The biting test is a helpful test to diagnose if any teeth present with periapical inflammation or to look for a fracture.
Before you begin: select which teeth you will be testing.
It is helpful to test 3-4 teeth at a time: a tooth on the opposite side of the mouth from the symptomatic side/tooth,a tooth on either side of the tooth of interest, a tooth opposing the tooth of interest, and the tooth of interest.
Every situation is different, so you will need to adjust your selection based on your patient’s symptoms and natural dentition
Ideally try to select control teeth that have similar anatomy or restorations (consider crown materials, size/location of restorations) to the tooth of interest. It is important to establish a baseline for comparison, as some patients may express discomfort when biting on a normal tooth (especially in patients who grind or clench their teeth), but then experience a more intense pain when biting on the affected tooth.
Give each tooth a number and ask your patient to compare “tooth number 1, 2, and 3” at the conclusion of the test
It is recommended to end with the tooth of interest in case there is lingering discomfort
Place a cotton roll between the tooth you are testing and the opposing tooth. While holding the cotton roll in place, ask the patient to bite down gently, and if the patient does not experience severe pain on biting, then ask them to bite down firmly.
With a commercially available bite testing device, place the small, cupped surface on a cusp of the tooth you are testing. Ask the patient to bite down.
Repeat this on all cusps of the tooth you wish to test.
Record the patient’s response (pain/no pain) to biting for each tooth and/or each cusp in a record keeping table.
Repeat this test until all control teeth and the tooth of interest have been tested.
Torabinejad M, Fouad A, Shabahang S. Endodontics: Principles and Practice. 6th ed. London, United Kingdom: Elsevier, 2020.
Blicher B, Pryles RL, Lin J. Endodontics Review: A Study Guide. Hanover Park, IL: Quintessence Publishing Co, Inc, 2019.