Latest update March 24th, 2025 7:05 AM
PULP VITALITY
By Dr. Neromini Fagu
There are several layers of a tooth, the outermost layers being the enamel in the crown and cementum in the root. Below these two layers is the dentine and directly below this is the pulp. The pulp is housed in a chamber and traverses both the crown and root parts of a tooth. The pulp is said to be the nerve of the tooth, and for good reason, as it contains both the neural and vascular tissues.
Electric Pulp Testing
A vital pulp is one that is alive and capable of providing the support for maintaining the health of a tooth. The pulp has several functions:
Nourishment: The blood vessels contained within the pulp provide nutrients essential to the wellbeing of the tooth.
Pain sensation: Differences in temperature and pressure as well as pain from trauma are said to be sensed by the pulp and these sensation travel to register in our brain.
Dentine formation: The pulp contains specialized cells that produce dentine. When the tooth experiences trauma, these cells produce secondary dentine, also called reparative dentine to protect the tooth.
Your pulp may become inflamed due to a number of reasons including tooth decay, infection or trauma. The severity of these factors determines the vitality of the pulp. Since the pulp is the living part of the tooth, any action to compromise its integrity will have an effect on the entire tooth.
Issues that are not dealt with promptly and are left to worsen will overtime render the pulp non-vital. A tooth with a non-vital pulp will either have to be extracted to prevent further infection or may be retained in the mouth by way of root canal treatment. Once removed from the tooth, the pulp will not regenerate inside the tooth.
Testing for pulp vitality is important in determining the course of treatment for a troubled tooth. There are several methods for testing whether the pulp is alive or not and they include:
Electric Pulp Testing: This involves sending an electric current through the tooth in question to assess the status of the pulp. A known healthy tooth is also tested to compare results. The sensation will quickly disappear when the stimulus is removed from a vital tooth. When the sensation lingers, it signifies stimulation of nerve fibres, and an irreversible condition of the pulp. No response indicates the pulp is non-vital or dead.
Thermal Testing – Cold: Applying a cold stimulus to the tooth is another way to gauge vitality. A good old fashion piece of ice or containerized Ethyl Chloride may be used. Again, a sensation that lingers may mean pulpitis and no sensation may indicate a non-vital tooth.
Thermal Testing – Hot: Applying heat can be tricky but often warmed gutta-percha is used to illicit a response. Also, isolating the tooth with a rubber dam and immersing it in hot water is another method for assessing the pulp’s reaction to a thermal stimulus.
Laser Doppler Flowmetry: This is a non- invasive test for blood flow within the pulp tissue. It has been shown to be quite reliable, except it is very technique sensitive and time consuming.
Test Cavity: This is considered a last resort as it is quite crude and invasive. It involves cutting a cavity into a tooth without the administration of local anesthetic. If pain is experienced then the tooth is vital!
Tooth Discolouration: While not strictly a test, clinical appearance of a tooth may indicate what is happening to the pulp. Tooth discolouration may indicate pulpal haemorrhage, necrosis, microleakage from enamel crazing or leaking restorations, or gutta-percha in the pulp chamber.
For more information contact OMNI DENTAL at 295 Quamina Street, Georgetown Tel: 227-0025, Parika Tel: 260-3133 or send emails to nerominifagu@hotmail.com.
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