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Frequently Asked Questions

Pulp Testing with the Digitest II

By Dr. Michael Karter, D.D.S.

Q: Can I use the Digitest II

on patients that have a pacemaker?

keep flashing alternately.) What should I do?

Q: When diagnosing problem teeth,

how reliable is the Digitest II in definitively indicating which tooth is the problem?

A: No. The Digitest II should not be

A: This is an indication that the bat-

used on patients with pacemakers or any other intra-corporeal electronic devices (internal defibrillator, insulin pump, etc.).

tery is weak and should be replaced. Replacing the battery can be done in your office. All it takes is a small screwdriver and a highoutput 9-volt replacement battery.
does that mean I no longer have to do cold or heat testing during diagnosis?

A: The Digitest II is a diagnostic aid

Q: I am a clinician and I have a A: It depends.

Q: If I get an electric pulp tester, A: No. Even though there may be

pacemaker. Is the Digitest II the type of device I can use?

that provides information which, when evaluated in conjunction with the results of other tests, can be helpful in determining which tooth is causing the patients discomfort.
I use in combination with the Digitest II when trying to determine which tooth is causing the problem?

Q:  What other methods should

 You can use it: If you are wearing gloves and are using the lip clip (recommended for compliance with infection control protocol), your hands are insulated from being part of the electric circuit.

instances in which electric pulp testing alone confirms radiographic findings, for most cases the combination of thermal and electric pulp testing are both useful for diagnosis.
have to wait a certain amount of time before I follow that test up with electric pulp testing?

A: Additional tools and tests you

can use to assist in endodontic diagnosis are:

 Do not use it: If you are not wearing gloves. When you are not wearing gloves your hand is in direct contact with the metal plate on the front of the Digitest II. This plate serves the same function as the lip clip in completing the electric circuit. If you are holding the Digitest II with your bare hand and you accidently or intentionally come in direct contact with the patient, you will become part of the electric circuit. This might affect your intra-corporeal electronic device (pacemaker, internal defibrillator, insulin pump, etc.).
irregularly, kind of like the lights at a railroad crossing. (The two positions on the digital display

Q: I just pulp tested with cold. Do I A: No. Studies indicate cold testing
prior to electric pulp testing does not impact the result of the electric test.
already been anesthetized?

Q: Can I pulp test a tooth that has A: Anesthetized teeth will not respond
to electric stimuli. For pulp testing to be of any diagnostic value you should always pulp test before using anesthetic.
autoclavable?

 Listen to the patient: Get a history. Is there a record of trauma to a tooth? Is there a large restoration that the patient was advised might some day become problematic? Try to understand what the patient believes their problem is and what they think initiated the problem.  Radiographic evaluation: Dont just take x-rays of the tooth the patient thinks is the cause of the problem. Very often the pain is referred. Get films of adjacent and opposing teeth as well. P  ercussion: A gentle tapping with the back end of a mirror can help identify inflammation in the ligament as the affected tooth will have heightened sensitivity.

Q: The digital readout is flashing

Q: Are the tooth probes A: Yes. The stainless steel tooth

probes are autoclavable.

continued

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P  alpation: Gentle compression in the areas around the root apices often results in tenderness around the problem tooth.  Heat and Cold testing: Additional sensory tests that depending on the patients response may be helpful in diagnosis.  Anesthesia: If the pain goes away when a specific tooth is anesthetized, this tooth is probably the cause of the pain. (For lower teeth this can be accomplished with an intraligamentary injection.)

A: Very important. Using toothpaste

or a fluoride gel with both the lip clip and the tooth probe enhances electrical conductivity at both sites, thereby ensuring more accurate and consistent test results.
several patients and noticed that the numerical results vary from patient to patient. Shouldnt normal readings be the same for all patients?

tion. This should help minimize the potential for patient discomfort.

Q: I noticed the Digitest II has three

speed settings. Which one should I use?

Q:  I have used the Digitest II on

Slow

Medium

Fast

A: No. Each patient will have their own

base level to electric stimulus that must be determined during testing. As an example, young patients with larger pulp chambers will likely be more sensitive at a lower setting than an older patient whose pulp chamber has receded with age.

A: New users should start with the

Q: If the Digitest II goes up to 64

(the top reading) and I get no response from the patient, does that mean the tooth is non-vital and that I should begin root canal treatment?

A: If you do not get a response to a

 If the electric pulp tester is working properly, a non-response to maximum stimulus on a single tooth can be interpreted in several ways. Usually you will need more information from the patient, along with additional diagnostic tests, to make a determination as to what the lack of a response from a single tooth to an electric pulp test means.

pulp test the first thing you should do is repeat the test, making sure you have good connections between the probe and the tooth, and the lip clip and the lip. If you still get no response, perform a pulp test on a healthy tooth. Testing a healthy tooth and getting a positive response will confirm that the Digitest II is working properly.

 The base level for each patient can be determined by pulp testing similar teeth to the tooth in question. As an example, if the upper left first molar is believed to be the problematic tooth, the upper right first molar (assuming it is vital and healthy) can be pulp tested to establish a comparative reference. If the corresponding tooth is not available, either because it is missing or already endodontically treated, similar teeth such as maxillary second molars would be used for the example given above.

slowest setting until they feel comfortable using the device. As you become more experienced you may want to selectively employ the faster settings on specific patients who you anticipate may not respond until the Digitest II reaches the higher end of the stimulus range. Most doctors, however, find the slowest setting is more than adequate for performing pulp tests on the majority of their patients.
ress at each setting?

Q:  How fast do the numbers progA: At the slowest setting the stimulus
increases about every half a second. At the medium setting the stimulus increases approximately every quarter of a second. At the fastest setting the stimulus increases approximately every eighth of a second.
tion on the Digitest II?

Q:  Does electric pulp testing cause

the patient discomfort?

Q:  Where can I get more informaA: Additional information about the

About the Author:
Michael Karter, D.D.S., maintains a General Dental Practice in Levittown, NY, where he has been in private practice for over 28 years. He is also a consultant for Parkell, Inc., where he evaluates products in a clinical setting and provides hands-on opinions as to their effectiveness. He can be reached by phone on Tuesday and Friday, from 9:30 a.m. to 4:00 p.m., E.S.T., or via e-mail at MKarter@parkell.com.

A: In most instances, the first sensation

patients notice is a warm tingling feeling. When the patient advises you of this sensation, you simply stop the test and record the reading from the digital display on the Digitest II.

Digitest II can be found on the Digitest II product information page at www.parkell.com.

Q: Do I have to use the lip clip? A: All electric pulp Lip clip included

testing devices with Digitest II require a complete circuit to function. Using the lip clip allows you to complete the required circuit while maintaining appropriate infection control protocol.
paste on the tip of the probe and on the lip where it contacts the lip clip?

Q:  How important is it to use tooth-

 It is also possible that a tooth with a pulpitis may have an exaggerated response to electric pulp testing. This heightened sensitivity may potentially cause patient discomfort if the test is not discontinued immediately upon the patient indicating an awareness of sensation within the tooth. Using the slowest setting on the Digitest II will allow you to discontinue the electric stimulus at a lower output level when the patient indicates they are feeling sensa-

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