Abstracts

Accurate assessment of the health of the dental pulp may be a diagnostic dilemma to the clinician. Special investigations, such as pulp vitality and sensibility testing, can assist the practitioner in attaining this diagnosis, but how accurate and reliable are these tests? Accurate assessment of the state of the health of the dental pulp is achieved through a detailed patient history, thorough clinical and radiographic examination and the use of special diagnostic tests. Pulp sensibility and vitality testing are special diagnostic tests that form a part of the clinician's armamentarium in assisting and guiding this diagnostic process in assessing the health of the dental pulp. This review critically appraised 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.

They searched a variety of electronic databases for English language in vivo studies evaluating the accuracy of pulp sensibility and pulp vitality tests in human teeth. Only studies using a reference or ‘gold’ standard and providing sensitivity and specificity values or data allowing their calculation were considered. Study quality was assessed independently by two reviewers: 8 studies (4 cohorts and 4 case-controlled studies) were included. A variety of tests were evaluated, including, electric pulp tester (9 results from 8 studies), CO₂ Snow (4 from 3), Endo-Ice^® (4 from 3), ethyl chloride (4 from 3), laser doppler flowmeter (2 from 2), pulse oximetery (2 from 2), ice sticks (2 from 1), coolant (1 from 1) and heated gutta percha (1 result from 1 study).

However, due to the limited number of studies meeting the inclusion criteria, there was insufficient foundation to evaluate the clinical performance of pulp vitality tests, which were rarely compared within the studies. Within the limits of this review, it was concluded 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. It is generally regarded that assessment of the blood supply within the dental pulp (pulp vitality) is the earliest indicator and may be the only available true indicator of the actual state of pulpal health. This type of testing is particularly useful for clinical situations in which pulp sensibility tests are expected to be unreliable, particularly following traumatic dental injuries. Pulp sensibility testing, despite being subject to error, can provide valuable diagnostic information in the hands of an experienced clinician, particularly when electric pulp testing is used in combination with either CO₂ Snow or Endo-Ice^®. These tests can provide valuable information on the health status of the pulp: however, these should never be used solely to diagnose and should always be interpreted in light of a thorough history, clinical examination and radiographic examination, as appropriate.