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Module 5 - Endodontics > Pulp Sensitivity Testing > Flashcards

Pulp Sensitivity Testing Flashcards

1
Q

Why may teeth that have experienced trauma lead to a false negative on EPT?

A
  • Cervical areas have temporary paresthesia.
  • If pulp remains vital, it will respond normally in 30-60 days.
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2
Q

What does a NORMAL sensibility test response SUGGEST?

A

Suggests healthy pulp OR reversible pulpitis.

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3
Q

What are 5 causes of false negative EPT?

A
  • Patient is pre-medicated.
  • Inadequate contact with enamel.
  • Trauma.
  • Immature apex.
  • Calcified canal.
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4
Q

How is Laser Doppler Flowmetry carried out?

A

LASER LIGHT is transmitted to the dental pulp using a FIBRE OPTIC PROBE placed on the tooth surface, movement is detected.

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5
Q

What are the 3 different types of nerve fibres found in the pulp?

A
  • Myelinated A delta fibres.
  • Myelinated A beta fibres.
  • Unmyelinated C fibres.
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6
Q

What feeling does an EPT cause? What nerve fibres are affected? What is the physiological process behind this?

A
  • TINGLING, WARM sensation, affect ALPHA DELTA FIBRES.
  • Application of an electric current causes IONIC SHIFT and an AP POTENTIAL IN A DELTA FIBRES.
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7
Q

What does a positive and negative electric pulp test suggest?

A
  • Positive response: presence of sensory alpha delta nerve fibres.
  • Negative response: suggestive of pulpal necrosis.
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8
Q

What vitality testing is best indicated in an immature tooth with an open apex following trauma?

A

COLD

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9
Q

What does an INTENSE, PROLONGED sensibility test response SUGGEST?

A

Irreversible pulpitis?

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10
Q

What vitality testing is best indicated in an immature tooth with pulp canal mineralization following trauma?

A

EPT

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11
Q

What does an increased response to heat suggest?

A

Pulpal/ periapical pathology that may require endodontic intervention.

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12
Q

What does NO RESPONSE sensibility test response SUGGEST?

A

NECROTIC PULP, FALSE NEGATIVE (calcified canal, immature apex, recent trauma).

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13
Q

What vitality testing is best indicated in a mature tooth with pulp canal mineralization following trauma?

A

EPT

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14
Q

What do alpha delta and alpha beta fibres innervate? How are they stimulated and what does their stimulation cause? Threshold?

A
  • Innervate DENTINE.
  • Stimulated by MOVEMENT OF DENTINAL FLUID.
  • acute SHARP pain.
  • Low threshold.
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15
Q

What can cold test help differentiate between?

A
  • Reversible: pain subsides on removal of stimulus.
  • Irreversible: pain lingers after removal of stimulus.-
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16
Q

What is the most accurate determinant of pulp vitality?

A

VASCULAR SUPPLY and not pulpal innervation.

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17
Q

What two materials can be used for a cold test?

A
  • Ethyl chloride, -5.
  • Propane/butane/isobutane, -50 (endofrost)
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18
Q

How can a periapical abscess lead to a false positive on EPT?

A
  • Due to gaseous and liquefied elements within the pulp which can transmit electric changes to periapical tissues.
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19
Q

What do C fibres innervate? How are they stimulated and what does their stimulation cause? Threshold?

A
  • Innervate the BODY OF THE PULP.
  • Remain excitable even after compromised blood flow.
  • DULL, BURNING PAIN, POORLY LOCALIZED, can RADIATE.
  • High threshold.
20
Q

What is the definition of sensitivity? In pulp testing?

A
  • The ability of a test to detect disease in patients who HAVE the disease.
  • Pulp testing: identify NON VITAL teeth.
21
Q

How common is a false positive/ false negative in EPT?

A

10 - 20%

22
Q

What does a response to a cold stimulus indicate?

A

Potentially vital pulp, can be NORMAL or COMPROMISED.

23
Q

What does pulp vitality test?

A

The BLOOD SUPPLY of the pulp.

measures PULPAL BLOOD FLOW – VASCULAR SUPPLY IS THE MOST ACCURATE MARKER OF PULP VITALITY.

24
Q

What does a positive sensibility test indicate?

A

Does NOT indicate a healthy pulp - just indicates that there are some nerve fibres carrying sensory impulses.

25
Q

What are 3 causes of a periapical radiolucency on radiograph?

A
  • Apical pathology.
  • Other pathology (ex. cysts).
  • Normal structures (ex. mental foramen).
26
Q

What are 4 indications for the use of Laser Doppler Flowmetry?

A
  • Pulp testing in children.
  • Traumatized teeth.
  • Monitoring revascularization of replanted teeth.
  • Differential diagnosis of periapical radiolucencies.
27
Q

What does sensibility testing test?

A

The nerve supply of the pulp.

way of assessing the presence of FUNCTIONING A DELTA FIBERS IN PULP

28
Q

What feeling does a cold test cause? What nerve fibres are affected? What is the physiological process behind this?

A
  • SHARP PAIN. Alpha delta fibres affected.
  • Causes CONTRACTION OF FLUID IN DENTINAL TUBULES
  • RAPID OUTFLOW
  • HYDRODYNAMIC FORCES act on ADELTA FIBRES
  • SHARP SENSATION.
29
Q

4 types of pulp sensibility testing

A
  • Thermal (cold and heat)
  • EPT
  • Test cavity preparation.
  • Local anesthetic test.
30
Q

What is laser doppler flowmetry?

A
  • An optical measuring method that enables the NUMBER and VELOCITY of particles conveyed by a fluid to be measured.
31
Q

What are the 4 key uses of pulp sensibility testing?

A
  • Prior to operative procedure
  • Pain diagnosis
  • Investigation of radiolucent area
  • Post trauma assessment
32
Q

What does EPT response NOT reflect?

A

DOES NOT REFLECT THE DEGREE OF HEALTH OR DISEASE OF THE PULP.

33
Q

Where do you place EPT on anteriors? Molars? What should you avoid?

A
  • Anteriors: incisal third.
  • Molars: tip of MB cusp (highest innervation).
  • Avoid metal restorations.
34
Q

What is an example of pulp vitality testing?

A

Laser Doppler Flowmetry.

35
Q

What is the definition of specificity? In pulp testing?

A
  • The ability of a test to detect the ABSENCE of disease.
  • Pulp testing: Vital teeth.
36
Q

What is endofrost made of? Temperature?

A
  • Propane, butane, isobutane.
  • -50 celsius.
37
Q

What feeling does a cold test cause? What nerve fibres are affected?

A
  • DULL PAIN OF LONGER DURATION.
  • Activates C FUBRES.
38
Q

What vitality testing is best indicated in a mature tooth with patent canal space following trauma?

A

EPT, cold, heat

39
Q

What are 2 downsides of a heated gutta percha stick test?

A
  • Difficult on molars.
  • Excessive heating can cause pulp damage.
40
Q

What are two methods of conducting a heat test in practice?

A
  • Hot water (teeth isolated with rubber dam, syringe hot water a tooth at a time).
  • Heated gutta percha stick.
41
Q

What are two “last resort” sensibility tests?

A
  • Test cavity preparation.
  • Local anesthetic test.
42
Q

Why may immature teeth lead to a false negative on EPT?

A
  • Contain fewer alpha delta fibres.
  • Myelinated nerves have not reached their maximal depth of penetration into the pulp until the apex completes development.
43
Q

What are 5 causes of EPT false positives?

A
  • Electrode makes contact with gingiva/ large amalgam.
  • Tooth not dry/ well isolated.
  • Area of liquefaction necrosis/ periapical abscess.
  • Patient anxious.
  • Partial necrosis (multi rooted tooth, one canal remains vital while others necrotic).
44
Q

In the dental pulp, what does Laser Doppler Flowmetry test?

A
  • This is an OBJECTIVE TEST of the presence of MOVING RBCs within a tissue.
45
Q

How is a diagnosis of the dental pulp reached?

A

Synthesis of history, clinical examination, special tests and radiological examination. NOT THE OUTCOME OF ONE SPECIFIC TEST.

Module 5 - Endodontics (11 decks)

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