How to Administer a Gingival Cold Test

This test is utilized when you have a focal, intraoral, probable neuropathic pain disorder involving a branch of the trigeminal nerve with palpable gingival allodynia/hyperalgesia and no obvious, local dental pathology exists such as tooth fractures, periapical lesions, or non-vital dental pulp (irreversible pulpitis).

The goal of this test is to see if pain can be provoked and then lingers with a topical cold application to suspected neuropathically altered gingival tissues.  If the pain is not provoked and lingers less than 10 seconds then it is less likely neuropathic pain.

Indications

The clinical history and/or examination findings needed to order this diagnostic test include:

1. Focal continuous pain in gingival site (tooth site)
2. Gingival site pain should not have a local pathologic explanation

Contraindications

1. Anesthetic allergies or high sensitivity to epinephrine
2. Any clinically visible local dental disease (e.g. gingival inflammation, cracked tooth)
3. No current pain in the test area
4. Unable to demonstrate a focal area of increased pain on light palpation of the gingiva
   

Related Reading: Neuropathic Pain Questionnaires for Diagnosing Trigeminal Neuralgia

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Gingival Cold Test

Before conducting the gingival cold test, clinicians must first rule out local dental disease, identify a focal area of current pain and palpable gingival allodynia, and isolate the site with self-retained photographic cheek retractors to keep the cheek tissues off the gingival area of concern.

Test two sites (usually contra and ipsilateral) as follows:

1. Use a Q-tip which is approximately 5 mm in diameter, spray it with ethyl chloride for 5 seconds
2. Immediately apply the cold Q-tip to the selected gingival allodynic area
3. Hold the cotton tip in firm contact with the tissue for 3 seconds
4. Have your patient rate their pain level in the site before and immediately after the cold Q-tip is applied using a 0 to 10 scale with 0 = “no sensation/no pain” 10 = “worst possible pain”.
5. After removing the cold Q-tip have your patient tell you when pain returns to the pre-application level and record the elapsed time.

NOTE: this test should be performed on a normal (non-painful) contralateral tissue site to establish the baseline level of neuronal lingering and cold-induced pain.

Related Reading: How to Map and Test Allodynia Zones for Chronic Trigeminal Neuralgia

Interpreting Gingival Cold Test Results

Pain is not changed and/or does not linger (<10s) when the cold is removed:  the inability to activate or induce substantial prolonged nerve firing in gingival/alveolar pain site with a cold Q-tip suggests the gingival sensory nerves are not neuropathically altered.

Pain is substantially increased and lingers (>10s) when the cold is removed: the ability to greatly activate or induce substantial prolonged nerve firing in gingival/alveolar pain site with a cold Q-tip suggests the gingival sensory nerves are neuropathically altered.

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