 Hello everyone, welcome back to another session in dentistry and more. Today's topic in conservative dentistry is called vitality test. So it is a common test we conduct before doing an endodontic procedure to make sure that the tooth is vital or non vital. So depending upon the vitality status we can opt the required treatment. So it is basically plays a very important role in diagnosis of the status of pulp. So pulp tests are usually done before restorative or endodontic treatment to aid in treatment plan. Pulp that is vital is indicated for restorative treatment and pulp that is non vital is indicated for endodontic treatment. So now let's learn the pulp vitality test one by one. First one we have cold test then electrical pulp test, anaesthesia test, percation test, heat test, cavity test, bite test and palpation test. So we will start with the cold test. So cold test suppose we have a suspected tooth, this is our suspected tooth, okay. So we are trying to check the vitality of this tooth by using a stimulus that is a cold stimulus. All are different different approach to check whether the tooth is vital or not. So in this case we are applying cold. So we should start always from the adjacent tooth. If this is the tooth of interest we should start with the adjacent. So then only the patient will be able to distinguish between the normal tooth and abnormal tooth, okay. So this might be the normal vital tooth, this is might not be the vital tooth. So when we apply cold or any stimulus here the patient will be having a response. So next we apply on the tooth which we are planning to do a vitality test and the patient might not feel the response or might not feel the pain or sensitivity. So we can differentiate between the normal tooth and the tooth which we are suspecting a non vitality. So cold test always start with the adjacent tooth. So we keep eye stick on the cervical area. So usually at the cervical area we keep an eye stick because where the enamel is very thin so that the conductivity to pulp will be very fast. So we keep an eye stick over the cervical area and we check the vitality. So there can be basically three conditions. The first one the patient feel immediate pain which will last for 1 to 3 seconds after the removal of eye sticks. So that indicates vital pulp that is the first scenario. The second scenario patient feel immediate severe pain that lasts for several minutes even after the removal of eyes. That indicates irreversibly inflamed pulp irreversibly inflamed pulp. And the last scenario the patient feels nothing that means the tooth is non vital. So these are the three scenarios we can expect after doing the cold test. Next we have heat test. So this is also following the same mechanism. So we start with the adjacent tooth. Place a hot instrument such as burnisher or hot material such as heated ghatapurcha over the cervical third of the tooth. And again we have three responses that is immediate pain for 1 to 3 seconds. That indicates vital pulp. Immediate severe pains which last for several minutes that indicates irreversibly inflamed pulp and patient feels nothing which indicates non vital tooth. So next we have the electrical pulp testing. So electrical pulp testing is different where we use electric current that is starting again with the adjacent tooth. So place one of the electrodes. So there will be having two electrodes. One electrode which is black and another electrode which is red color. So there will be two electrodes black and red. So the black electrode on the patient's finger. So this goes to patient finger. Patient finger and the electrode which is the red one which is on the tooth. So this goes to the tooth. This is on the tooth. So because we need to complete the electric circuit. We need to complete the electric circuit. Then apply little electric current and increase it slowly. So turn on the device and slowly increase electric current and ask the patient to tell when he feels pain. So each tooth should be tested two to three times and the results are compared. If the results are not definitive test the adjacent tooth and tooth on the opposite touch. So if patient feels pain then the tooth is vital. If no pain then the tooth is non vital. So we can use another technique in combination with electrical pulp testing to reach a reliable diagnosis. So why we actually starting with the adjacent tooth. As I mentioned to serve as a control. So that I can compare it with the questionable tooth. If both tooth are not responsive to the pulp test it either mean the pulp is non vital for both the teeth or something wrong with the testing procedure. So next we have the cavity test. So this method should be used only when all other test methods provide inconclusive results. The tooth is not anesthetized and tooth is drilled with a round bar with water coolant. So it is we can say it is not very ethical. But if all other are giving very inconclusive result the next option is cavity test as a last result. So the patient is asked if he feels any pain during drilling. So always you should make sure not to expose pulp. So never ever expose pulp. So after that we need to refill the cavity. So here also we can expect two conditions. Patient feels immediate severe pain which indicates vital pulp and patient feels nothing. So it is a non vital pulp. So next is the anesthesia test. So when patient is not able to specify the site of pain and when other pulp testing techniques are inconclusive this test is used. So what we do is we anesthetize single tooth at a time using only a intra-ligamentary injection. So the most posterior tooth is in the suspected quadrant. So we have so this is canine to premolars and we have premolars. So what we do is we start with the most posterior. So we expect one tooth that is this one this is the expected tooth. So this quadrant the most posterior. So this is the most posterior tooth we start from this using an intra-ligamentary injection. So the most posterior tooth anesthetized first. So if pain persists repeat the procedure to the next tooth medial to it then it is continued until the pain disappears. If source of pain cannot be determined repeat the same technique on the opposite arch. Next we have the bite test. So bite test is nothing but if patient complains of pain on mastication. So in that scenario we should perform bite test. So patient feel pain on biting if bulb necrosis has reached to periodontal space or the periapical area or there is vertical fracture in the tooth. So how to conduct this bite test? So the first thing is ask the patient to bite on a hard object such as cotton roll tooth pick or tooth sloth. So this is something like tooth sloth apparatus which used for the bite test. So ask the patient to bite on the suspected tooth and the tooth on the opposite arch. So if patient report pain then there will be a vertical fracture or pulp infraction which has reached to periodontal space or periapical area. So the next one is percation test. Percation test place a vinker at the incisal edge or occlusal area of the tooth and gently press it inward. If patient feel pain then the periapical area is inflamed because when there is infection at the periapical area and we apply pressure here that is at the incisal edge or occlusal so it will push the tooth towards the inflamed area. So it will elicit pain. So if patient report no pain then periapical area is healthy. So more accurate result can be obtained from radiograph and combination of other test. So the last one is palpation test. So palpation is using our index finger and place it at the periapical area not on the tooth. So periapical area of the suspected tooth. So the patient will report pain if the periapical area is infected. So no pain if it is intact. So more accurate result can be obtained from radiograph. So how much reliable are these pulp vitality tests? So pulp test can be helpful tools for dentists through diagnostic phase. So but a single pulp test with negative result is not that much reliable. So therefore always dentists prefer combination of tests. So sometimes pulp test tell you that the tooth is non vital while the reality the tooth might be a vital one. So this kind of situation is called false negative result. So sometimes the test results show that the tooth is vital but it might be non vital. So that is known as false positive. False positive actually it is non vital but your test tell you it is vital. False negative actually it is vital but your test tell you it is non vital. So what on occasions we get a false negative result? So that is the pulp shows that tooth is non vital but the reality is the tooth is vital. In cases such as recently traumatized tooth, recently erupted tooth with immature apex, patients with high pain threshold, tooth with calcified canals while doing electric pulp tester if the battery is very low and patient taking any kind of pain killers or psychiatric tricks. One necrotic canal in multi router tooth while other canals are vital. In all these cases we might get false negative result. So whereas a false positive results. So false positive it is a false assurance. The tooth is non vital but we are saying it is vital. So these kind of results occur in situations like error in pulp testing. Like when ice is melting and reaching another tooth or gingiva or when electrical current conducting with adjacent tooth and similar situations. One vital canal in multi router tooth while other canals are necrotic in tooth with abscess. There is liquefaction necrosis in the pulp which conduct electricity during electric pulp testing. In all these cases we get false positive result. So these are the common test we apply for checking pulp vitality. So these are the conventional test but we have some of the newer test. So they are very accurate and very reliable ones. The one is laser doppler flow metering LDF. So it actually sends laser light to the tooth and transmitted beam is received by the photo detector and checking the vitality. So that is laser doppler flow metering. The second one is pulp symmetry. So it basically measures the pulse rate of blood in the tooth and shows the result in screen. So we get a numerical value which shows that the pulse rate of blood and we can find out whether it is vital or non vital. Then we have one more that is dual wavelength spectrophotometry. So this method measures the oxygen level in capillaries using a light beam and provide the result on a screen. So it measures the oxygen level in capillaries. This measures the pulse rate of blood, this laser which sends a light to the tooth and transmitted beam is received. So there are many other newer technologies and techniques such as measuring the temperature of tooth surface, transfer illumination with fiber optic light, then Xenon 133, then gas desaturation, radiolabelled microscopes, electromagnetic flow metering. So all are the newer pulp vitality test but conventional ones are what we learnt. T-test, cold test, electric test, pulp vitality test, the percation test, palpation test, all are the conventional ones. So this is very commonly asked short essay in conservatory dentistry. So hope you understood this simple concept of pulp vitality, checking the vitality of pulp to decide the treatment protocol of that particular tooth. So I will come up with a new topic in conservatory dentistry, thank you.