Pulp Sensitivity Testing Flashcards
Why may teeth that have experienced trauma lead to a false negative on EPT?
- Cervical areas have temporary paresthesia.
- If pulp remains vital, it will respond normally in 30-60 days.
What does a NORMAL sensibility test response SUGGEST?
Suggests healthy pulp OR reversible pulpitis.
What are 5 causes of false negative EPT?
- Patient is pre-medicated.
- Inadequate contact with enamel.
- Trauma.
- Immature apex.
- Calcified canal.
How is Laser Doppler Flowmetry carried out?
LASER LIGHT is transmitted to the dental pulp using a FIBRE OPTIC PROBE placed on the tooth surface, movement is detected.
What are the 3 different types of nerve fibres found in the pulp?
- Myelinated A delta fibres.
- Myelinated A beta fibres.
- Unmyelinated C fibres.
What feeling does an EPT cause? What nerve fibres are affected? What is the physiological process behind this?
- TINGLING, WARM sensation, affect ALPHA DELTA FIBRES.
- Application of an electric current causes IONIC SHIFT and an AP POTENTIAL IN A DELTA FIBRES.
What does a positive and negative electric pulp test suggest?
- Positive response: presence of sensory alpha delta nerve fibres.
- Negative response: suggestive of pulpal necrosis.
What vitality testing is best indicated in an immature tooth with an open apex following trauma?
COLD
What does an INTENSE, PROLONGED sensibility test response SUGGEST?
Irreversible pulpitis?
What vitality testing is best indicated in an immature tooth with pulp canal mineralization following trauma?
EPT
What does an increased response to heat suggest?
Pulpal/ periapical pathology that may require endodontic intervention.
What does NO RESPONSE sensibility test response SUGGEST?
NECROTIC PULP, FALSE NEGATIVE (calcified canal, immature apex, recent trauma).
What vitality testing is best indicated in a mature tooth with pulp canal mineralization following trauma?
EPT
What do alpha delta and alpha beta fibres innervate? How are they stimulated and what does their stimulation cause? Threshold?
- Innervate DENTINE.
- Stimulated by MOVEMENT OF DENTINAL FLUID.
- acute SHARP pain.
- Low threshold.
What can cold test help differentiate between?
- Reversible: pain subsides on removal of stimulus.
- Irreversible: pain lingers after removal of stimulus.-
What is the most accurate determinant of pulp vitality?
VASCULAR SUPPLY and not pulpal innervation.
What two materials can be used for a cold test?
- Ethyl chloride, -5.
- Propane/butane/isobutane, -50 (endofrost)
How can a periapical abscess lead to a false positive on EPT?
- Due to gaseous and liquefied elements within the pulp which can transmit electric changes to periapical tissues.
What do C fibres innervate? How are they stimulated and what does their stimulation cause? Threshold?
- Innervate the BODY OF THE PULP.
- Remain excitable even after compromised blood flow.
- DULL, BURNING PAIN, POORLY LOCALIZED, can RADIATE.
- High threshold.
What is the definition of sensitivity? In pulp testing?
- The ability of a test to detect disease in patients who HAVE the disease.
- Pulp testing: identify NON VITAL teeth.
How common is a false positive/ false negative in EPT?
10 - 20%
What does a response to a cold stimulus indicate?
Potentially vital pulp, can be NORMAL or COMPROMISED.
What does pulp vitality test?
The BLOOD SUPPLY of the pulp.
measures PULPAL BLOOD FLOW – VASCULAR SUPPLY IS THE MOST ACCURATE MARKER OF PULP VITALITY.
What does a positive sensibility test indicate?
Does NOT indicate a healthy pulp - just indicates that there are some nerve fibres carrying sensory impulses.
