experience  a  lingering  sensation  to  cold.  Other  cold test  materials  that  can  be  used  are  ethyl  chloride  and skin  refrigerants. HEAT TEST.—The heat test consists of isolating the suspected tooth with a rubber dam and applying a warm  liquid  (hot  water  or  coffee)  to  the  tooth.  The warm  liquid  should  not  be  hotter  than  140°F  and should  not  burn  your  skin.  If  the  tooth  reacts  with  a painful  response  that  lingers  a  few  seconds  after  the heat is removed, pulpitis may be present. If the patient experiences a violent pain reaction to the heat and is relieved by a cold application, the pulp is irreversibly inflamed  and  will  need  a  root  canal.  If  the  patient experiences  no  response  to  heat  or  cold,  the  pulp  is necrotic. Percussion Percussion is the gentle tapping of the crown of the tooth with the finger or the end of a mirror handle to determine the presence of periapical inflammation. If a patient  has  an  acute  inflammation  at  the  apex  of  the root,  percussion  stimulates  the  already  inflamed  area and pain results. An abnormal dull sound may signify a root  that  has  attached  to  the  bone.  Several  normal, opposing,  and  adjacent  teeth  should  be  checked  for comparison. Palpation Palpation is the application of the finger with light pressure  to  areas  of  the  mouth  to  detect  normal  or abnormal tissue. Swelling, pain, and degree of rigidity of  tissues  are  determined  by  palpation.  When  using palpation  in  the  diagnosis  of  periapical  diseases,  the fingers  are  pressed  gently  against  the  soft  tissue overlying the bone and apexes of the teeth to compare the tissues. Mobility Test The  mobility  test  is  done  by  moving  the  tooth between  the  handles  of  2  instruments.  Abnormal mobility  of  a  tooth  when  compared  to  healthy  teeth signifies  temporary  or  permanent  loss  of  supporting alveolar bone or trauma. Mobility of the tooth tends to increase if an infection or injury is long standing and has affected the supporting periodontium tissues. Selective Anesthesia Selective  anesthesia  can  be  of  assistance  if  the patient cannot accurately determine which teeth are the source  of  discomfort.  If  other  diagnostic  tests  have narrowed the choice down to two teeth, one tooth can be anesthetized to determine if the pain disappears. If the  pain  does  not  disappear  until  the  second  tooth  is anesthetized, the second tooth is the probable source. Selective anesthesia is most effective when the choice is between a maxillary and a mandibular tooth. Transillumination Transillumination  uses  fiber  optic  lighting  to allow  an  intense,  concentrated  light  to  pass  through  the tooth from the lingual to the facial aspect. This is done most  effectively  on  anterior  teeth  because  of  their structure and location in the arch. The light transmits through   the   enamel   and   dentin,   permitting   the detection of caries or a fractured crown. TYPES  OF  PROCEDURES There are several types of endodontic procedures. The  more  common  procedures  include  pulp  capping, pulpotomy,   pulpectomy,   and   root   canal   therapy. Occasionally  other  procedures  such  as  incision  and drainage,  apicoectomy,  periapical  curettage, retrograde  filling,  root  amputation,  and  bleaching  of teeth are indicated. PULP  CAPPING In an attempt to protect the pulp against additional injury and stimulate pulp regeneration, an application of  protective  dressing,  such  as  calcium  hydroxide,  is placed over an exposed or nearly exposed vital pulp. This treatment is referred to as  pulp capping.  When the  pulp  is  exposed  mechanically  during  tooth preparation,  placing  a  pulp  cap  directly  over  the exposed pulp is referred to as a direct pulp cap. If deep caries  are  present  and  a  danger  of  exposing  the  pulp exists,  placing  a  pulp  cap  over  a  layer  of  remaining dentin is termed an indirect pulp cap. If pulp capping in  not  effective,  the  pulp  can  be  treated  with endodontic therapy. PULPOTOMY  AND  PULPECTOMY A pulpotomy is the surgical removal of the coronal part (pulp chamber) of an exposed vital pulp. The pulp is  retained  in  root  canals  with  the  exposed  ends covered with applications of calcium hydroxide, zinc oxide  and  eugenol,  and  zinc  phosphate   cement  to preserve  its  vitality  and  function.  If  indicated,  root canal treatment is completed at a later date. 7-3