experience a lingering sensation to cold. Other cold test materials that can be used are ethyl chloride and skin refrigerants.
HEAT TEST. - The heat test consists of isolating the suspected tooth with a rubber dam and applying a warm liquid (hot water or coffee) to the tooth. The warm liquid should not be hotter than 140°F and should not burn your skin. If the tooth reacts with a painful response that lingers a few seconds after the heat is removed,
pulpitis may be present. If the patient experiences a violent pain reaction to the heat and is relieved by a cold application, the pulp is irreversibly inflamed and will need a root canal. If the patient experiences no response to heat or cold, the pulp is necrotic.
Percussion is the gentle tapping of the crown of the tooth with the finger or the end of a mirror handle to determine the presence of periapical inflammation. If a patient has an acute inflammation at the apex of the root, percussion stimulates the already inflamed area and pain results. An abnormal dull sound may signify a root that has attached to the bone. Several normal, opposing, and adjacent teeth should be checked for comparison.
Palpation is the application of the finger with light pressure to areas of the mouth to detect normal or abnormal tissue. Swelling, pain, and degree of rigidity of tissues are determined by palpation. When using palpation in the diagnosis of periapical diseases, the fingers are pressed gently against the soft tissue overlying the bone and apexes of the teeth to compare the tissues.
The mobility test is done by moving the tooth between the handles of 2 instruments. Abnormal mobility of a tooth when compared to healthy teeth signifies temporary or permanent loss of supporting alveolar bone or trauma. Mobility of the tooth tends to increase if an infection or injury is long standing and has affected the supporting periodontium tissues.
Selective anesthesia can be of assistance if the patient cannot accurately determine which teeth are the source of discomfort. If other diagnostic tests have narrowed the choice down to two teeth, one tooth can be anesthetized to determine if the pain disappears. If the pain does not disappear until the second tooth is anesthetized, the second tooth is the probable source. Selective anesthesia is most effective when the choice is between a maxillary and a mandibular tooth.
Transillumination uses fiber optic lighting to allow an intense, concentrated light to pass through the tooth from the lingual to the facial aspect. This is done most effectively on anterior teeth because of their structure and location in the arch. The light transmits through the enamel and dentin, permitting the detection of caries or a fractured crown.
There are several types of endodontic procedures. The more common procedures include pulp capping, pulpotomy, pulpectomy, and root canal therapy. Occasionally other procedures such as incision and drainage, apicoectomy, periapical curettage, retrograde filling, root amputation, and bleaching of teeth are indicated.
In an attempt to protect the pulp against additional injury and stimulate pulp regeneration, an application of protective dressing, such as calcium hydroxide, is placed over an exposed or nearly exposed vital pulp. This treatment is referred to as pulp capping. When the pulp is exposed mechanically during tooth preparation, placing a pulp cap directly over the exposed pulp is referred to as a direct pulp cap. If deep caries are present and a danger of exposing the pulp exists, placing a pulp cap over a layer of remaining dentin is termed an indirect pulp cap. If pulp capping in not effective, the pulp can be treated with endodontic therapy.
A pulpotomy is the surgical removal of the coronal part (pulp chamber) of an exposed vital pulp. The pulp is retained in root canals with the exposed ends covered with applications of calcium hydroxide, zinc oxide and eugenol, and zinc phosphate cement to preserve its vitality and function. If indicated, root canal treatment is completed at a later date.Continue Reading