Dental Clinical Practice 2

Diagnostic Tests
- Dental Pulp status
- Tooth biting teeth
-Dr Bill Kahler, University of Adelaide, School of Dentistry
-Dr. V. K. Gopinath M.D.S., PhD. University of Sharjah

Introduction
The purpose of a diagnosis is to
determine what problem the patient is
having and why the patient is having
the problem ultimately this will
directly relate to what treatment, if
any will be necessary.

Copyright 2006/07 The University of Adelaide

slide 2

Process of making diagnosis

Patients tell why he or she seeks advice
Clinician questions about symptoms and
history
Clinician performs objective clinical test
Correlate objective findings with subjective
details and creates tentative diagnosis
Clinician formulates a definitive diagnosis

Copyright 2006/07 The University of Adelaide

slide 3

Dental pulp status

A healthy pulp is vital without
inflammation
A healthy pulp will be asymptomatic
and be responsive to vitality tests
such as thermal or electric pulp tests

Copyright 2006/07 The University of Adelaide

slide 4

Dental pulp status

For older patients thermal tests may
be less conclusive though electric
pulp testing may be the more
appropriate test
Tests on immature teeth can be
inconclusive

Copyright 2006/07 The University of Adelaide

slide 5

Dental pulp status

The test can be responsive and
indicate
1.A vital and healthy pulp
2.Reversible pulpitis
3.Irreversible pulpitis
A non-responsive test may indicate a
necrotic pulp or a false-negative test
Copyright 2006/07 The University of Adelaide

slide 6

Reversible pulpitis
Generally indicates that the pulp is vital
with mild inflammation
Discomfort following pulp sensibility
test does not linger after test
Symptoms usually resolve after
conservative treatment
Copyright 2006/07 The University of Adelaide

slide 7

Irreversible pulpitis
Generally indicates that the pulp is vital with
severe inflammation that will not respond
to conservative treatment
Discomfort following pulp sensibility test
does linger after test
A history of spontaneous pain, throbbing and
interrupted sleep is typical
Copyright 2006/07 The University of Adelaide

slide 8

Following trauma
Pulp tests do NOT assess vitality (blood
circulation)
Tests rather assess neural activity which
may be disturbed/destroyed following a
traumatic incident
A non-responsive test may not indicate a
necrotic pulp following trauma
Copyright 2006/07 The University of Adelaide

slide 9

Electric pulp test

The electric pulp tests utilize an electric
current to excite sensory nerves in the
pulp
The response of immature teeth is
unreliable
Be aware that some patients may over
react and generate false positives
Copyright 2006/07 The University of Adelaide

slide 10

Electric pulp testing

Copyright 2006/07 The University of Adelaide

slide 11

Electric pulp testing

Apply any
toothpaste to tip
before use

Copyright 2006/07 The University of Adelaide

slide 12

Thermal tests
Application of cold, carbon dioxide,
heat to the tooth
The most effective cold tests are with
sticks of carbon dioxide (-78C) or
sprayed with diflourodichloromethane
(-50C)
Copyright 2006/07 The University of Adelaide

slide 13

Correct placement of CO2 stick on the incisal edge

Copyright 2006/07 The University of Adelaide

slide 14

Correct placement of CO2 stick on the MB cusp

Copyright 2006/07 The University of Adelaide

slide 15

Diflourodichloromethane (-50C)

Must be kept in
cold storage
Spray till
adsorbed into
pellet and place
onto tooth for
testing
Copyright 2006/07 The University of Adelaide

slide 16

Teeth can be isolated with rubber dam and

cold/hot water applied directly

Copyright 2006/07 The University of Adelaide

slide 17

Mechanical tests
These are tests of an inflamed
periodontal ligament rather than a
true pulp test
A positive response is generally
indicative of pulp necrosis

Copyright 2006/07 The University of Adelaide

slide 18

Percussion-light tapping

Copyright 2006/07 The University of Adelaide

slide 19

Palpation- an inflamed muco-periosteum

Copyright 2006/07 The University of Adelaide

slide 20

Mobility- possibly periodontal disease?

Copyright 2006/07 The University of Adelaide

slide 21

Probing- Periodontal disease or tooth fracture?

Copyright 2006/07 The University of Adelaide

slide 22

Radiography- An important test and record

Copyright 2006/07 The University of Adelaide

slide 23

Occlusion-Eccentric contacts

Copyright 2006/07 The University of Adelaide

slide 24

Tooth biting test

Patient generally complains of sharp
pain after biting or on release of bite
pressure
Generally indicates a crack in one or
more cusps of the tooth
Pulp usually reversibly inflamed
Copyright 2006/07 The University of Adelaide

slide 25

Apply Fracfinder to individual cusps

Copyright 2006/07 The University of Adelaide

slide 26

Copyright 2006/07 The University of Adelaide

slide 27