Restorative & Materials · patient case question

Which pulp testing approach best establishes which tooth is actually responsible?

Patient case: Post-restorative sensitivity in the mandibular right posterior sextant

Patient: Adult periodontal maintenance patient

Chief complaint: Sensitivity after restorations were placed in teeth #28 and #29.

Background: Controlled periodontal patient. The restorations were well executed.

Current findings: Gingival recession of 3 mm and bone loss. Radiographs of the region are provided.

Test only the tooth the patient identifies as painful
Rely on the radiograph alone
Rely on percussion alone
Test several adjacent and contralateral teeth to establish a baseline before testing the suspect tooth

Show answer and explanation

Correct answer: D. Test several adjacent and contralateral teeth to establish a baseline before testing the suspect tooth

A. Testing only the indicated tooth is precisely the error that referred pain sets you up to make.
B. Radiographs show periapical change only after substantial bone demineralisation, and reveal nothing about pulp vitality.
C. Percussion assesses the periodontal ligament, and so distinguishes periapical involvement, but does not assess pulp vitality.
D. CORRECT. Because pulpal pain refers so readily, you must test MULTIPLE teeth, including a known-healthy contralateral control, to establish that patient's normal response before interpreting the suspect tooth. Testing one tooth in isolation yields an uninterpretable result.