INDICATIONS

While any teeth that show some possibility of endodontic (pulp) compromise should be transilluminated, it is a simple procedure to provide this service to every tooth in every mouth.
- Worn, chipped or fractured teeth: obvious injury; canal may or may not be exposed (see Chapters 33 and 34)
- Discolored teeth: blunt trauma without enamel injury, indicative of pulpal hemorrhage or inflammation if pink, purple to gray (see Chapters 31 and 36)

EQUIPMENT

Transilluminator extension on otoscope device
Strong penlight

PROCEDURE

Once the second half/side of the mouth has been cleaned (calculus gone from crown surfaces), gently prop open the mouth
Place the transillumination beam behind the tooth being observed, and examine the extent of light transmitted through the tooth
- Examine all “up-side” teeth, moving from tooth to tooth, beaming the light from the lingual/palatal surface of the tooth outward
- Examine the “down-side” teeth, beaming the light from the buccal surface inward, as you observe the palatal/lingual surface of the tooth being transilluminated (Fig. 3-1)
Compare extent of light transmittance from tooth to tooth and record any variations
- Vital teeth should transilluminate well, allowing the light to pass through the tooth structure, even showing the pink of the pulp (Fig. 3-2)
- Nonvital teeth will not transilluminate well, appearing dark or dull, especially in the chamber portion (central), although the light will sometimes shine through the peripheral dentin to some degree (Fig. 3-3)
- Contrast similarly-sized teeth in cases that are subtly different
Record any variation
Further evaluate teeth with intraoral radiographs to assess additional indications of pulp compromise (periapical bone loss, inappropriately large canal size; see Chapter 4)

Figure 3-1 A bright light is shone through the tooth, here from the buccal surface, so the light can be seen transmitting through to the lingual surface.