ARE PULP SENSIBILITY TESTS STILL SENSIBLE?
AbstractBackground: Electric and thermal tests are the most commonly employed methods for the diagnosis of pulp health status. The objectives of our study are to assess the validity, yield and accuracy of cold and electric pulp tests in determining pulp vitality of teeth requiring endodontic treatment. Methods: A cross sectional study was carried out at the Dental Clinic of Aga Khan University Hospital on 75 patients requiring endodontic treatment. Before commencement of endodontic treatment, a provisional diagnosis of pulp status was made using an electric pulp tester and cold test. The tooth was then labelled as either vital or necrotic. Then an access openings was made and tooth’s actual pulp status (vital/necrotic) was determined by observing bleeding in the pulp chamber. The validity, yield and accuracy were calculated on the basis of these findings. Results: The sensitivity, specificity, positive predictive value and negative predictive value and accuracy of cold test were 84%, 88%, 93%, 73% respectively. The sensitivity & specificity of electric test were 82% and 88% respectively whereas the positive predictive value, negative predictive value and accuracy of electric test were 93% and 71% respectively. The accuracy of cold and electric pulp test were 85% and 84% respectively. Conclusion: Both cold test and EPT have similar sensitivity, specificity and accuracy values. Although vitality tests have a promising future in diagnosis of pulp health status but within limitation of this study we found that sensibility tests have satisfactory validity and accuracy values to be used routinely prior to endodontic and restorative treatments especially when used in conjunction with one each other.
American Association of Endodontists. Glossary of endodontic terms. 7th ed. Chicago: American Association of Endodontists; 2003.
Gopikrishna V, Pardeep G, Venkateshbabu N. Assessment of pulp vitality: a review. Int J Paediatr Dent 2009;19:3–15.
Kramer IR. The relationship between pain and changes in the dental pulp following the insertion of fillings. Br Dent J 1954;9:9–13.
Grossman LI. Endodontic Practice, 9th ed. Philadelphia: Lea & Febiger; 1978. p.440.
Mumford JM, Bjorn H. Problems in electric pulp testing and dental algesimetry. Int Dent J 1962/1976;12:161–79.
Urbanska DK, Mumford JM. Autogenous transplantation of non-root-filled maxillary canines: a long term follow-up. Int Endod J 1980;13:156–60.
Polat S, Er K, Polat NT. Penetration depth of laser Doppler flowmetry beam in teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endo 2005;100(1):125–29.
Akpinar KE, Er K, Polat S, Polat NT. Effect of gingiva on laser doppler pulpal blood flow measurements. J Endod 2004;30(3):138–40.
Wilson WC, Shapiro B. Preoperative hypoxia: the clinical spectrum and current oxygen monitoring methodology. Anesthesiol Clin North America 2001;19(4):769–812.
Chen E, Abbott PV. Dental pulp testing: A review. Int J Dent 2009;2009:365785.
Rickoff B, Trowbridge H, Baker J, Fuss Z, Bender IB. Effects of thermal vitality tests on human dental pulp. J Endod 1988;14(10):482–85.
Udoye CI, Jafarzadeh H, Okechi UC, Aguwa EN. Appropriate electrode placement site for electric pulp testing of anterior teeth in Nigerian adults: a clinical study. J Oral Sci 2010;52(2):287–92.
Petersson K, Söderström C, Kiani-Anaraki M, Lévy G. Evaluation of the ability of thermal and electrical tests to register pulp vitality. Endod Dent Traumatol 1999;15(3):127–31.
Trope M, Sigurdsson A. Clinical manifestations and diagnosis. In: Ørstavik D, Pitt Ford RT, eds. Essential Endodontology: Prevention and Treatment of Apical Periodontitis. Oxford: Blackwell Science, 1998:157–78.
Fuss Z, Trowbridge H, Bender IB, Rickoff B, Sorin S. Assessment of reliability of electrical and thermal pulp testing agents. J Endod 1986;12(7):301–5.
Shender O et al. How helpful are diagnostic tests for pulpal conditions. http://wc1.ns.utoronto.ca/dentistry/newsresources
Petrie A, Bulman JS, Osborn JF. Further statistics in dentistry. British Dental Association; 2002.
Kamburoğlu K, Paksoy CS. The usefulness of standard endodontic diagnostic tests in establishing pulpal status. Pain Clin 2005;17(2):157–65.
Weisleder R, Yamauchi S, Caplan DJ, Trope M, Teixeira FB. The Validity of Pulp Testing: A Clinical Study. J Am Dent Assoc 2009;140(8):1013–17.
Evans D, Reid J, Strang R, Stirrups D. A comparison of laser Doppler flowmetry with other methods of assessing the vitality of traumatized anterior teeth. Endod Dent Traumatol 1999;15(6):284–90.
Peters DD, Baumgartner JC, Lorton L. Adult pulpal diagnosis, part I: evaluation of the positive and negative responses to cold and electrical pulp tests. J Endod 1994;20(10):506–11.
Fuss Z, Trowbridge H, Bender IB, Rickoff B, Sorin S. Assessment of reliability of electrical and thermal pulp testing agents. J Endod 1986;2(7):301–5.
Gopikrishna V, Tinagupta K, Kandaswamy D. Comparison of Electrical, Thermal, and Pulse Oximetry Methods for Assessing Pulp Vitality in Recently Traumatized Teeth. J Endod 2007;33(5):531–35