CHAPTER 3

What are the six main features assessed when evaluating endodontic pain?

Quality, location, duration, onset, initiation, and relief

What type of pain is associated with periodontal pain because of A-beta proprioceptive fibers?

Localized pain

Why is pulpal pain often diffuse?

The pulp lacks proprioceptive fibers

What type of pain is associated with pulpal pain because of the lack of proprioceptive fibers?

Diffuse pain

Which nerve fibers are stimulated by movement of dentinal fluid?

A-delta fibers

What type of pain results from A-delta fiber stimulation?

Momentary pain

What diagnoses are associated with momentary pain on stimulation?

Dentinal pain and reversible pulpitis

Which nerve fibers are associated with spontaneous pain of long duration?

C fibers

What diagnosis is associated with spontaneous pain of long duration?

Irreversible pulpitis

Tooth fracture

What additional condition may cause spontaneous pain of long duration?

Tooth fracture

What diagnosis is associated with sharp shooting momentary pain on provocation in the notes?

Irreversible pulpitis

What type of pain is associated with reversible pulpitis during mastication in the notes?

Sharp shooting pain

What type of pain is strongly associated with irreversible pulpitis?

Spontaneous dull, throbbing pain of long duration

Which nerve fibers produce sharp, lancinating pain?

A-delta fibers

Which nerve fibers produce dull, throbbing, lingering pain?

C fibers

What stimulus commonly causes reversible pulpitis through A-delta fiber stimulation?

Sweet and sour

What causes pain from sweet and sour stimuli according to the notes?

Stimulation of A-delta fibers

What diagnosis is associated with sweet and sour sensitivity?

Reversible pulpitis

Why does heat cause pulpal pain?

Vasodilatation stimulates C fibers

What diagnosis is associated with heat-induced pulpal pain?

Irreversible pulpitis

Which nerve fibers are stimulated by cold through dentinal fluid movement?

A-delta fibers

What condition is associated with cold sensitivity from dentinal fluid movement?

Dentin hypersensitivity

What pulpitis stages may produce both heat and cold sensitivity?

Early and late irreversible pulpitis

What pain pattern is associated with acute irreversible pulpitis?

Heat-stimulated pain relieved by cold

What may aggravate endodontic pain ?

Lying down or sleep

What does an electric pulp test (EPT) primarily test?

A-delta fiber response

What type of nerve fibers does EPT stimulate?

A-delta fibers

What does a positive EPT result indicate?

Presence of sensory fibers

What does a positive EPT result NOT indicate?

Pulp health

What cardiac condition is a contraindication to EPT in the notes?

Cardiac pacemaker

What sensation should a patient normally report during EPT?

Tingly, warm, or slight pain

What sensation should EPT NOT normally produce?

Shock-like sensation

What is required for reliable EPT contact?

Dry field and good probe contact

What type of tooth surface is required for reliable EPT?

Natural tooth structure

What is a false-positive EPT result?

A response despite absence of normal vital pulp tissue

What can cause a false-positive EPT result in a pus-filled canal?

Conductivity through pus

What pulpal condition can produce a false-positive EPT result?

Partial necrosis

What psychological factor can produce a false-positive EPT result?

Patient anxiety

What contamination can produce a false-positive EPT result?

Moisture contamination

What restoration-related factor can produce a false-positive EPT result?

Contact with metal

What medication-related factor can produce a false-positive EPT result according to the notes?

Analgesics

What can cause a false-negative EPT result after dental trauma?

Recently traumatized tooth

What developmental condition can cause a false-negative EPT result?

Immature/open apex

What calcific condition can cause a false-negative EPT result?

Calcific obliteration

What technical factor can cause a false-negative EPT result?

Poor probe contact

What restoration can cause a false-negative EPT result?

Full-coverage crown

What isolation problem can cause inconsistent EPT results?

Failure to isolate the tooth properly

What electrode-related problem can cause inconsistent EPT results?

Poor electrode-tooth contact

What pulpal condition can cause erratic EPT results?

Severe pulpal calcification

What anatomical factor can contribute to inconsistent EPT results?

Multiple canals

Which thermal pulp test is considered the most reliable in the notes?

Cold test

Which cold-testing method is considered most effective?

CO₂ ice

Which cold-testing method is very effective and commonly used?

Ethyl chloride spray

What is another effective cold-testing agent?

Tetrafluoroethane

Which cold-testing method is least effective?

Ice stick

What does a sharp, short response to cold generally indicate?

Vital pulp

What may a sharp, short cold response indicate?

Normal pulp

What pulpal condition may produce a sharp, short cold response?

Reversible pulpitis

Can irreversible pulpitis sometimes produce a sharp, short cold response?

Yes

What does an intense, prolonged response to cold suggest?

Irreversible pulpitis

What does no response to cold suggest?

Pulp necrosis

What is a false-negative cold test associated with?

Calcific metamorphosis

What is a false-positive cold test associated with?

Stimulus contacting gingiva or adjacent teeth

On which teeth is cold testing generally more effective?

Anterior teeth

What cold test is particularly useful for full ceramic crowns according to the notes?

Ethyl chloride

When is heat testing particularly useful?

When the patient reports heat sensitivity but cannot localize the tooth

What is the best heat-testing technique listed in the notes?

Dry rubber prophy cup

How does a dry rubber prophy cup produce heat?

Friction

What is another method of applying heat during pulp testing?

Heated gutta-percha

What other material can be used for heat testing?

Compound stick

What liquid can be used for heat testing?

Hot water

What does a prolonged response to heat or cold suggest?

Irreversible pulpitis

What does no response across multiple pulp tests suggest?

Pulp necrosis

What does pulp vitality testing ideally assess?

Blood flow

What is the gold-standard physiologic basis for pulp vitality?

Pulpal blood flow

What does neural pulp testing assess instead of true vitality?

Sensory nerve response

What technique can measure pulpal blood flow?

Laser Doppler flowmetry

What other technique can assess pulpal blood flow?

Pulse oximetry

What is a major limitation of blood-flow testing?

Expensive and not widely used clinically

What two conditions can blood-flow testing help differentiate according to the notes?

Acute periradicular abscess and acute periodontal abscess

What does percussion testing assess?

Periapical inflammation

How is percussion testing performed?

Tapping the occlusal surface

What does pain on percussion suggest?

Periapical inflammation

What does palpation assess?

Spread of inflammation

How is palpation performed?

Pressing over the apex

What does pain on facial tapping only suggest?

Periodontal involvement

What type of pain is more suggestive of periapical inflammation?

Sharp pain

What type of pain is more suggestive of periodontal involvement?

Dull or mild-to-moderate pain

What does Grade 1 mobility indicate?

Slight movement greater than normal

What does Grade 2 mobility indicate?

Horizontal movement less than 1 mm

What does Grade 3 mobility indicate?

Horizontal movement greater than 1 mm with or without rotation or vertical movement

When is a tooth a poor RCT candidate based on mobility?

When mobility is caused by periodontal disease

What is the purpose of the biting test?

Reproduce pain during chewing

What instruments can be used for the biting test?

Tooth Slooth or cotton swab

What endodontic condition is an indication for the biting test?

Symptomatic apical periodontitis

What structural condition is an indication for the biting test?

Cracked tooth

What finding may be particularly characteristic of a cracked tooth during biting?

Pain on release

What is the purpose of transillumination?

Detect cracks in the crown

How does transillumination help identify a crack?

The fracture line blocks light transmission