[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Dentistry](https://durgical.com/en/dentistry/) › [The oral and dental exam](https://durgical.com/en/dentistry/areas/exam/) › Pulp and periapical tests: cold, heat, percussion and palpation

# Pulp and periapical tests: cold, heat, percussion and palpation

- Examination

Simple bedside tests tell whether the tooth nerve is healthy, inflamed or dead, and whether infection has reached the bone around the root.

Updated Nov 12, 2026

## Key points

- Short pain to cold = reversible; lingering pain = irreversible pulpitis.
- No response to cold = probably necrotic pulp.
- Pain on tapping = inflammation beyond the root tip.

## What it is

Pulp sensibility tests check whether the nerve inside a tooth responds; they do not measure blood flow directly. Cold (a cotton pellet with refrigerant spray or ice) is the most useful. Electric pulp testers are an alternative. Periapical tests (tapping the tooth and pressing on the gum over the root tip) tell whether inflammation has spread beyond the root into the periodontal ligament and bone. Results are always compared with a healthy tooth on the other side, tested first.

## Findings and interpretation

- Brief, sharp pain to cold that stops at once: normal pulp or reversible pulpitis.
- Intense pain to cold that lingers for many seconds or more: irreversible pulpitis.
- No response to cold: pulp necrosis (or a false negative in a heavily restored or recently traumatised tooth).
- Pain on percussion or biting: inflammation in the periodontal ligament (apical periodontitis or a cracked tooth).
- Heat that hurts and cold that relieves suggests advanced irreversible pulpitis.

## How it is done

- Explain the test and start with a healthy control tooth so the patient knows what normal feels like.
- Isolate and dry the tooth; apply cold to the middle of the crown for a few seconds.
- Note whether pain appears, how strong it is and how long it lasts after removing the cold.
- Tap the biting surface and the side of the tooth gently with the end of a mirror handle (percussion).
- Press on the gum over the root tip (palpation) and look for swelling or a sinus tract («gum boil»).

## Common mistakes

- Recently traumatised teeth may not respond for weeks even when the pulp is alive; do not declare them dead too soon.
- Teeth with large fillings or crowns and teeth of older adults with narrow pulps can give false negatives.
- Tapping too hard on an acutely inflamed tooth causes needless pain; start gently.

## Next step / Initial management

- Lingering pain to cold or spontaneous pain: refer to the dentist promptly for root canal treatment or extraction; give analgesia meanwhile.
- No response with tenderness, swelling or a sinus tract: refer for endodontic treatment and drainage; antibiotics only if there is spreading infection or systemic illness.
- Normal pulp tests with tooth pain: consider dentine sensitivity, a cracked tooth, sinusitis, TMJ or referred pain.

## Test yourself

Think of the answer, then tap the question to see it.

## What response to cold suggests irreversible pulpitis?

Intense pain that lingers well after the cold is removed.

## What does pain on percussion of a tooth indicate?

Inflammation of the periodontal ligament, as in apical periodontitis or a cracked tooth.

## Why should a recently traumatised tooth that does not respond to cold not be declared necrotic at once?

Because nerves may stop responding for weeks after trauma while the pulp is still alive.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/dentistry/pulp-and-periapical-tests-cold-heat-percussion-and-palpation/)

## Connections

## Related 3

- [Pulpitis: reversible or irreversible](https://durgical.com/en/dentistry/pulpitis-reversible-or-irreversible/)
- [Pulp necrosis, apical periodontitis and the dental abscess](https://durgical.com/en/dentistry/pulp-necrosis-apical-periodontitis-and-the-dental-abscess/)
- [Toothache: approach](https://durgical.com/en/dentistry/toothache-approach/)

[← All of dentistry](https://durgical.com/en/dentistry/)

Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once.

Sources: [Anatomy, Head and Neck, Dental Pulp](https://www.ncbi.nlm.nih.gov/books/NBK537112/) (StatPearls Publishing (NCBI Bookshelf), 2025); [Apical Periodontitis](https://www.ncbi.nlm.nih.gov/books/NBK589656/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Dental Emergencies](https://www.ncbi.nlm.nih.gov/books/NBK589664/) (StatPearls Publishing (NCBI Bookshelf), 2022).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/dentistry/pulp-and-periapical-tests-cold-heat-percussion-and-palpation/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/dentistry/pulp-and-periapical-tests-cold-heat-percussion-and-palpation/