Endodontics and Pulp Testing for Children’s Teeth

Your child’s tooth contains soft tissues known as pulp that contain blood vessels and nerves, helping form dentin – an extremely hard substance which shields its inner surface against bacteria and pressure.

Pulp cavities may become damaged from dental trauma or large cavity fillings, leading to inflammation of the pulp that leads to non-reversible pulpitis which is extremely painful.

Endo-Ice Test

Electric pulp testing entails using a conducting probe to stimulate a tooth’s nerve tissue with an electric current, with healthy nerve tissue responding while dead or decayed tissue does not. A negative response doesn’t automatically mean endodontic treatment is required – various factors, including metal dental restorations or small root canals can significantly lower reliability of electric testing, leading to false-positives (Torabinejad).

The purpose of this test is to stimulate nerve fibres within the pulp and provoke a neurological response, typically short and sharp pain that quickly subsides once stimulus has been removed, showing that nerve fibres remain present and functional. Any prolonged or continuous painful sensation may indicate irreversible pulpitis.

As with the warm test, the cold test can also help assess pulpal health. Patients’ responses to cold stimuli should be compared with responses of other teeth; any significant difference suggests an inflamed pulp that needs endodontic treatment.

Measurement of blood flow to the tooth can also provide insight into its status. Pulpal blood flow has long been considered an indicator of pulpal health and has been measured using various techniques – Pulse oximetry being one such technique, although initial studies were disappointing.

Recent laboratory research examined various methods for cooling an extracted tooth’s pulp chamber using dichlorodifluoromethane (also known as Endo Ice). Results indicated that spraying large cotton pellets held with college pliers with this refrigerant was most successful at reaching its target pulp region – and replicate the patient’s complaint as closely as possible. This test should be run directly on any offending teeth in order to replicate symptoms accurately.

Hot Test

Thermal testing may provide an alternative method of diagnosing patients who do not respond to cold stimulation, and is an easy, painless and non-invasive diagnostic tool used by clinicians to check whether nerve tissue remains healthy. Thermal tests are particularly useful if persistent clinical symptoms or radiographic findings exist.

At this stage, a tooth is tested using an electrical probe to ascertain if its pulp horns are still functioning normally. A dentist applies conducting medium (typically toothpaste) onto the surface of the tooth being tested and presses down on it with an electric tester tip, increasing or decreasing current until patients notice a tingling sensation caused by action potentials in Type Ad fibres of their nerve. Tingling may indicate action potentials triggering an afferent response in Type Ad fibers of their nerve.

Duration of Tingling can help determine whether an stimulus has provided adequate stimulation to stimulate pulp and nerve health, with intensity being less significant. Software assisted fast Fourier transforms can also be utilized to assess tooth sensitivity to thermal stimuli by identifying patterns in LDF output signal frequency patterns.

Like with cold tests, in rare instances a patient may not respond to thermal testing; this may indicate a calcified or receding pulp chamber, immature apex formation or root canal treatment failure.

As such, it is recommended that a clinician begin by performing tests on asymptomatic teeth first to establish a normal baseline for pulpal responses before proceeding with tests on symptomatic ones in order to establish a sensitive baseline and compare with responses of symptomatic ones to detect any irregularities or anomalies. Pulp vitality tests are one of the most widely-used endodontic diagnostic tools that can provide invaluable insight into dental pulp health.

Apical Foramen Test

Physiological Apical Foramen is essential to providing blood supply to pulp tissues of teeth. When this foramen becomes blocked, blood is no longer flowing freely and necrotic tissue will form, leading to eventual tooth death. The physiological apical foramen test can help assess the status of pulp by applying electrical or cold (EndoIce) stimulation. To be successful during endodontic preparation, foramina should remain free from obstruction in order to allow penetration and permeability. An understanding of the morphology of foramina can assist in selecting instruments with appropriate caliber for each case, complementing periapical radiographs, electronic apex locators and tactile sensitivity as essential tools to provide non-surgical endodontic care.

An anatomic apical foramen is located on the external surface of a root while its physiological counterpart can be found on its internal side. Both may feature narrow openings with either narrow and oblong or circular shapes due to factors like dentin shape, presence of calcifications, or bony constrictions; or age-related changes in foramen diameter and canal diameters.

Finding an endodontic apex using traditional techniques often fails clinically, due to a number of variables. One major challenge lies within this traditional method itself – trying to locate the dentinocemental junction as a histologic landmark can vary between teeth; further complicating matters further with age as distance increases from foramen to apical constriction and potential apical resorption may affect this classic anatomical feature.

There have been various approaches developed for testing the apical foramen, including using ethyl chloride, ice and CO2 snow to conduct examinations of its foramens. Furthermore, numerous studies have been carried out in order to assess pulp blood flow measurements’ reliability; Fuss et al. and Petersson et al. only tested for sensitivity while Evans et al. and Gazelius et al. conducted additional tests analyzing positive and negative predictive values as well.

Ramsay et al. collected repeated pulp blood flow readings from thirteen upper central incisors over four sessions at two week intervals and found that intraindividual variation was small while intersession variability was greater.

Endodontic Examination

At an endodontic examination, your dentist will conduct a review of your dental history and ask about any concerns regarding your chief complaint. This information will then help them select an appropriate pulp test and formulate a treatment plan – so be honest and accurate when responding so as to help the dentist interpret test results appropriately.

Pulp vitality testing involves monitoring dental pulp for its response to hot or cold stimuli to assess its health. A positive result from such testing indicates that it has access to sufficient blood supply and is alive – valuable information for endodontists and restorative dentists when it comes time to restore your tooth. First step of this process: isolating affected tooth with rubber dam and performing test. Results will then be compared with surrounding teeth so as to set baseline standards of health while helping identify problems within pulp.

Thermal and electric pulp tests are non-sensitive assessments; they simply indicate whether a pulp is vital or non-vital but do not detect changes in response to percussion, thus being ineffective at detecting pulp inflammation or infection in asymptomatic patients.

Laser Doppler flowmetry is another method of testing blood circulation within the pulp. A diode emits laser light which scatters off of circulating blood within the tissue being tested, and this creates a frequency shift on returned signals which allows a dentist to quickly determine whether pulpal tissues are flowing or static.

Palpation is a method in which a dentist uses gloved fingers to feel for any periapical signs of inflammation or infection, like tenderness or swelling, using their index fingers on either buccal and lingual aspects, firm pressure being applied as needed and palpating both sides for comparison purposes. This manual method often accompanies other diagnostic tests.