Module 5 - Endodontics > Pulp Sensitivity Testing > Flashcards

Pulp Sensitivity Testing Flashcards

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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?

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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?

Study These Flashcards
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?

22
Q

What does a response to a cold stimulus indicate?

Study These Flashcards
A

Potentially vital pulp, can be NORMAL or COMPROMISED.

23
Q

What does pulp vitality test?

Study These Flashcards
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?

Study These Flashcards
A

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

25
What are 3 causes of a periapical radiolucency on radiograph?
- Apical pathology. - Other pathology (ex. cysts). - Normal structures (ex. mental foramen).
26
What are 4 indications for the use of Laser Doppler Flowmetry?
- Pulp testing in children. - Traumatized teeth. - Monitoring revascularization of replanted teeth. - Differential diagnosis of periapical radiolucencies.
27
What does sensibility testing test?
The nerve supply of the pulp. way of assessing the presence of FUNCTIONING A DELTA FIBERS IN PULP
28
What feeling does a cold test cause? What nerve fibres are affected? What is the physiological process behind this?
- SHARP PAIN. Alpha delta fibres affected. - Causes **CONTRACTION** OF FLUID IN DENTINAL TUBULES - RAPID **OUTFLOW** - **HYDRODYNAMIC FORCES** act on ADELTA FIBRES - SHARP SENSATION.
29
4 types of pulp sensibility testing
- Thermal (cold and heat) - EPT - Test cavity preparation. - Local anesthetic test.
30
What is laser doppler flowmetry?
- An optical measuring method that enables the NUMBER and VELOCITY of particles conveyed by a fluid to be measured.
31
What are the 4 key uses of pulp sensibility testing?
- Prior to operative procedure - Pain diagnosis - Investigation of radiolucent area - Post trauma assessment
32
What does EPT response NOT reflect?
DOES NOT REFLECT THE DEGREE OF HEALTH OR DISEASE OF THE PULP.
33
Where do you place EPT on anteriors? Molars? What should you avoid?
- Anteriors: incisal third. - Molars: tip of MB cusp (highest innervation). - Avoid metal restorations.
34
What is an example of pulp vitality testing?
Laser Doppler Flowmetry.
35
What is the definition of specificity? In pulp testing?
- The ability of a test to detect the ABSENCE of disease. - Pulp testing: Vital teeth.
36
What is endofrost made of? Temperature?
- Propane, butane, isobutane. - -50 celsius.
37
What feeling does a cold test cause? What nerve fibres are affected?
- DULL PAIN OF LONGER DURATION. - Activates C FUBRES.
38
What vitality testing is best indicated in a mature tooth with patent canal space following trauma?
EPT, cold, heat
39
What are 2 downsides of a heated gutta percha stick test?
- Difficult on molars. - Excessive heating can cause pulp damage.
40
What are two methods of conducting a heat test in practice?
- Hot water (teeth isolated with rubber dam, syringe hot water a tooth at a time). - Heated gutta percha stick.
41
What are two "last resort" sensibility tests?
- Test cavity preparation. - Local anesthetic test.
42
Why may immature teeth lead to a false negative on EPT?
- Contain fewer alpha delta fibres. - Myelinated nerves have not reached their maximal depth of penetration into the pulp until the apex completes development.
43
What are 5 causes of EPT false positives?
- 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
In the dental pulp, what does Laser Doppler Flowmetry test?
- This is an OBJECTIVE TEST of the presence of MOVING RBCs within a tissue.
45
How is a diagnosis of the dental pulp reached?
Synthesis of history, clinical examination, special tests and radiological examination. NOT THE OUTCOME OF ONE SPECIFIC TEST.
Module 5 - Endodontics
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