I recently got a comment on my blog that some patients are saying no to a cold test on a tooth every now and then. And let me be the first to say—I get it. It isn’t terribly fun to be submitted to the ol’ Endo Ice test.
But as a clinician, you have to advocate for what’s important and guide your patients to make the best decisions for their health. A cold test is not optional. One must be performed early on so you can be certain about what you’re working with. It’s a diagnostic basic.
I feel so passionately about the results that cold tests deliver. Because cold tests mean effectively treating pain and making life better for our patients.
Cold Test On a Tooth = Proper Diagnosis
Without doing this essential Endo Ice test, you cannot get a proper diagnosis.
Lemme just climb up on my soapbox for a second to convince you!
What are the consequences of failing to perform this test? First of all, it could lead to a misdiagnosis and then, inevitably, mistreatment.
The consequences here are HUGE. Your diagnosis is your roadmap. When you don’t properly diagnose, you can’t create a treatment plan, refer when necessary, or perform a root canal yourself (that isn’t going to need a retreatment). Worst of all, without an accurate diagnosis, you lose a whole lot of trust, with your patients and your referring doctors. And you might lose your patient’s business altogether.
To help your patient and to help their teeth—you must perform a cold test.
Yet a misdiagnosis is not the only consequence—all this could even result in you getting reported to the board or getting a negative online review that impacts your practice. As clinicians we have to adhere to best practices, which leads to proper care. And performing the cold test on a tooth is a crucial (and standard) part of our processes as dentists. Failing to effectively diagnosis and treat your patients can snowball into much bigger problems.
Stand your ground and let your patients know that you are just trying to find the culprit tooth—the one that is causing pain and begging to be treated. Because if you don’t and you start treatment, it could be the wrong tooth and all the time, money, and energy they are spending won’t give them the results they’re after. (Trust me, I’ve been there. UGH, I was not a happy patient!)
Just make sure to warn your patient that the cold test is pretty sensitive and it is not going to feel great—but it will give you a lot of absolutely essential information on where their pain is coming from.
Reassure them that the whole cold test will only take about 30 seconds—so it will be over before they know it.
A Quick Tip to Implement Immediately
This is probably the most economical quick tip I will ever give you —so sit up and pay attention!
Don’t EVER use a cotton applicator for your cold test!!
Why? Because if you do, you will never elicit a real cold response during your test. In fact, you may start to believe all of the teeth are necrotic since it doesn’t get the response you’re looking for during the cold test on a tooth—and it will appear that way for every tooth!
Here’s the deal: a cotton applicator produces a false test result almost every single time.
Instead, I want you to use a simple cotton pellet on a college plier.
Cotton pellets have more surface area than a cotton applicator—making them better at getting the job done when it comes to performing a cold test on a tooth. Cotton pellets transfer the cold better, which will give you WAY more information about where your patient’s pain is coming from.
But, it goes deeper than that. You need to feel your cotton pellet and make sure it has some give; the cotton pellet shouldn’t be too hard. The ones that are super hard don’t hold cold well, so they could skew results.
Make sure that cotton pellet gets SUPER saturated with that cold spray, like in this video:
We all have cotton pellets at our disposal—so use them! And make sure you have some Endo Ice on hand for your Endo Ice test, too!
Cold Tests and Beyond!
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I’ve spent more than a decade gathering endodontic information, in-depth how-tos, and quick tips. And I’ve packed it all into my online course, E-School. It will transform the way you do endo.
E-School is a GREAT way to improve your endodontics practice, build your business, impress your clients, and become a better dentist — and you can get started right away.
Pulpal and Periapical Diagnosis Checklist (because performing a cold test is part of the diagnosis process)
Let me know in the comments what your biggest takeaway was from this blog post!
Thank you, Dr. Cummings!
Thank you. Please could you advise re how to cold test a tooth with a crown?
Hi Mohamed – Cold testing with a crown in place is really no different if there was no crown. I do recommend placing the cold cotton pellet as close to the crown margin as possible. One thing that I teach in Eschool is how to interpret your cold test because it really is so much deeper than just doing the cold test.
No wonder I got never get anything with cotton tip applicator and I started doubting endo ice . One of the assistant I worked with showed me a trick. Use the lid of a disposable needle and put water in it and small cotton tip applicator put in freezer u get a little popsicle it worked great. I love your tips.
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