Pulp vitality testing

Palpation
  • Feel teeth with gloved finger.

Percussion

  • Pain to percussion does not indicate that the tooth is vital or non-vital, but is rather an indication of inflammation in the periodontal ligament (i.e., an acute periradicular periodontitis). The contralateral tooth should first be tested as a control, as well as several adjacent teeth that are certain to respond normally.
  • The testing should initially be done gently, with light pressure being applied digitally with a gloved finger-tapping. If the patient cannot detect any significant difference between any of the teeth, the test should be repeated using the blunt end of an instrument, like the back end of a mirror handle.
  • The teeth should first be percussed occlusally, and if the patient discerns no difference, the test should be repeated, percussing the buccal and lingual aspects of the teeth.

Mobility
  • An increase in tooth mobility is not an indication of pulp vitality. It is merely an indication of a compromise to the periodontal attachment apparatus.

Thermal
  • A normal response to either hot or cold is a patient’s report that a sensation is felt but disappears immediately upon removal of the thermal stimulus.
  • Abnormal responses include a lack of response to the stimulus, the lingering or intensification of a painful sensation after the stimulus is removed, or an immediate, excruciating painful sensation as soon as the stimulus is placed upon the tooth.
  • Often a tooth that is sensitive to heat may also be responsible for some spontaneous pain. In these cases the patient may present with cold liquids in hand just to minimize the pain. 
  • To be most reliable, cold testing should be used in conjunction with the electric pulp tester so that the results from one test will verify the findings of the other test.
  • If a mature, untraumatized tooth does not respond to both electric pulp test and cold test, then the tooth should be considered non-vital.
  • Studies have also shown that the application of CO2 to teeth does not result in any irreversible damage to the pulp tissues or cause any significant enamel crazing.
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