Endodontics · patient case with 1 question
Testing pulp vitality
Scenario: Which of the following tests is the MOST SENSITIVE in evaluating the tooth's pulp vitality?
Question 1
Which test is most sensitive for evaluating pulp vitality?
Show answer and explanation
Correct answer: C. Thermal (cold) test
- A. Palpation assesses the buccal and lingual cortical plates for tenderness or expansion, indicating periapical inflammation extending through bone.
- B. Percussion assesses the PERIODONTAL LIGAMENT, not the pulp — it tells you about periapical inflammation.
- C. Correct per the source key. THERMAL testing — particularly COLD, using refrigerant spray on a cotton pellet — is the most widely used and most reliable chairside test of pulpal status. It stimulates A-delta fibres via hydrodynamic fluid movement in the dentinal tubules, and both the presence and the CHARACTER of the response (immediate versus lingering) inform the diagnosis.
- D. Radiographs show bone and hard tissue changes but cannot determine whether a pulp is vital — a tooth with a completely normal-appearing periapex may have a necrotic pulp.
Note: Note the terminology trap: cold and electric pulp tests are SENSIBILITY tests — they assess nerve response, not blood supply. TRUE vitality (blood flow) is assessed by laser Doppler flowmetry or pulse oximetry, which are not routine chairside tests. This matters in recently traumatised teeth, where the nerve may not respond even though the pulp is still vascularised.