Dr. Barry Musikant
Pulpitis is inflammation of the pulpal tissues. Such inflammation may be reversible or irreversible. It may be symptomatic or asymptomatic. Assuming the pulpal tissue is still vital, the differentiation between a tooth that needs endodontic therapy and one that will not is most often determined by the use of thermal testing with some form of ice (endo-ice) being applied to the tooth.
Prior to applying the stimulus to the tooth in question, apply it first to teeth that are deemed normal, so one can get a baseline normal response. Please realize that normal testing will produce different results based on a patients age their individual threshold for sensitivity to pain. An 80 year old is less likely to respond to the application of cold on a normal tooth than a 20 year old.
After establishing the normal baseline, apply the cold stimulus to the tooth in question. The tooth in question should at least be limited to the right side or the left side of the face. Dental pain generally does not cross the midline. If after application there is a sharp response that disappears within a few seconds, the tooth is probably in a state of reversible pulpitis. This can happen when a new filling is placed or a restoration that is a bit to high is present. The treatment is generally limited to adjusting the bite. If the patient is having sensitivity when biting, but otherwise is responding normally to cold, note whether or not large fillings are present and then check with a bite stick (or tooth sleuth) to see if the pain is limited to function one particular cusp. This cusp may represent a thin shell of dentin and enamel that is ...
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