Electric pulp testing: a review.

Electric pulp testing (EPT) has been available for more than a century and used in dental practices worldwide. This article provides an overview of this diagnostic aid. The PubMed database from 1953 was used initially; the reference list for pulp testing featured 1071 articles, and for EPT identified 121 papers. A forward search was undertaken on these articles and using selected author names. Potentially relevant material was also sought in contemporary endodontic texts, while older textbooks on endodontics, operative dentistry and pain revealed historic information and primary research not found electronically. A short account of the innervation of the pulp is followed by an historic overview. Clinical considerations discussed include tooth isolation, glove wearing and tester electrode placement. Orthodontic treatment, pacemaker wearing and patient medications are considered. Research applications are also discussed. While EPT is valuable, no single pulp testing technique can reliably diagnose all pulp conditions. Careful collection of patient history regarding the problem tooth and prudent use of appropriate radiographs are also helpful. The shortcomings of electric tests, especially in the case of immature and concussed teeth, must be understood. The demeanour of the patient and the responses given by control teeth also require careful consideration.

[1]  S. Kim,et al.  Hypersensitive teeth. Experimental studies of dentinal desensitizing agents. , 1990, Dental clinics of North America.

[2]  J O Andreasen,et al.  Influence of splints and temporary crowns upon electric and thermal pulp-testing procedures. , 1976, Scandinavian journal of dental research.

[3]  M. Byers.  Dental sensory receptors. , 1984, International review of neurobiology.

[4]  E H Ehrmann,et al.  Pulp testers and pulp testing with particular reference to the use of dry ice. , 1977, Australian dental journal.

[5]  A. Reader,et al.  An evaluation of an electric pulp tester as a measure of analgesia in human vital teeth. , 1987, Journal of endodontics.

[6]  Theodore Kaletsky,et al.  Reliability of Various Types of Pulp Testers as a Diagnostic Aid , 1935 .

[7]  H Martin,et al.  An evaluaion of media used in electric pulp testing. , 1969, Oral surgery, oral medicine, and oral pathology.

[8]  K Petersson,et al.  Evaluation of the ability of thermal and electrical tests to register pulp vitality. , 1999, Endodontics & dental traumatology.

[9]  J. Andreasen,et al.  Influence of maturation status and tooth type of permanent teeth upon electrometric and thermal pulp testing. , 1976, Scandinavian journal of dental research.

[10]  Jae-Hong Choi,et al.  PULP RESPONSES TO AN ELECTRIC PULP STIMULATOR IN THE DEVELOPING PERMANENT ANTERIOR DENTITION , 1979 .

[11]  I. N. Steen,et al.  Pulpal anaesthesia for mandibular permanent first molar teeth: a double-blind randomized cross-over trial comparing buccal and buccal plus lingual infiltration injections in volunteers. , 2006, International endodontic journal.

[12]  I. Mjör,et al.  The structure and distribution of nerves in the pulp-dentin organ. , 1973, Acta odontologica Scandinavica.

[13]  E A Pantera,et al.  Reliability of electric pulp testing after pulpal testing with dichlorodifluoromethane. , 1993, Journal of endodontics.

[14]  B Matthews,et al.  Some observations on pulp testers , 1974, British Dental Journal.

[15]  Johnsen Dc.  Innervation of teeth: qualitative, quantitative, and developmental assessment. , 1985 .

[16]  Daniel E. Ziskin,et al.  Observations on Electrical Pulp Testing , 1938 .

[17]  J. Modaresi,et al.  The efficacy comparison of ibuprofen, acetaminophen-codeine, and placebo premedication therapy on the depth of anesthesia during treatment of inflamed teeth. , 2006, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[18]  Simon Civjan,et al.  Electric Pulp Vitality Testers , 1973, Journal of dental research.

[19]  M E Cohen,et al.  The predictive value of endodontic diagnostic tests. , 1984, Oral surgery, oral medicine, and oral pathology.

[20]  S. Seltzer,et al.  THE DYNAMICS OF PULP INFLAMMATION: CORRELATIONS BETWEEN DIAGNOSTIC DATA AND ACTUAL HISTOLOGIC FINDINGS IN THE PULP. , 1963, Oral surgery, oral medicine, and oral pathology.

[21]  T. Huopaniemi,et al.  Electrical stimulation of teeth with a pulp tester in the cat. , 1979, Scandinavian journal of dental research.

[22]  Mumford Jm,et al.  Pain perception threshold on stimulating human teeth and the histological condition of the pulp. , 1967 .

[23]  P M Dummer,et al.  The response of caries-free, unfilled teeth to electrical excitation: a comparison of two new pulp testers. , 1986, International endodontic journal.

[24]  A. Reader,et al.  Anesthetic efficacy of lidocaine/meperidine for inferior alveolar nerve blocks. , 2006, Anesthesia progress.

[25]  K. Thoma.  A Comparison of Clinical, Roentgen, and Microscopical Findings in Fifteen Cases of Infected Vital Pulps , 1929 .

[26]  M. Rosso.  Electric pulp testing. , 1974, University of Toronto undergraduate dental journal.

[27]  Samuel A. White.  Diseases of the Dental Pulp , 1883, The American journal of dental science.

[28]  T. Lundy,et al.  Correlation of pulpal histopathology and clinical symptoms in human teeth subjected to experimental irritation. , 1969, Oral surgery, oral medicine, and oral pathology.

[29]  A. Reader,et al.  A comparison of articaine and lidocaine for inferior alveolar nerve blocks. , 2005, Journal of endodontics.

[30]  David B Marx,et al.  Effect of narcotic pain reliever on pulp tests in women. , 2002, Journal of endodontics.

[31]  J. M. Mumford,et al.  PAIN THRESHOLD OF NORMAL HUMAN ANTERIOR TEETH. , 1963, Archives of oral biology.

[32]  Y. Kuo,et al.  Evaluation of mandibular block using a standardized method. , 2006, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[33]  S. Dworkin,et al.  Intraligamentary anesthesia: a double-blind comparative study. , 1984, Journal of the American Dental Association.

[34]  K C Nam,et al.  Reduction of excessive electrical stimulus during electric pulp testing. , 2005, International endodontic journal.

[35]  Richard F. Martin,et al.  Physiological properties of intradental mechanoreceptors , 1985, Brain Research.

[36]  S. Poulsen,et al.  Longitudinal study of electrometric sensitivity of young permanent incisors. , 1988, Scandinavian journal of dental research.

[37]  C. Francischone,et al.  Onset and duration periods of articaine and lidocaine on maxillary infiltration. , 2005, Quintessence international.

[38]  S Sorin,et al.  Assessment of reliability of electrical and thermal pulp testing agents. , 1986, Journal of endodontics.

[39]  R L Cooley,et al.  Evaluation of a digital pulp tester. , 1984, Oral surgery, oral medicine, and oral pathology.

[40]  Jack Lin,et al.  Appropriate electrode placement site for electric pulp testing first molar teeth. , 2007, Journal of endodontics.

[41]  S. Seltzer,et al.  DIFFERENTIAL DIAGNOSIS OF PULP CONDITIONS. , 1965, Oral surgery, oral medicine, and oral pathology.

[42]  J. Whitworth,et al.  Speed of injection influences efficacy of inferior alveolar nerve blocks: a double-blind randomized controlled trial in volunteers. , 2006, Journal of endodontics.

[43]  B Matthews,et al.  Thresholds of vital and non-vital teeth to stimulation with electric pulp testers , 1974, British Dental Journal.

[44]  A. Reader,et al.  An evaluation of volumes and concentrations of lidocaine in human inferior alveolar nerve block. , 1989, Journal of endodontics.

[45]  J P Scheetz,et al.  Change in pain threshold by meperidine, naproxen sodium, and acetaminophen as determined by electric pulp testing. , 1998, Anesthesia progress.

[46]  H D Millard,et al.  Electric pulp testers. , 1973, Journal of the American Dental Association.

[47]  R. M. Stephan.  Correlation of Clinical Tests with Microscopic Pathology of the Dental Pulp , 1937 .

[48]  Daniel E. Ziskin,et al.  The Pulp Testing Problem: the Stimulus Threshold of the Dental Pulp and the Peridental Membrane as Indicated by Electrical Means , 1945 .

[49]  T. Dumsha,et al.  The reliability of electric pulp test after concussion injury. , 1996, Endodontics & dental traumatology.

[50]  C. Broberg,et al.  Safety of electronic apex locators and pulp testers in patients with implanted cardiac pacemakers or cardioverter/defibrillators. , 2006, Journal of endodontics.

[51]  J. F. Taintor,et al.  The effect of orthodontic force application on the pulpal tissue respiration rate in the human premolar. , 1980, American journal of orthodontics.

[52]  J W Myers,et al.  Demonstration of a possible source of error with an electric pulp tester. , 1998, Journal of endodontics.

[53]  Certosimo Aj,et al.  A clinical evaluation of the electric pulp tester as an indicator of local anesthesia. , 1996 .

[54]  Infection control in the dental office: a realistic approach. , 1986, Journal of the American Dental Association.

[55]  C S Miller,et al.  Selective interference with pacemaker activity by electrical dental devices. , 1998, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[56]  P. Robinson.  A comparison of monopolar and bipolar electrical stimuli and thermal stimuli in determining the vitality of autotransplanted human teeth. , 1987, Archives of oral biology.

[57]  T. Gunji,et al.  Morphological research on the sensitivity of dentin. , 1982, Archivum histologicum Japonicum = Nihon soshikigaku kiroku.

[58]  The pacemaker patient in the dental surgery. , 1982, IADS newsletter.

[59]  G. Ambrosano,et al.  A double-blind comparison of 0.5% bupivacaine with 1:200,000 epinephrine and 0.5% levobupivacaine with 1:200,000 epinephrine for the inferior alveolar nerve block. , 2006, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[60]  F. Marshall.  Planning endodontic treatment. , 1979, Dental Clinics of North America.

[61]  P E Teplitsky,et al.  Electric pulp testing with examination gloves. , 1988, Oral surgery, oral medicine, and oral pathology.

[62]  P Treasure,et al.  Capacitance effect of rubber gloves on electric pulp testers. , 1989, International endodontic journal.

[63]  J. Lilja.  Sensory differences between crown and root dentin in human teeth. , 1980, Acta odontologica Scandinavica.

[64]  J. Modaresi,et al.  Comparing the quality of anaesthesia in normal and inflamed teeth by pulp testing. , 2005, Australian Endodontic Journal.

[65]  M. Närhi,et al.  Dental injury models: experimental tools for understanding neuroinflammatory interactions and polymodal nociceptor functions. , 1999, Critical reviews in oral biology and medicine : an official publication of the American Association of Oral Biologists.

[66]  F. Sundström,et al.  Intradental nerve activity and jaw-opening reflex in response to mechanical deformation of cat teeth. , 1988, Acta physiologica Scandinavica.

[67]  I. B. Bender,et al.  The optimum placement-site of the electrode in electric pulp testing of the 12 anterior teeth. , 1989, Journal of the American Dental Association.

[68]  S. Seltzer,et al.  FACTORS AFFECTING SUCCESSFUL REPAIR AFTER ROOT CANAL THERAPY. , 1963, Journal of the American Dental Association.

[69]  Sami Chogle,et al.  Electric pulp tester conductance through various interface media. , 2006, Journal of endodontics.

[70]  D. Pashley,et al.  Microleakage of three temporary endodontic restorations. , 1988, Journal of endodontics.

[71]  W. K. Dong,et al.  Autoradiographic location of sensory nerve endings in dentin of monkey teeth , 1983, The Anatomical record.

[72]  L. Grossman,et al.  Endodontics 1776-1976: a bicentennial history against the background of general dentistry. , 1976, Journal of the American Dental Association.

[73]  T. Freer,et al.  The effects of early orthodontic force application on pulp test responses. , 1998, Australian dental journal.

[74]  W. Barkmeier,et al.  An alternative to electric pulp testing. , 1977, Quintessence international, dental digest.

[75]  H. Podlich,et al.  Pulp-test responses in orthodontic patients. , 2002, Australian orthodontic journal.

[76]  R. Averbach,et al.  Electronic and Clinical Comparison of Pulp Testers , 1982, Journal of dental research.

[77]  L Lorton,et al.  Adult pulpal diagnosis. I. Evaluation of the positive and negative responses to cold and electrical pulp tests. , 1994, Journal of endodontics.

[78]  C I DEGERING,et al.  Physiologic Evaluation of Dental-Pulp Testing Methods , 1962, Journal of dental research.

[79]  E A Pantera,et al.  Influence of a barrier technique on electric pulp testing. , 1988, Journal of endodontics.

[80]  John S. Marshall.  ELECTRICITY AS A THERAPEUTICAL AGENT IN THE TREATMENT OF HYPERAEMIA AND CONGESTION OF THE PULP AND PERIDENTAL MEMBRANE. , 1892 .

[81]  E A Lado.  Use, abuse, and misuse of the electric pulp tester. , 1983, Operative dentistry.

[82]  J A Guerra,et al.  Electric pulp tester and apex locator barrier technique. , 1993, Journal of endodontics.

[83]  Leif Oloart.  Excitation of intradental sensory units by pharmacological agents. , 1974 .

[84]  S. C. Harris.  Problems of experimental algesimetry and a comment on the tooth pulp method. , 1956, Journal of chronic diseases.

[85]  J. Whitworth,et al.  Articaine and lidocaine mandibular buccal infiltration anesthesia: a prospective randomized double-blind cross-over study. , 2006, Journal of endodontics.

[86]  A. Reader,et al.  An evaluation of the incisive nerve block and combination inferior alveolar and incisive nerve blocks in mandibular anesthesia. , 1992, Journal of endodontics.

[87]  B H Seidberg,et al.  An in vivo evaluation of interface media used with the electric pulp tester. , 1975, Journal of the American Dental Association.

[88]  T. Kaletsky.  The management of traumatized pulps , 1944 .

[89]  S N Bhaskar,et al.  Dental vitality tests and pulp status. , 1973, Journal of the American Dental Association.

[90]  P M Dummer,et al.  A laboratory study of four electric pulp testers. , 1986, International endodontic journal.

[91]  J G Cailleteau,et al.  Using the electric pulp tester with gloves: a simplified approach. , 1989, Journal of endodontics.

[92]  J. M. Mumford,et al.  Pain perception threshold and adaptation of normal human teeth. , 1965, Archives of oral biology.

[93]  A. Waikakul,et al.  Response of autotransplanted teeth to electric pulp testing. , 2002, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[94]  R. M. Stephan,et al.  Pathology and Protection of the Dental Pulp in Partial Denture Construction , 1934 .

[95]  T. Huopaniemi,et al.  Conduction velocities of single pulp nerve fibre units in the cat. , 1982 .

[96]  I G Chambers,et al.  The role and methods of pulp testing in oral diagnosis: a review. , 1982, International endodontic journal.

[97]  A. Reader,et al.  A prospective, randomized, double-blind comparison of bupivacaine and lidocaine for inferior alveolar nerve blocks , 2005, Journal of endodontics.

[98]  D. Johnsen,et al.  Session III: Innervation of the Dentin, Predentin, and Pulp — H.O. Trowbridge, Chairman , 1985 .

[99]  A G Hannam,et al.  A comparison of monopolar and bipolar pulp-testing. , 1974, Dental journal.

[100]  T R Pitt Ford,et al.  The assessment of pulpal vitality. , 1990, International endodontic journal.

[101]  Millard Hd.  Electric pulp testers. Council on Dental Materials and Devices. , 1973 .

[102]  R. R. Burnside,et al.  Electric vitality testing in orthodontic patients. , 1974, The Angle orthodontist.

[103]  J. Hietanen,et al.  Screening some modern pulp vitality testers. , 1973, Proceedings of the Finnish Dental Society. Suomen Hammaslaakariseuran toimituksia.

[104]  P. Dummer,et al.  Clinical signs and symptoms in pulp disease. , 1980, International endodontic journal.

[105]  R L Cooley,et al.  Variables associated with electric pulp testing. , 1980, Oral surgery, oral medicine, and oral pathology.

[106]  M. Närhi,et al.  The Characteristics of Intradental Sensory Units and Their Responses to Stimulation , 1985, Journal of dental research.

[107]  R. Pelzner,et al.  Rationalization of electric pulp-testing methods. , 1977, Oral surgery, oral medicine, and oral pathology.

[108]  T. Montagnese,et al.  A comparative study of the Gow-Gates technique and a standard technique for mandibular anesthesia. , 1984, Journal of endodontics.

[109]  L H Woolley,et al.  A preliminary evaluation of the effects of electrical pulp testers on dogs with artificial pacemakers. , 1974, Journal of the American Dental Association.