were filled
with a zinc oxide and eugenol cement, whereas in
our earlier investigations, the cavities were filled
with silver amalgam and silicate cement. It seems
possible, therefore, that leakage around restora
tions, thermal conductivity, chemical irritation of
various cements, and the trauma of insertion of
restorative materials are more important factors
in producing pulpal irritation than cavity prepara
tion itself.
Cavity depth did not have as great an influence
on the severity of reactions as generally is ac
cepted. Perhaps this slight influence can be ex
plained by the fact that all reactions were extreme
ly mild and, therefore, differences as a result of
cavity depth would be less apparent. In this study,
an intermittent grinding technic and fluted burs
were used. The use of other technics, the technic
with diamond stones for example, would not nec
essarily yield the same results.
98 ■ JADA, Vol. 76, Jan. 1968
Summary
A ir
coole d
A clinicopathologic study on 100 teeth was car
338
822
ried out to compare pulpal reactions with Class V
1,286 cavity preparations done with an ultrahigh-speed
736
handpiece and a water or an air coolant. Histologic
examinations revealed that inflammatory changes
with both types of coolants were absent or ex
tremely mild but that the air-cooled preparations
produced more odontoblastic damage. A compari
son of these changes in pairs of teeth within the
same patient revealed that water-cooled prepara
tions resulted in somewhat milder reactions. The
authors interpret the mild changes produced in
this study as o f little clinical significance and think
that they do not represent a contraindication to
judicious cavity preparation with an ultrahigh-
speed, air-cooled handpiece.
This investigation was supported by research grant DE
02074 from the National Institute for Dental Research, Na­
tional Institutes of Health.
Doctor Dachi is professor of oral diagnosis and oral medi­
cine, College of Dentistry, University of Kentucky, Lexing­
ton, 40506. Doctor Stigers is staff dentist at the U.S. Vet­
erans Administration Hospital, Lexington, Ky.
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1961.
3. Diamond, R. D.; Stanley, H. R., and Swerdlow, H.
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