Evaluation of the ability of thermal and electrical tests to register pulp vitality

Abstract

The aim of the present study was to evaluate the ability of thermal and electrical tests to register pulp vitality. Sensitivity, specificity, negative predictive value and positive predictive value were calculated by comparing the test results with a "gold standard". The thermal tests studied were a cold test (ethyl chloride) and a heat test (hot gutta-percha). For the electrical test, the Analytic Technology Pulp Tester was used. The examined teeth were 59 teeth with unknown pulpal status in need of endodontic treatment and 16 intact teeth, all with radiographically normal periapical bone structures. In total 46 teeth with vital pulps and 29 teeth with necrotic pulps were tested. This gave a disease prevalence of 39%. The gold standard was established by direct pulp inspection of the 59 teeth in need of endodontic treatment. In the 16 intact teeth the pulp was judged as vital. The number of true positive (TP), false positive (FP), true negative (TN) and false negative (FN) test results was calculated for each method as compared to the gold standard. Based on this, the sensitivity, specificity, positive predictive value and negative predictive value were calculated for each method. The sensitivity was 0.83 for the cold test, 0.86 for the heat test and 0.72 for the electrical test. The specificity was 0.93 for the cold test, 0.41 for the heat test and 0.93 for the electrical test. The positive predictive value was 0.89 for the cold test, 0.48 for the heat test and 0.88 for the electrical test, and the negative predictive value was 0.90 for the cold test, 0.83 for the heat test and 0.84 for the electrical test. This indicated that the probability of a non-sensitive reaction representing a necrotic pulp was 89% with the cold test, 48% with the heat test and 88% with the electrical test. It also indicated that the probability of a sensitive reaction representing a vital pulp was 90% with the cold test, 83% with the heat test and 84% with the electrical test.

Applications of sensory and physiological measurement in oral‐facial dental pain

“…Ideally, a diagnostic test will always be positive when pathology is present, and negative when pathology is absent – however, sensitivity and specificity analyses have revealed that the most common pulp tests (i.e., cold and electrical pain threshold [EPT] testing) are imperfect diagnostic tools. Most of the time, these diagnostic tests show high negative predictive values (80% to 90%) and lower positive predicted values (30% to 70%) 49. This wide range could be due to the difficulty in predicting histological states from diagnostic tests.…”

“…Dentists have long used externally applied stimuli to determine a tooth's vitality as a form of “bedside” QST 49. The most commonly used tests stimulate the pulp by means thermal stimuli (e.g., cold testing) or electrical current (e.g., Electrical Pulp Test –EPT).…”

“…The most commonly used tests stimulate the pulp by means thermal stimuli (e.g., cold testing) or electrical current (e.g., Electrical Pulp Test –EPT). These tests are used routinely in clinical practice to evaluate pulpal status, including the presence of healthy, inflamed, or necrotic pulp 49, 99, 100. However, a significant limitation in the current clinical implementation of these techniques in the assessment of dental pain is that perceptual responses are measured only in the form of qualitative and dichotomous “yes / no” subjective reports of the patient's evoked sensory experience.…”

Prise en charge des foyers infectieux bucco-dentaires

“…• 0 : ankylose • 1 : mobilité physiologique perc entre deux doigts • 2 : mobilité transversale visible à l'oeil nu inférieure à 1 mm • 3 : mobilité transversale supérieure à 1 mm • 4 : mobilité axiale -La vitalité pulpaire de tests électriques ou ƚŚĞƌŵŝƋƵĞƐͿ͘ Dans leur étude évaluant les performances diagnostiques des différents tests, Petersson et al [106] ont observé que pour des dents vivantes, la probabilité d'obtenir une sensibilité aux tests était évaluée à 90 % pour le test au froid, 83 % pour le test au chaud et 84 % pour le test électrique ; pour les dents nécrosées, la probabilité de ne pas obtenir une sensibilité aux mêmes tests était respectivement évaluée à 89 %, 48 % et 88 %. Les auteurs ont conclu qu'une réponse positive au froid et au test électrique était fortement associée à une probabilité de vitalité pulpaire.…”

Dental Lasers and Application Fields in Endodontics

“…Vitality tests indicate vitality of the sensory fibers within pulp (23); however, up to 16% of test results were proved to be false positive (24). It can be explained with the resistance of neurons including sensory fibers against degenerative processes of inflammation even though the surrounding connective tissues are necrotic or degenerated (25).…”