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A Clinician’s Guide to Clinical Endodontics

Course Number: 562

Cold Test, EPT, and/or Heat Test for Pulp Sensibility

Pulp sensibility tests (thermal and electric) have been used to indirectly determine the state of pulpal health by assessing the condition of the dental pulp nerves. Pulp vitality, on the other hand, is the direct assessment of pulp blood flow. 1 This assessment is obtained with laser doppler flowmetry (LDF) or pulse oximetry (PO). The reason clinicians perform sensibility tests rather than pulpal vitality tests is that LDF and PO applications in dentistry are limited (i.e., they have not been designed for specific usage in dentistry).

Heat and cold tests do not jeopardize the health of the pulp.2 Additionally, teeth with porcelain or metal crowns conduct temperature and, therefore, can be tested for pulpal sensibility with cold or heat.3

With an electric pulp test (EPT), the clinician should understand what the numerical readings represent. Although the use an EPT can establish pulp sensibility, the numerical readout should not be used to determine the overall health of the pulp.4 For example, if tooth No. 8 has an EPT reading of 12 and tooth No. 9 has an EPT reading of 24, it does not mean tooth No. 8 is twice as vital as tooth No. 9. The EPT is used to determine whether the pulp is vital. In addition, when using an EPT, the clinician must be aware that teeth with metal restorations can give false-positive or false-negative responses.

Weisleder et al5 reported that the cold test and EPT used in conjunction resulted in a more accurate method for proper pulpal diagnostic testing. In another study, Jespersen et al6 reported that a pulp-testing spray and EPT are accurate and reliable methods for determining pulpal sensibility.