Review of pulp sensibility tests. Part I: general information and thermal tests.

A major, and essential, part of the diagnostic process for pulp disease is the use of pulp sensibility tests. When diagnosing pulp pain, these tests can be used to reproduce the symptoms reported by the patient to diagnose the diseased tooth as well as the disease state. However, a major shortcoming with these tests is that they only indirectly provide an indication of the state of the pulp by measuring a neural response rather than the vascular supply, so both false positive and false negative results can occur. The relevant literature on pulp sensibility tests in the context of endodontics up to January 2009 was reviewed using PubMed and MEDLINE database searches. This search identified papers published between November 1964 and January 2009 in all languages. Thermal tests have been used as an integral part of dental examinations. Two types of thermal tests are available, one uses a cold stimulus and the other uses a hot stimulus, and each has various methods of delivery. If these tests are used properly, injury to the pulp is highly unlikely. A review of the literature regarding the rationale, indications, limitations, and interpretation of thermal tests, the value of these diagnostic tests, as well as a discussion of the important points about each of these tests is presented.

[1]  Kennedy Dc,et al.  Efficacy of electrical pulp testing. , 1987 .

[2]  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.

[3]  S. Seltzer,et al.  The dental pulp: Biologic considerations in dental procedures , 1965 .

[4]  D. M. Jones.  Effect of the type carrier used on the results of dichlorodifluoromethane application to teeth. , 1999, Journal of endodontics.

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

[6]  J. M. Mumford.  Stimulus-evoked pain in teeth. , 1976, Frontiers of oral physiology.

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

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

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

[10]  A. Sigurdsson,et al.  Efficacy of laser Doppler flowmetry for the diagnosis of revascularization of reimplanted immature dog teeth. , 2001, Dental traumatology : official publication of International Association for Dental Traumatology.

[11]  B. Gazelius,et al.  Non-invasive recording of blood flow in human dental pulp. , 1986, Endodontics & dental traumatology.

[12]  H. Klein.  Pulp responses to an electric pulp stimulator in the developing permanent anterior dentition. , 1978, ASDC journal of dentistry for children.

[13]  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.

[14]  B. Y. Cha,et al.  Endodontic anesthesia in mandibular molars: a clinical study. , 1993, Journal of endodontics.

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

[16]  K. Langeland,et al.  The effect of lowered temperatures on dental tissues. , 1969, Journal - Connecticut State Dental Association.

[17]  R. Walton,et al.  Comparison of carbon dioxide versus refrigerant spray to determine pulpal responsiveness. , 2002, Journal of endodontics.

[18]  Srinivas M Susarla,et al.  Use of the cold test as a measure of pulpal anesthesia during endodontic therapy: a randomized, blinded, placebo-controlled clinical trial. , 2007, Journal of endodontics.

[19]  R. Emling,et al.  Sensory response to thermal stimulation in human teeth. , 1980, Journal of endodontics.

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

[21]  J. Palamara,et al.  Thermal transfer in extracted incisors during thermal pulp sensitivity testing. , 2008, International endodontic journal.

[22]  A. Garfunkel,et al.  Dental pulp pathosis. Clinicopathologic correlations based on 109 cases. , 1973, Oral surgery, oral medicine, and oral pathology.

[23]  M. Brännström,et al.  Movements of the dentine and pulp liquids on application of thermal stimuli. An in vitro study. , 1970, Acta odontologica Scandinavica.

[24]  M. Pogrel.  Evaluation of over 400 autogenous tooth transplants. , 1987, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

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

[26]  R M Browne,et al.  A comparison of monopolar and bipolar electrical stimuli and thermal stimuli in determining the vitality of human teeth. , 1989, Archives of oral biology.

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

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

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

[30]  G. Bergenholtz,et al.  Textbook of endodontology , 2009 .

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

[32]  D. Stirrups,et al.  A comparison of laser Doppler flowmetry with other methods of assessing the vitality of traumatised anterior teeth. , 1999, Endodontics & dental traumatology.

[33]  W. Douglas,et al.  The effect of localized cooling on conduction in cat nerves , 1955, The Journal of physiology.

[34]  M. Iqbal,et al.  An investigation into differential diagnosis of pulp and periapical pain: a PennEndo database study. , 2007, Journal of endodontics.

[35]  R. Reynolds,et al.  The determination of pulp vitality by means of thermal and electrical stimuli , 1966 .

[36]  L. Tronstad,et al.  Root resorption--etiology, terminology and clinical manifestations. , 1988, Endodontics & dental traumatology.

[37]  H S Selden.  Diagnostic thermal pulp testing: a technique. , 2000, Journal of endodontics.

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

[39]  M. England,et al.  Histopathologic study of the effect of pulpal disease upon nerve fibers of the human dental pulp. , 1974, Oral surgery, oral medicine, and oral pathology.

[40]  J. Strother,et al.  Cold testing through full-coverage restorations. , 2004, Journal of endodontics.

[41]  Stephen Cohen,et al.  Pathways of the Pulp , 1976 .

[42]  Velayutham Gopikrishna,et al.  Comparison of electrical, thermal, and pulse oximetry methods for assessing pulp vitality in recently traumatized teeth. , 2007, Journal of endodontics.

[43]  D. F. Mitchell,et al.  Transplantation of Developing Teeth , 1955, Journal of dental research.

[44]  F. McDonald,et al.  Blood flow changes in permanent maxillary canines during retraction. , 1994, European journal of orthodontics.

[45]  J. Palamara,et al.  An investigation of thermal stimulation in intact teeth. , 2007, Archives of oral biology.

[46]  R. Bolton.  Autogenous transplantation and replantation of teeth: report on 60 treated patients. , 1974, The British journal of oral surgery.

[47]  A. Feinstein,et al.  Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. , 1978, The New England journal of medicine.

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

[49]  Antti S. J. Virtanen,et al.  Electrical stimulation of pulp nerves— comparison of monopolar and bipolar electrode coupling , 1985, Pain.

[50]  P. Hardy.  The autogenous transplantation of maxillary canines , 1982, British Dental Journal.

[51]  K. Haavikko,et al.  Evaluation of autotransplantations of completely developed maxillary canines. , 1978, International journal of oral surgery.

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

[53]  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.

[54]  Vivek Trikha,et al.  Clinical Study , 1961, Acta neurologica Scandinavica.

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

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

[57]  T. Bayer,et al.  A long-term study of 370 autotransplanted premolars. Part II. Tooth survival and pulp healing subsequent to transplantation. , 1990, European journal of orthodontics.

[58]  A. Ohman.  HEALING AND SENSITIVITY TO PAIN IN YOUNG REPLANTED HUMAN TEETH. AN EXPERIMENTAL, CLINICAL AND HISTOLOGICAL STUDY. , 1965, Odontologisk tidskrift.

[59]  S. Seltzer,et al.  Roentgenographic and direct observation of experimental lesions in bone: I. 1961. , 1961, Journal of endodontics.

[60]  K. Langeland,et al.  The pulpal effect of freezing temperatures applied to monkey teeth. , 1983, Oral surgery, oral medicine, and oral pathology.

[61]  S. Shabahang,et al.  State of the art and science of endodontics. , 2005, Journal of the American Dental Association.

[62]  Mumford Jm,et al.  Thermal and electrical stimulation of teeth in the diagnosis of pulpal and periapical disease. , 1967 .

[63]  H. Goodis,et al.  Seltzer and Bender's Dental Pulp , 2012 .

[64]  Ben T. Williams,et al.  Computer AIDS to Clinical Decisions , 1982 .

[65]  Hamid Jafarzadeh,et al.  Xeroradiography: Stagnated after a Promising Beginning? A Historical Review , 2010, European journal of dentistry.

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

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

[68]  C. Hill.  The efficacy of transillumination in vitality tests. , 1986, International endodontic journal.

[69]  George Freedman,et al.  Composites in the mainstream. , 2002, Dentistry today.

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

[71]  B Matthews,et al.  Electrophysiological evidence on the types of nerve fibres excited by electrical stimulation of teeth with a pulp tester. , 1972, Archives of oral biology.

[72]  E A Pantera,et al.  Use of dental instruments for bridging during electric pulp testing. , 1992, Journal of endodontics.

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

[74]  R. E. Barker,et al.  Thermally induced stresses and rapid temperature changes in teeth. , 1972, Journal of biomedical materials research.

[75]  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 .

[76]  R. Howell,et al.  Resistance of nerve fibers to pulpal necrosis. , 1970, Oral surgery, oral medicine, and oral pathology.

[77]  M Cvek,et al.  A clinical report on partial pulpotomy and capping with calcium hydroxide in permanent incisors with complicated crown fracture. , 1978, Journal of endodontics.

[78]  J. Andreasen,et al.  Prognosis of permanent teeth involved in jaw fractures. A clinical and radiographic follow-up study. , 1970, Scandinavian journal of dental research.

[79]  T. P. Ford,et al.  Technical equipment for assessment of dental pulp status , 2004 .

[80]  Hare Gc.  Diagnostic value of vitality tests. , 1969 .

[81]  M. Trope,et al.  Endodontics Manual for the General Dentist , 2005 .

[82]  Mumford Jm,et al.  Dental pain and the histological condition of the pulp. , 1970 .

[83]  Hamid Jafarzadeh,et al.  Appropriate electrode placement site for electric pulp testing of anterior teeth in Nigerian adults: a clinical study. , 2010, Journal of oral science.

[84]  W. E. Harris.  Pseudoendodontic sinus tract: report of case. , 1971, Journal of the American Dental Association.

[85]  J. E. Sanders,et al.  Standardization of a test for dental sensitivity to cold. , 1967, Oral surgery, oral medicine, and oral pathology.

[86]  Z. Fuss,et al.  Effects of thermal vitality tests on human dental pulp. , 1988, Journal of endodontics.

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

[88]  J. C. Brauer.  Dentistry for children , 1959 .

[89]  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.

[90]  M. Braden.  Heat Conduction in Teeth and the Effect of Lining Materials , 1964, Journal of dental research.

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

[92]  B J Millar,et al.  An assessment of the reliability of pulp testing deciduous teeth. , 2009, International journal of paediatric dentistry.

[93]  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.

[94]  D. D. Peters,et al.  In vitro effects of ice, skin refrigerant, and CO2 snow on intrapulpal temperature. , 1981, Journal of endodontics.

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

[96]  Hamid Jafarzadeh,et al.  The application of tooth temperature measurement in endodontic diagnosis: a review. , 2008, Journal of endodontics.

[97]  M. Tansy,et al.  Vascular and cellular responses of teeth after localized controlled cooling. , 1972, Cryobiology.

[98]  H Jafarzadeh,et al.  Laser Doppler flowmetry in endodontics: a review. , 2009, International endodontic journal.

[99]  Hamid Jafarzadeh,et al.  Pulse oximetry: review of a potential aid in endodontic diagnosis. , 2009, Journal of endodontics.

[100]  Lilienfeld Am,et al.  Foundations of epidemiology. 2nd ed. , 1980 .

[101]  Amitha M Hegde,et al.  Pulse oximetry: a diagnostic instrument in pulpal vitality testing. , 2002, The Journal of clinical pediatric dentistry.

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

[103]  W. Johnson,et al.  Detection of pulpal circulation in vitro by pulse oximetry. , 1996, Journal of endodontics.

[104]  J M Schnettler,et al.  Pulse oximetry as a diagnostic tool of pulpal vitality. , 1991, Journal of endodontics.

[105]  M. Mengel,et al.  Pain sensation during cold stimulation of the teeth: differential reflection of Aδ and C fibre activity? , 1993, Pain.

[106]  J. Andreasen,et al.  Textbook and Color Atlas of Traumatic Injuries to the Teeth , 2019, STOMATOLOGY EDU JOURNAL.

[107]  A. Chosack,et al.  A clinical evaluation of vitality tests in anterior teeth following fracture of enamel and dentin. , 1972, Oral surgery, oral medicine, and oral pathology.

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

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

[110]  S. Tajima.  A longitudinal study on electrical pulp testing following Le Fort type osteotomy and Le Fort type fracture. , 1975, Journal of maxillofacial surgery.

[111]  J. C. Donnelly,et al.  Evaluation of the effects of carbon dioxide used as a pulpal test. 3. In vivo effect on human enamel. , 1986, Journal of endodontics.

[112]  I. B. Bender.  Pulpal pain diagnosis--a review. , 2000, Journal of endodontics.

[113]  R. L. Cooley,et al.  A quantitative evaluation of thermal pulp testing. , 1977, Journal of endodontics.

[114]  W. E. Harris.  Endodontic pain referred across the midline: report of case. , 1973, Journal of the American Dental Association.

[115]  L. Baume.  Diagnosis of diseases of the pulp. , 1970, Oral surgery, oral medicine, and oral pathology.

[116]  D. D. Peters,et al.  Evaluation of the effects of carbon dioxide used as a pulpal test. Part 2. In vivo effect on canine enamel and pulpal tissues. , 1983, Journal of endodontics.

[117]  C. Goodis.  Endodontic diagnostic procedures. , 1998, New Mexico dental journal.