C ontraindications of Electric Pulp Testing

EPT should not be used in patients having cardiac pacemaker as it may interfere with electric activity of pacemaker.

It should not be used on recently erupted tooth with immature apex because the relationship between the odontoblasts and the nerve fibers has not yet developed fully.

It means tooth doesn’t have fully developed sensitivity and may lead to false-negative reading.

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It should not be used on recently traumatized tooth.

Responses

The ability of electric test to indicate pulp vitality is based on sensitivity of neural transmission, which can lead to false-positive and false-negative values, but a positive response usually indicates that there are vital sensory fibers present. Generally, thicker enamel gives delayed the response.

False-negative

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1. Presence of pulp stone.

2. Extensive caries.

3. High amount of reparative dentin.

4. Patients heavily medicated with analgesics, sedatives, narcotics or alcohol.

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5. Teeth with large restoration and pulp protective base.

6. Recently erupted tooth with immature root. (It has underdeveloped plexus of Rashkow as well as greater unmyelinated nerve fibers.

Pulp tester is based on excitation of AS fibers which are not fully developed till the age of adolescent and hence may not respond in recently erupted tooth).

7. Recently traumatized tooth as nerves fibers are in state of shock.

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8. Inadequate contact of electrode with tooth structure due to insufficient conductor or due to improper placement of tip.

9. Low battery of tester. (With battery operated device, if battery is running low, it may not deliver full current).

False-positive

1. Presence of partially necrotic pulp in one canal of multirole tooth because partial necrosis is indicated as total necrosis by pulp tester.

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2. Moist gangrenous pulp which requires more current to elicit the response.

3. Electrode contacting any part of oral mucosa allowing current to reach the attachment apparatus directly.

4. Anxious patient may become hyperactive before perception of the actual sensation.

5. Improper isolation of tooth.

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False vitality responses are common in posterior teeth due to presence of vital pulp tissue in one of the canals.