255:(SaO2). Pulse oximetry, as well as laser Doppler flowmetry vitality tests may not truly reflect the real state of health of the dental pulp. This mainly happens in clinical scenarios when the dental pulp is diseased, yet a viable blood supply is maintained. In a study from Slovenia, correlations were found between clinical tests and histological analysis of dental pulp in 26 healthy permanent premolars extracted for orthodontic reasons. It was found that a higher density of blood vessels in the pulp tissue corresponded to increased oxygen saturation levels measured through pulse oximetry, lending support to the validity of pulse oximetry as a reliable method for assessing pulp vitality. Furthermore, teeth with closed apices had a higher density of nerve fibers in the upper part of the dental pulp compared to teeth with open apices1. This further indicated individual variations in sensitivity, with teeth showing a higher density of nerve fibers having a lower threshold for electrical stimulation.
198:
sensation is felt, which would indicate pulpal vitality. In the event of a vital pulp, a painful response is provoked when dentin is contacted by the bur and the procedure will be stopped. A restoration would be then placed. Contrarily, when compared with vital pulp, pulp with partial necrosis will not be stimulated as extensively. In the case of partial necrosis, access to and into dentine would be needed, with the dentist progressively invading and drilling deeper into dentine, checking the sensory response—which is usually without sensory response because of the partial necrosis. Due to the invasiveness and possible anxiety that it may generate in patients, the test cavity technique is generally avoided. Also, there is little literature supporting its effectiveness, and it has been relatively anecdotal within clinical practice.
219:
to a lower threshold for electrical stimulation, suggesting the involvement of neural factors in pulp sensibility. Moreover, the positive correlation between blood vessel density and oxygen saturation, as well as the negative correlation between nerve fiber density and electrical voltage perception, provide valuable insights into the complex nature of dental pulp. Therefore, in addition to the standard sensitivity testing, more objective and accurate methods such as pulse oximetry might be necessary for a comprehensive understanding of pulp vitality. However, the findings of this study should be generalized with caution due to its small sample size and focus on healthy teeth extracted for orthodontic reasons.
211:
teeth due to inadequate isolation of the tooth being tested, or in anxious patients who perceive pain despite no sensory stimulus, or in multi-rooted teeth which still have residual pulpal tissue residing in canals. False negative results occurs when innervated teeth do not respond to sensibility testing. Such can occur in individuals who have recently traumatised teeth, teeth with incomplete root development, teeth with heavy restorations or teeth that have significantly reduced pulp size due to production of tertiary or sclerotic dentine.
189:
pain diminishes. If the pain is still present, the procedure is repeated on the mesial teeth, one by one until the pain diminishes and is gone. If one can still not determine the source of the pain, the procedure will be repeated on the opposite arch. In the case that the pain cannot be localised to either the maxillary or mandibular arch, an inferior alveolar nerve block would be used. If the pain stops, such would imply that it involves teeth of the mandibular arch.
240:
blood cells. The reflected light is
Doppler-shifted and has a different frequency to those reflected by the surrounding tissues which are static. An arbitrary unit of measurement, ‘perfusion unit’ (PU), is used to measure the concentration and velocity (flux) of blood cells. The output of laser Doppler flowmetry may be influenced by the blood flow in surrounding tissues, and therefore the test tooth must be adequately isolated to avoid inaccuracies.
218:
Despite the insights gained from sensitivity testing, a research study found that the density of nerve fibers and blood vessels in the pulp tissue, and the degree of oxygen saturation, may play a crucial role in interpreting the results. The presence of a higher density of nerve fibers may contribute
210:
False positive or false negative results are possible when performing a sensitivity testing. A false positive response occurs when a patient is respondent to sensitivity testing despite a lack of sensory tissue in the tooth that is being tested. Such responses may occur due to innervation of adjacent
206:
All tests have some limitations and test results should be interpreted by an experienced dentist under the bidirectional consideration of both clinical symptoms and radiography. Sensitivity tests only indicate the presence or absence of the nerve supply to an individual tooth. Even though a prolonged
175:
in the Type Aδ fibres within pulp, eliciting a neurological response. Such tests are conducted by applying a conducting medium (e.g. toothpaste) on a dried tooth and placing the probe tip of an electric pulp tester on the surface of the tooth closest to the pulp horn(s). The patient is then directed
227:
Vitality tests assess the vascular supply of a tooth. Vascular supply is generally accepted as the earliest indicator of pulpal health. However, vitality tests have limitations and require strict adherence to correct application techniques. The diagnostic methods to assess the vascular response of
214:
Pulpal sensitivity testing may be regarded as inferior to vitality testing as they do not definitively prove that the tooth has a blood supply and is vital. Nonetheless, electric pulp testing and cold testing tests have been found to be accurate and reliable in the case of assessing pulpal health,
188:
When pulp testing results are inconclusive and that patients cannot localise or specify the pain or symptoms, an anaesthetic would be helpful and be used. The most posterior tooth in the area where the pain resonates undergoes anaesthesia by either infiltration or intraligamentary injection until
38:
Dental pulp tests are valuable techniques used to establish the pulpal health status of a tooth in dentistry. The diagnostic information obtained from pulpal testing is then used alongside a patient's history, clinical and radiographic findings to determine a diagnosis and prognosis of the tooth.
239:
is able to assess blood flow within the dental pulp directly. A laser beam directed onto the tooth follows the path of dentinal tubules to the pulp. The viability of the vascular supply of the pulp is determined by the output signal generated by the backscattered reflected light from circulating
179:
The use of electric pulp testing has been questioned in patients with traditional cardiac pacemakers despite no evidence of interferences in humans, particularly with more modern devices. Care must be taken if using an electric pulp test on a tooth adjacent to metallic restorations, as these can
197:
The test cavity technique is only used as a last resort when results produced by all other methods above are inconclusive. High-speed burs are used without anaesthetic, drilling through enamel, or restorations to dentine. Throughout the drilling process, the patient is asked whether a painful
74:
Pulpal tests may be conducted via stimulation of the sensory fibres within the pulp (sensitivity testing) or by assessing pulpal blood flow (vitality testing). All available techniques are reported to have limitations in terms of accuracy and reproducibility and therefore require careful
83:
Sensitivity tests assess the sensory response of a tooth to an external stimulus, results which may be extrapolated to indirectly determine pulpal health status. Sensory stimuli, such as heat, cold or an electrical current, are applied to the tooth in question in order to stimulate the
144:(−78 °C ) can be used, however there have been concerns regarding the damaging effects of using something so cold in the oral cavity despite evidence to suggest that dry ice has no negative impact on mucosal or tooth structure. Refrigerant sprays, such as
111:
A heightened or prolonged response — an exaggerated or lingering response to sensitivity testing indicates some degree of pulpal inflammation. If the pain is pronounced yet subsides once the stimulus has been removed, a diagnosis of reversible
163:, a rubber commonly used in root canal procedures. Such tests are less commonly used as they are thought to be less accurate than cold tests, and may be more likely to cause damage to the teeth and surrounding mucosa.
108:
A normal response — healthy pulps respond to sensitivity testing by eliciting a short, sharp pain which subsides when the stimulus is removed, indicating that the nerve fibres are present and responsive.
140:
A number of products are available for cold testing, each with varying melting points. Although household ice (0 °C ) is cheap and easy to obtain, it is not as accurate as colder products.
652:
Peters, Donald D.; Baumgartner, J. Craig; Lorton, Lewis (October 1994). "Adult pulpal diagnosis. I. Evaluation of the positive and negative responses to cold and electrical pulp tests".
215:
especially when tests are used in combination. In addition, cold testing is also more accurate than electric pulp in the case of running tests upon immature or traumatised teeth.
1134:
Polat, Serkan; Er, Kürşat; Akpinar, Kerem E; Polat, N.Tülin (January 2004). "The sources of laser
Doppler blood-flow signals recorded from vital and root canal treated teeth".
88:
within the pulp. The type of sensory fibres activated and therefore the response felt by the patient depends on the stimulus used. Sensibility testing is based on Brännström's
1064:
Ingolfsson, AEgir Rafn; Tronstad, Leif; Hersh, Elliot V.; Riva, Charles E. (April 1994). "Efficacy of laser
Doppler flowmetry in determining pulp vitality of human teeth".
757:
Jespersen, James J.; Hellstein, John; Williamson, Anne; Johnson, William T.; Qian, Fang (March 2014). "Evaluation of Dental Pulp
Sensibility Tests in a Clinical Setting".
838:
Fuss, Zvi; Trowbridge, Henry; Bender, I.B.; Rickoff, Bruce; Sorin, Solomon (January 1986). "Assessment of reliability of electrical and thermal pulp testing agents".
365:
Fuss, Zvi; Trowbridge, Henry; Bender, I.B.; Rickoff, Bruce; Sorin, Solomon (January 1986). "Assessment of reliability of electrical and thermal pulp testing agents".
27:
within the pulp chamber and root canals of a tooth. Such investigations are important in aiding dentists in devising a treatment plan for the tooth being tested.
965:
Baumgardner, K.R.; Walton, R.E.; Osborne, J.W.; Born, J.L. (October 1996). "Induced
Hypoxia in Rat Pulp and Periapex Demonstrated by 3H-Misonidazole Retention".
30:
There are two major types of dental pulp tests. Vitality testing assesses the blood supply to the tooth, whilst sensitivity testing tests the sensory supply.
1300:
Nissan, R.; Trope, M.; Zhang, C. D.; Chance, B. (October 1992). "Dual wavelength spectrophotometry as a diagnostic test of the pulp chamber contents".
722:
Jafarzadeh, H.; Abbott, P. V. (2010-07-01). "Review of pulp sensibility tests. Part I: general information and thermal tests: Pulp sensibility tests".
251:
utilises the difference in red and infrared light absorption by oxygenated and deoxygenated red blood cells within blood circulation to determine the
330:
Brännström, Martin (January 1986). "The hydrodynamic theory of dentinal pain: Sensation in preparations, caries, and the dentinal crack syndrome".
119:
No response — lack of response to sensitivity testing suggests that the nerve supply to the tooth has been diminished, as in the case of pulpal
495:
Rickoff, Bruce; Trowbridge, H.; Baker, John; Fuss, Z.; Bender, I.B. (January 1988). "Effects of thermal vitality tests on human dental pulp".
207:
response to aforementioned tests indicate pulpal inflammation, the degree of inflammation or innervation cannot be inferred from these tests.
1099:
Vongsavan, N.; Matthewst, B. (1 January 1996). "Experiments in pigs on the sources of laser
Doppler blood-flow signals recorded from teeth".
530:
Augsburger, Robert A.; Peters, Donald D. (March 1981). "In vitro effects of ice, skin refrigerant, and CO2 snow on intrapulpal temperature".
152:(−26.5 °C ) or a propane/butane/isobutane gas mixture are further commonly used cold tests. Cold testing is thought to stimulate
1169:
Munshi, A.; Hegde, Amitha; Radhakrishnan, Sangeeth (January 2003). "Pulse oximetry: a diagnostic instrument in pulpal vitality testing".
137:
Thermal testing, which involves the application of either hot or cold stimuli to the tooth, is the most common form of sensibility test.
176:
to hold the end of the conducting probe to complete the circuit and asked to let go of the probe when a ‘tingling’ sensation is felt.
116:
may be probable. However, a lingering pain which continues despite the removal of the stimulus is indicative of irreversible pulpitis.
89:
687:
Gopikrishna, Velayutham; Pradeep, Gali; Venkateshbabu, Nagendrababu (January 2009). "Assessment of pulp vitality: a review".
252:
1245:"Comparison of the vitality tests used in the dental clinical practice and histological analysis of the dental pulp"
875:"Comparison of the vitality tests used in the dental clinical practice and histological analysis of the dental pulp"
565:
Kleier, D.J.; Sexton, J.R.; Averbach, R.E. (December 1982). "Electronic and
Clinical Comparison of Pulp Testers".
149:
1204:
Noblett, W. Craig; Wilcox, Lisa R.; Scamman, Franklin; Johnson, William T.; Diaz-Arnold, Ana (January 1996).
236:
799:"Pulp sensibility and vitality tests for diagnosing pulpal health in permanent teeth: a critical review"
1029:
MATTHEWS, B.; VONGSAVAN, N. (January 1993). "Advantages and limitations of laser
Doppler flow meters".
930:
Thomas, Robyn (2010-02-11). "Pathways Of The Pulp (4th Ed) By: Stephen Cohen and
Richard Burns (Eds)".
1345:
153:
1205:
1340:
1243:
Tenyi, Ana; Nemeth, Lidija; Golež, Aljaž; Cankar, Ksenija; Milutinović, Aleksandra (2022-06-01).
1008:
873:
Tenyi, Ana; Nemeth, Lidija; Golež, Aljaž; Cankar, Ksenija; Milutinović, Aleksandra (2022-06-01).
590:
92:, which postulates that the activation of nocireceptors is caused by fluid movement within the
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The use of dual wavelength light establishes the contents within the pulp chamber.
160:
978:
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24:
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458:"Pulp testers and pulp testing with particular reference to the use of dry ice"
47:
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613:"Pulp vitality tests - an overview on comparison of sensitivity and vitality"
20:
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Heat tests include using heated instruments, such as a ball-ended probe or
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An electrical current can be applied to the tooth in order to generate an
987:
481:
120:
113:
457:
141:
815:
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96:
in response to thermal, electrical, mechanical or osmotic stimuli.
42:
Pulp tests are useful for the following procedures in dentistry:
400:
398:
396:
180:
create electrical conduction and yield false negative results.
104:
There are three primary outcomes of a pulp sensitivity test:
56:
differentiating between odontogenic and non-odontogenic pain,
1206:"Detection of pulpal circulation in vitro by pulse oximetry"
1024:
1022:
797:
Alghaithy, R. A.; Qualtrough, A. J. E. (February 2017).
156:
in the pulpal tissue, which elicit a short, sharp pain.
792:
790:
788:
1302:Oral Surgery, Oral Medicine, and Oral Pathology
689:International Journal of Paediatric Dentistry
8:
611:Mythri, H; Arun, A; Chachapan, Dale (2015).
1276:
1249:Bosnian Journal of Basic Medical Sciences
986:
906:
879:Bosnian Journal of Basic Medical Sciences
814:
628:
432:
422:
306:
296:
19:is a clinical and diagnostic aid used in
66:establishment of pulpal health prior to
1171:Journal of Clinical Pediatric Dentistry
271:
405:Chen, Eugene; Abbott, Paul V. (2009).
123:or in previously root treated canals.
75:interpretation in clinical practice.
7:
606:
604:
23:to help establish the health of the
1183:10.17796/jcpd.26.2.2j25008jg6u86236
1078:10.1111/j.1600-9657.1994.tb00065.x
1043:10.1111/j.1365-2591.1993.tb00531.x
944:10.1111/j.1747-4477.1987.tb00193.x
474:10.1111/j.1834-7819.1977.tb04511.x
411:International Journal of Dentistry
285:International Journal of Dentistry
202:Limitations of sensitivity testing
59:assessing pulpal status following
14:
259:Dual wavelength spectrophotometry
1031:International Endodontic Journal
932:Australian Endodontic Newsletter
803:International Endodontic Journal
736:10.1111/j.1365-2591.2010.01754.x
724:International Endodontic Journal
701:10.1111/j.1365-263X.2008.00955.x
100:Responses to sensitivity testing
617:Indian Journal of Oral Sciences
407:"Dental Pulp Testing: A Review"
281:"Dental Pulp Testing; A Review"
279:Chen, Eugene (September 2009).
1:
1222:10.1016/S0099-2399(96)80226-3
1148:10.1016/S0003-9969(03)00197-3
852:10.1016/S0099-2399(86)80112-1
666:10.1016/S0099-2399(06)80048-8
544:10.1016/S0099-2399(81)80124-0
509:10.1016/S0099-2399(88)80104-3
379:10.1016/S0099-2399(86)80112-1
344:10.1016/S0099-2399(86)80198-4
291:(Article ID 365785): 365785.
1314:10.1016/0030-4220(92)90304-9
1113:10.1016/0003-9969(94)00076-X
979:10.1177/00220345960750100801
579:10.1177/00220345820610120701
456:Ehrmann, EH (August 1977).
53:localisation of tooth pain,
1362:
967:Journal of Dental Research
771:10.1016/j.joen.2013.11.009
567:Journal of Dental Research
128:Types of sensitivity tests
462:Australian Dental Journal
150:1,1,1,2-tetrafluoroethane
1261:10.17305/bjbms.2021.6841
1136:Archives of Oral Biology
1101:Archives of Oral Biology
891:10.17305/bjbms.2021.6841
630:10.4103/0976-6944.162622
253:oxygen saturation level
237:Laser Doppler flowmetry
232:Laser Doppler flowmetry
148:(−12.3 °C ),
1210:Journal of Endodontics
840:Journal of Endodontics
759:Journal of Endodontics
654:Journal of Endodontics
532:Journal of Endodontics
497:Journal of Endodontics
367:Journal of Endodontics
332:Journal of Endodontics
167:Electric pulp testing
17:Dental pulpal testing
34:Clinical application
1066:Dental Traumatology
424:10.1155/2009/365785
298:10.1155/2009/365785
184:Anaesthesia testing
90:hydrodynamic theory
79:Sensitivity testing
228:the pulp include:
973:(10): 1753–1760.
816:10.1111/iej.12611
573:(12): 1413–1415.
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173:action potential
94:dentinal tubules
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107:
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105:
99:
97:
95:
91:
87:
86:nocireceptors
78:
76:
69:
68:prosthodontic
65:
62:
61:dental trauma
58:
55:
52:
49:
46:diagnosis of
45:
44:
43:
40:
33:
31:
28:
26:
22:
18:
1305:
1301:
1295:
1252:
1248:
1238:
1213:
1209:
1199:
1174:
1170:
1164:
1142:(1): 53–57.
1139:
1135:
1129:
1104:
1100:
1094:
1072:(2): 83–87.
1069:
1065:
1059:
1034:
1030:
970:
966:
960:
935:
931:
925:
882:
878:
868:
843:
839:
833:
806:
802:
762:
758:
752:
727:
723:
717:
692:
688:
682:
657:
653:
647:
620:
616:
570:
566:
560:
535:
531:
525:
500:
496:
490:
468:(4): 272–9.
465:
461:
451:
414:
410:
370:
366:
360:
335:
331:
325:
288:
284:
274:
262:
247:
235:
226:
217:
213:
209:
205:
196:
187:
178:
170:
161:gutta-percha
158:
139:
136:
103:
82:
73:
41:
37:
29:
16:
15:
1346:Endodontics
1037:(1): 9–10.
695:(1): 3–15.
193:Test cavity
25:dental pulp
1335:Categories
1216:(1): 1–5.
417:: 365785.
267:References
70:treatment.
50:pathology,
48:endodontic
1341:Dentistry
1269:2831-090X
997:0022-0345
952:0313-7384
938:(1): 11.
899:2831-090X
639:0976-6944
623:(2): 41.
21:dentistry
1287:35150478
1191:11874005
1156:14693197
1013:18460204
917:35150478
825:26789282
779:24565651
744:20609022
709:19120505
595:42448558
443:20339575
317:20339575
121:necrosis
114:pulpitis
1322:1408029
1278:9162753
1230:8618078
1121:8833597
1086:8062812
1051:8473040
1005:8955670
908:9162753
860:3461119
674:7714424
587:6960045
552:6938630
517:3255773
434:2837315
387:3461119
352:3465849
308:2837315
142:Dry ice
1320:
1285:
1275:
1267:
1228:
1189:
1154:
1119:
1084:
1049:
1011:
1003:
995:
950:
915:
905:
897:
858:
823:
777:
742:
707:
672:
637:
593:
585:
550:
515:
482:277144
480:
441:
431:
385:
350:
315:
305:
1009:S2CID
591:S2CID
1318:PMID
1283:PMID
1265:ISSN
1226:PMID
1187:PMID
1152:PMID
1117:PMID
1082:PMID
1047:PMID
1001:PMID
993:ISSN
948:ISSN
913:PMID
895:ISSN
856:PMID
821:PMID
775:PMID
740:PMID
705:PMID
670:PMID
635:ISSN
583:PMID
548:PMID
513:PMID
478:PMID
439:PMID
415:2009
383:PMID
348:PMID
313:PMID
289:2009
1310:doi
1273:PMC
1257:doi
1218:doi
1179:doi
1144:doi
1109:doi
1074:doi
1039:doi
983:hdl
975:doi
940:doi
903:PMC
887:doi
848:doi
811:doi
767:doi
732:doi
697:doi
662:doi
625:doi
575:doi
540:doi
505:doi
470:doi
429:PMC
419:doi
375:doi
340:doi
303:PMC
293:doi
1337::
1316:.
1306:74
1304:.
1281:.
1271:.
1263:.
1253:22
1251:.
1247:.
1224:.
1214:22
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1150:.
1140:49
1138:.
1115:.
1105:41
1103:.
1080:.
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