Endodontics L5: Pulp sensitivity testing video

Question 1

Q21: what must the tooth be when conducting the EPT?

Answer 1

Clean, dry, and isolated.

Question 2

Q8: which nerve fibre A delta, A beta and C fibres have a higher threshold?

Answer 2

C fibres

Question 3

Q27: why may a multi rooted teeth record a false positive?

Answer 3

In a multi rooted tooth, 1 root out of three may contain a vital nerve tissue.

Question 4

Q30: how does a local anaesthetic test work?

Answer 4

Using an infiltration, the most posterior tooth in the suspected area is anaesthetized, if the pain persists the next tooth mesial is also anaesthetized and so on until the pain disappears.

Question 5

Q12: an intense, prolonged response from a sensibility test would suggest the pulp is?

Answer 5

Undergoing irreversible pulpitis

Question 6

Q4: what effect does the myelination have on nerve fibres regarding speed?

Answer 6

If a nerve fibre is myelinated, the speed at which signals are transmitted are increased.

Question 7

Q25: if a patient does not feel a stimulus immediately what must you do?

Answer 7

Increase the level of current until a sensation is felt by the patient.

Question 8

Q28: why must the tooth be unanaesthetised when drilling through enamel-dentine junction in a test cavity preparation?

Answer 8

If the patient feels pain dentine is reached, then that would indicate pulpal vitality. This would not be achieved if tooth were anaesthetised.

Question 9

Q6: what are the name of the nerve fibres that innervate the dentine and what stimulates them?

Answer 9

A delta and A beta fibres stimulated by movement of dentinal fluid.

Question 10

Q24: what must you avoid when using a pulp tester?

Answer 10

Metal restorations.

Question 11

Q34: what would measure vascular supply in a pulp?

Answer 11

Laser doppler flowmetry

Question 12

Q11: A normal response from a sensibility test would indicate the pulp is what?

Answer 12

Vital or reversible pulpitis

Question 13

Q15: a response to cold usually indicates what of the pulp?

Answer 13

The pulp is vital regardless of whether the pulp is normal or compromised.

Question 14

Q29: when would you use local anaesthetic test:

Answer 14

when symptoms are poorly localized or referred.

Question 15

Q7: unmyelinated C fibres innervate what part of the tooth?

Answer 15

Innervate the body of the pulp.

Question 16

Q19: ethyl chloride has a temperature of -5 degrees, the use of endo frost which contains a mixture of propane, butane, and isobutane. What temperature is endo frost at?

Answer 16

-50 degrees

Question 17

Q17: what affect does the cold sensibility test have on the dentinal fluid?

Answer 17

The application of a cold substance causes contraction of the dentinal fluid within the tubules, resulting in a rapid outward flow which results in hydrodynamic forces acting on A delta fibres, which leads to a sharp sensation.

Question 18

Q23: where must you place the tip of the pulp test on a molar tooth?

Answer 18

MB cusp (highest innervation)

Question 20

Q31: if the source cannot be localized between maxillary and mandibular arch, what can be done?

Answer 20

An IANB can be given – cessation of pain indicates involvement of a mandibular tooth, if pain persists then it indicates the involvement of a maxillary tooth

Question 21

Q20: which nerve is targeted when using a electrical pulp test (EPT)?

Answer 21

Used to stimulate A delta nerve fibres in the pulp-dentine complex.

Question 22

Q33: what is the most accurate marker for pulp vitality?

Answer 22

Vascular supply

Question 23

Q13: a sensibility test which gives no response would indicate what?

Answer 23

More than likely a necrotic pulp, or a false negative.

Question 24

Q5: do faster transmitted signals give rise to dull or sharp pain?

Answer 24

Sharp

Question 25

Q9: what tooth must be tested before carrying out a sensibility testing on the affected tooth?

Answer 25

A control tooth.

Question 26

Q1: pulp sensibility testing is used to reproduce the symptoms reported by the patient, it involves stimulating sensory nerve fibres, which nerve fibre is stimulated in the dentine-pulp complex?

Answer 26

A delta fibres.

Question 27

Q22: where must you place the tip of the pulp tester on anterior tooth?

Answer 27

Incisal third

Question 28

Q10: what are the 4-pulp sensitivity testing techniques?

Answer 28

Thermal testing, electrical pulp test, test cavity preparation, local anaesthetic test.

Question 29

Q26: teeth with acute alveolar abscess may respond positively to EPT, why?

Answer 29

Because of the presence of gaseous and liquified elements within the pulp can transmit electrical charges to periapical tissues.

Question 30

Q18: how can cold test be used to differentiate between reversible and irreversible pulpitis?

Answer 30

Reversible – pain subsides on removal of stimulus

Irreversible – pain lingers after removal of stimulus

Question 31

Q32: what is the difference in sensitivity and specificity?

Answer 31

Sensitivity – the ability of a test to detect disease in patients who actually have the disease, in pulp sensibility testing, the ability to identify non-vital teeth

Specificity - the ability of a test to detect the absence of disease, in pulp sensibility testing the ability to identify the vital teeth.

Question 32

Q2: what are the determinants that the determine pulp vitality?

Answer 32

Vascular supply and pulpal innervation.

Question 33

Q3: pulpal innervation consists of myelinated A delta, A beta and unmyelinated C fibres, which of those three fibres innervate dentine?

Answer 33

A delta and A beta

Question 34

Q14: how would someone carry out a thermal testing?

Answer 34

Thermal testing involves the application of cold or heat stimuli to a tooth to determine sensitivity to thermal changes.

Question 35

Q16: an increased response to heat is suggestive of what?

Answer 35

Pulpal/periapical pathology that may require endodontic intervention.