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This show on Endodontic Diagnosis will focus on vital pulp testing. It is surprising how many international dentists do not routinely perform or understand how to perform reliable pulp testing methods. This segment will emphasize the importance of establishing a base line, how to predictably perform cold and hot tests, and how to create hand signals so that you do not fool your patient... and they do not fool you!
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I'm very happy to spend a little bit more time with you and have another discussion about endodontic diagnosis and this time the emphasis will be on vital pulp testing in a previous episode we looked at indict diagnosis from the perspective of gathering the clinical findings but today we'll look at how to determine the status of any given pulp within any given tooth now obviously when we talk about the three phases of the in atonic examination vital pulp testing we have no agreement regarding exactly how to do these tests what are the best methods is an example to deliver a cold stimulus to a tooth so I'm just going to simply share with you what I do there are other ways to do things and this isn't the only way to do things but it's a way that works in a very predictable method especially if you get used to vital pulp testing every single patient that comes into your office and I'll explain a little bit more about that in just a moment let's get started with vital pulp testing I guess the most important thing to say in vital pulp testing there are four methods there is the cold stimulus or the cold test there's the hot test there's the electric pulp test which is affectionately referred to as the EPT and then there is the cavity test today we will only speak about what patients actually do and what they actually do is they drink cold liquids and hot liquids and so they're reporting hot and cold sensitivity from time to time and when they do we need to reproduce their chief complaint so if a patient complains of cold I'm running a cold test if a patient complains of sensitivity to heat I'm running a hot test if the patient has having no thermal sensitivity hot or cold then because of the ease of performing the test I do the cold test I'm not using the electric bulb test and I will not be speaking today about the cavity test because it's done so infrequently that over about thirty five years of practice I think I've used that test two times so it really doesn't justify your time or my time describing when why and how to do the cavity test so let's look at how to do hot and cold pulp testing well first of all as a teacher I can tell you that most people don't do these tests and again I'll be redundant if they do them they do them on patients that are complaining of symptoms but they're not just doing vital pulp test on asymptomatic teeth and I believe they should in fact I'll say it more specifically before you ever pick up your handpiece and touch any tooth you should know the status of that pulp so that you're not working on a tooth that's irreversibly involved yet asymptomatic so to get a good baseline to be confident that your subsequent tests are reliable you need to first get the patient's familiarity with how the test works on contralateral teeth opposing teeth and finally adjacent to the tooth that you suspicions as the endodontic culprit and by getting a baseline we're not comparing Sam to Jim we're not comparing Mary to Martha we're comparing that patient's teeth to that patient's teeth so it is a fair apples to apples comparison what I like to do is when I'm out of the office my assistants will purge anesthetic out of a car pool and once the car peels empty they'll cut some floss so that it's about one inch or two and a half centimeters longer than the entire length of the car pool they will then fill up about eight or ten of these car pools with water and they'll put these car pools in a cup and put the cup in a freezer of your refrigerator the freezer compartment and the reason the cup is used is so that the car pool don't inadvertently fall over and drain out the water before it freezes this way when you need to have ice you can simply pull out the floss and remove a pencil of ice and you can take that ice and put it in a 2x2 gauze so that your fingers don't prematurely warm it again don't go to the tooth in question go to an opposing tooth or a contralateral tooth and let's use hand signals in fact how the hand signals would work is when the fascia first feels cold in their tooth have them raise their hand you come off the

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