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Cold Test

Pulpal Test

Overview

Function

The cold test is a helpful test to assess pulp’s health and vitality.

Armamentarium 

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Video

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Procedure

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

  • 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

  • Note: Previously-treated teeth rarely respond to pulp sensitivity testing, and should never be used as a control. Crowned teeth may not have a response to the cold test, and it is not recommended to use these as your control teeth unless necessary

Explain the procedure to your patient. Their participation is necessary for accurate interpretation of results. Be sure to instruct your patient to raise their hand when they feel the cold and to lower it when the cold goes away.


  • For example, you might say: “I’m going to perform a test on a few of your teeth now. I will be putting this cotton on your tooth, and it may feel cold like ice cream. When you feel the cold sensation, raise your hand and I’ll remove the tester. When the cold sensation goes away entirely, put your hand down.  We’ll start with what we think is a normal tooth so that we have a baseline to compare your other teeth to. Any questions before we start?”

Hold a Q-tip or a cotton pellet between cotton pliers and spray with refrigerant spray until the pellet or Q-tip is fully saturated. Always aim the spray away from the patient.


  • The cotton pellet should be smaller than the surface of the tooth you are testing, but large enough to adequately carry the refrigerant spray. We recommend a size #2 (5.5 mm diameter) cotton pellet or a cotton Q-tip for most clinical scenarios

Carefully retract the patient’s cheek with a dental mirror and hold the cotton pellet or Q-tip against the buccal surface of the tooth you are testing. Take note of whether the patient has an immediate or delayed response.


  • It is important to avoid touching the soft tissue around the teeth (e.g. cheeks, tongue, gingiva) or neighboring teeth while you are testing so as to avoid potential false positives

If your patient has a response to the cold and raises their hand, remove the cotton pellet immediately and begin a count to record the seconds that the sensation is felt in a record keeping table. This will later help you distinguish between lingering (++ / +++) and non-lingering (+) sensation.


  • Record the seconds until sensation was felt and the duration of sensation for this tooth

If your patient does not have a response to the cold they will not raise their hand. You should continue to hold the cotton pellet in place until it is no longer cold (~15 seconds). Record the negative response.

Repeat this test until all the control teeth and the tooth of interest have been tested. You should re-spray the refrigerant prior to testing each tooth.

References:

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.