Special tests Flashcards
List the 6 special tests relevant to Dental Hygiene Practice
- Saliva Testing
- Palpation
- Percussion
- Vitality
- Mobility
- Cracks/Fractures
Explain the rational behind performing a Saliva test i.e the importance of saliva
- Saliva is the primary defense system for oral environment
- Neutralizes acid, flushes food and bacteria
- Acts as lubricant by forming pellicle
- Delivers Calcium, Phosphate and Fluoride to the tooth
When saliva is unhealthy, demineralization becomes the dominant factor
Describe in detail the 5 steps to performing a GC Saliva test
Step 1: Resting flow rate. Hold back patients lower lip. Dry lightly. Measure how quickly saliva droplets form on the mucosa
• Low: more than 60 seconds
• Normal: between 30- 60 seconds
• Fast: less than 30 seconds
Step 2: Record Saliva appearance, viscosity and consistency of unstimulated saliva
• Bad: frothy, sticky
• Okay: bubbly but viscous
• Good: watery, clear
Step 3: Ask patient to spit into cup. Place in litmus paper to record the pH of resting saliva
Step 4: Measure quantity of stimulated saliva that can be produced. Ask your patient to continuously chew the tasteless wax for 5 minutes. The patient should spit out every 30 seconds stopping at the 5 minute mark. Record the quantity of saliva collected in the plastic cup
• Very low: <3.5 ml
• Low: 3.5 - 5.0 ml
• Good: >5.0 ml
Step 5: Record the buffering capacity of stimulated saliva. Take the collected saliva and deposit 3 drops onto the buffering paper provided as indicated. Record the colours of the 3 squares to identify the average Ph of the stimulated saliva
Describe the correct technique to assess a tooth with palpation
- Press into the fold above the apex of the root or roots
- You should also be able to detect any swellings or fistulas that may be present
- Palpate the lingual of teeth the same way
- Often the endodontically involved tooth will be more tender than the others if the inflammation has extended into the periapical region
Describe the percussion technique
- Tap the mirror handle on the tooth in a vertical direction often allows you to identify the tooth that has inflammation in the ligament and, consequently, hurts the most to tapping
- If two teeth together hurt to tapping, immobilize one with your finger while tapping the other and then reverse the process
- Often you will find that one hurts significantly more than the other and will be the more suspicious of the two
- If your patient is in a lot of pain and is identifying the tooth then be gentle and use finger pressure only.
List two methods for testing the Pulp vitality
Pulp-sensibility testing has two theories:
- Application of electric current ( not current theory)
- Application of cold
Explain the rational behind Cold testing and variables involved in pulp testing
Variables in pulp testing
* Thickness of enamel and dentine
- Number of nerve fibres in the underlying pulp: horns have high number of fibres whereas cervical and radicular areas do not have as much
- Direction of dentinal tubules
• Dentinal tubules run almost straight from incisal edge to pulp horn in anterior teeth
• In multi-cuspal teeth, the tubules are curved like an “S” shape
• It is the fluid in the tubules that conducts impulses to the pulp, the shorter the distance between the stimuli and the pulp, the quicker the pulp responses
List the two types of cold testing
- Cold thermal testing
* Dry ice
Explain the cold thermal testing technique, including:
- How it works
- What it’s made of
- How it is conducted
- Cautions with multi-rooted teeth
- Causes contraction of the dentinal fluid within the dentinal tubules. This hydrodynamic force stimulates the Aδ fibres with the pulp-dentine complex
- Ethyl chloride: a propane/butane/isobutane gas mixture stored in a pressurised can
- Sprayed onto a cotton bud resulting in the formation of ice crystals prior to application to the tooth
- Assess adjacent and contra lateral teeth
• Caution should be exercised when testing a multirooted tooth, it may respond positively to cold, even though only one root actually contains vital pulp tissue
Explain the dry ice testing technique, including:
- How it works
- What it’s used for
- Uses cylindrically shaped ice sticks
- Use to differentiate between reversible and irreversible pulpitis, to check if the pain subsides immediately or lingers on after removal of stimulus
- Clinician should also take into consideration of pain history and duration of pain prior to diagnosis
List 4 situations where cold testing may be ineffective and a patient gives “no response”
- Pulp necrosis / non-vitality
- Pulp recession
- Insufficient cooling
- Pulp still vital from trauma but not reactive to sensibility
Describe pulp testing on:
Primary teeth
Incomplete roots
Traumatised teeth
Primary teeth
• Testing primary teeth is questionable (child may be apprehensive, may not be able to convey results, although it will give an indication of whether the pulp is vital
• The test does not provide reliable evidence of the degree of inflammation of the pulp
• They are subjective tests which depend on the patient’s perceived response to a stimulus as well as the clinician’s interpretation of that response
Incomplete roots
• Require a stronger stimulation than normal to elicit a response.
• Teeth erupt and become functional before completion of neural development
Traumatised teeth
• May not respond to cold due to nerve rupture
• Pulps of these teeth may still be vital as their blood vessels remain intact or have revascularize
• These teeth should always be carefully monitored at periodic intervals as their nerve fibres may subsequently regain function
List the most common reasons for teeth to “Crack”
- Enamel and Dentinal cracks are usually caused by long term bruxing (Grinding) or Clenching
- They may also result from a one off incident e.g biting on an olive pip
Explain how to perform a test for Cracks/Fractures with a Fracfinder
- Have a patient bite on each cusp and laterally move the lower jaw, each cusp is subjected to lateral stresses
- If a section of the tooth under a cusp has an incipient fracture it will often hurt when pressure is applied
- The patient will report a symptom of a short sharp pain which will quickly resolve when the pressure is released
- This is a stereotypical symptom of “Cracked Tooth Syndrome”
