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Palpation

Periapical Test

Overview

Function

The palpation test is a helpful test to diagnose if any teeth are present with periapical inflammation

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 significant discomfort

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 any pain.


  • For example, you may tell your patient, “I’m performing a palpation test now. All I will be doing is pushing against the gums of your teeth. If you feel any discomfort, would you please raise your hand?”

With your index and middle fingers, gently palpate the soft tissue surrounding the apex of the tooth you are testing. Be sure to palpate both the buccal and palatal/lingual surfaces for each tooth.


  • Due to the thinner cortical bone in the maxilla, the palpation test is usually more effective for maxillary teeth than it is for mandibular teeth.

If the patient feels any pain or sensitivity while you are palpating, record the severity of the pain using a -/+/++ system.

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.