Pulp sensibility and vitality tests for diagnosing pulpal health in permanent teeth: a critical review

Abstract

The aim of this review was to critically appraise the literature related to pulp vitality and sensibility testing in order to determine the diagnostic accuracy of pulp tests with reference to a gold standard or control group. Implications of the results for research and clinical practice are also explored. The MEDLINE (Ovid), MEDLINE (PubMed), Embase and Cochrane databases were searched for English-language clinical trials in humans in which in vivo studies were designed to evaluate or compare the accuracy of selected pulp sensibility and pulp vitality tests in determining the state of pulpal health in permanent teeth. Studies were included only if the results were compared to a control group or to a valid gold or reference standard. Eight studies were identified. Shortcomings in research design were found to influence the findings. The limited number of studies investigating pulp vitality tests was insufficient to answer the research question. It was concluded from this critical appraisal of the literature that laser Doppler flowmetry appeared to be the most accurate method for diagnosing the state of pulpal health and came closest to serving as a gold standard. Pulp vitality tests proved superior to pulp sensibility tests for early and accurate assessments of the pulpal health of traumatized teeth. When accurately used and interpreted, pulp sensibility tests provide valuable diagnostic information, particularly when an electric pulp test is used in combination with either CO snow or Endo-Ice.

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

“…In one of the first studies demonstrating the utility of pulse oximetry in dentistry, Schnettler and Wallace showed that a pulse oximeter could detect pulse rate and oxygen saturation for vital teeth and not for root canal treated teeth. This work has now been replicated by several groups 20, 65, 66, 67, 69. Interestingly, Gopikishna showed that normal oxygen saturation in human permanent teeth was lower than systemic blood measured in fingers, 75% to 85% versus 98%, respectively 70.…”

“…Modern pulse oximeters now provide an inexpensive and efficient method to measure blood oxygenation. Pulse oximetry can detect oxygen saturation levels of the pulp tissue based on spectrophotometry using a light source (wavelengths 760 and 850 nm) 65, 66, 67, 68. In one of the first studies demonstrating the utility of pulse oximetry in dentistry, Schnettler and Wallace showed that a pulse oximeter could detect pulse rate and oxygen saturation for vital teeth and not for root canal treated teeth.…”

“…This work has now been replicated by several groups. 20,[65][66][67]69 Interestingly, Gopikishna showed that normal oxygen saturation in human permanent teeth was lower than systemic blood measured in fingers, 75% to 85% versus 98%, respectively. 70 The sensitivity of the pulse oximeter to detect pulp vitality was 100% in comparison to sensitivity of cold (81%) and EPT (71%) methods.…”

Microbiological aspects of traumatic injuries

“…Pulp diagnosis is complicated by the loss of sensibility caused by the traumatic injury and the difficulty of pulp sensibility tests in children. 3,4 Pulp vitality tests, such as using laser Doppler flowmetry (LDF), were shown to be more accurate than pulp sensibility tests, [5][6][7] especially after traumatic injuries. In case reports or case series, [8][9][10] LDF showed the onset of vitality signals in luxated teeth much sooner than sensibility | 325 FOUAD testing.…”

Pulp sensibility to electric stimuli in the Caucasian population

“…Determination of the pulp's response to stimuli is crucial in providing a diagnosis and choosing the proper treatment . In a clinical examination, subjective tests of the patient's response to thermal stimuli (heat and cold), mechanical procedures (dentin drilling) and electric tests are used . The pulp of the tooth is a highly innervated tissue rich in vessels.…”