Summary trial/Endodontics
Evidence-Based Dentistry (2007) 8, 102. doi:10.1038/sj.ebd.6400522
Using a cold test to assess pulpal anaesthesia
Is a cold test effective in determining whether a patient will experience pain during root canal therapy?
Address for correspondence: Dr Grace W Hsiao-Wu, Division of Endodontics, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston MA 02115, USA. E-mail: grace_hsiao@post.harvard.edu
Khaled Balto1
1Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
Hsiao-Wu GW, Susarla SM, White RR.. Use of the cold test as a measure of pulpal anesthesia during endodontic therapy: a randomized, blinded, placebo-controlled clinical trial. J Endod 2007; 33:406–410
Abstract
Design
This was a randomised controlled trial (RCT).
Intervention
Groups given a true cold test (test group) or a sham cold test (control) were compared.
Outcome measure
If pain was experienced during the procedure, patients were asked to point to their level of pain on a visual analogue scale (VAS). Stages of the RCT were divided as follows: before entering the pulp chamber, while entering the pulp chamber, preparing the canal, irrigating the canals, and obturation of the canals.
Results
Unadjusted results showed 12% of test subjects experienced pain during the RCT compared with 38% of control subjects (N=83; P 0.004; power, 84%). Multiple logistic regression analysis controlled for confounders and effect-modifiers (odds ratio, 0.20; P 0.01). Subjects who had a negative response to the cold test were approximately 80% less likely to experience pain during the procedure than subjects who had only soft tissue signs of anaesthesia.
Conclusions
The cold test is a significantly better indicator of pulpal anaesthesia than the current standard of care, ie, using soft tissue signs alone. We strongly advocate the use of the cold test to assess pulpal anaesthesia.
