Vitality tests

PULP VITALITY TESTS

• Assessment of vitality using routine methods
rely on the stimulation of Aδ nerve fibers and
there is no direct indication of the blood flow.
Three methods are used to stimulate the Aδ
nerve fibers Thermal stimulation Electrical
stimulation Direct dentin stimulation.
 THERMAL STIMULATION
• Inexpensive
• The temperature used is 65.5ºC to elicit the
response
• Can use Gutta percha – (base plate gutta
percha)
• Cast metal crown restorations are too thick to
allow heated GP to elicit response In such cases
a rubber wheel is used to elicit the response.
 COLD TEST
• Various materials used for cold test are
• Cones of ice
• -20ºC Ethyl chloride spray
• - 40ºC Carbon- di- oxide snow
• -70ºC Application of cold for 4 seconds lowers
the temperature to between 26 and 30ºC
eliciting pain.
• Within the pulp temperature is lowered by 0.2ºC.
• Heat causes vasodilatation and increase in intra
pulpal pressure (releases gaseous product of
proteolysis) (VAN HASSEL). In an intact pulp specific
pulpal temperature must be reached before there
is pain from heat. Therefore, application of heat to
normal teeth gives delayed response. In a tooth
with inflamed pulp, increased intra pulpal pressure
already exists. Therefore immediate painful
response to gradual/sudden increase in heat.
• Cold decreases intrapulpal pressure in normal intact pulp
and there is no pain. The pain from cold is due to
hydrodynamic mechanism. Contraction of fluid causes
outward flow of fluid in dentinal tubules, deforms Aδ
nerve and an action potential is generated. In advanced
acute pulpitis, no Aδ receptors are present. Cold
produces contraction and lowers the intrapulpal pressure
to a sub threshold level and relieves pain due to still
viable C fibers. Pain returns within 30 – 60 seconds as
intra pulpal pressure returns to its former suprathreshold
level.
 ELECTRIC PULP TEST
• Electrolyte applied on the teeth to transmit
current Jelly used for ECG is ideal When
electrolyte contacts the tooth an electric
charge is applied by pressing rheostat button.
A small charge is released initially and
increased until response is felt. Select control
teeth – contra lateral teeth and adjacent
teeth.
• INTERPRETATION : If the current required to gain a
response from a test tooth is same as that needed to
excite the control – the pulp of the test tooth is
considered normal. If less current is required for a
response – Hyperactive If more current is required–
delayed response/ high pain threshold Lack of response –
Pulpal necrosis
• Two readings are recorded and the average value is taken.
“Using EPT on any tooth more than 4 times can give
wrong reading due to additive action.”
• Only Aδ fibers are activated by electric tests
Aδ fibers produce initial momentary sharp
response to electric stimuli because of its
peripheral location, low threshold & greater
conduction velocity. Continuous constant pain
is produced by the smaller C fiber stimulation
as it is associated with tissue damage and
inflammatory process.
 DISADVANTAGES :

• DISADVANTAGES Battery plug in Electrical

deficiencies Output current variations Battery
run down and not delivering full current all
these give variable results with EPT Molars
give readings not indicative of the true pulpal
condition.
 LIMITATIONS :

• LIMITATIONS Tests are not reliable on

immature teeth of young patients as these
teeth contain fewer Aδ fibers than mature
teeth and myelinated nerves do not reach
their maximal depth of penetration into the
pulp until the apex completes its
development.
• When comparing teeth in question with the control teeth,
pulps of the control teeth may not be normal. Teeth with
acute alveolar abscess may respond positively to EPT
because the gaseous and liquefied elements within the
pulp can transmit electric charges to periapical tissues.
• In traumatic injuries, in the cervical areas there will be
temporary paraesthesia of the nerves. If pulp vitality
remains, the pulp will respond within normal limits after
30 to 60 days.