Efficiency and Reliability of Thermal and Electrical Tests to Evaluate Pulp Status in Primary Teeth with Assessment of Anxiety Levels in Children.

OBJECTIVE: Assessing the pulp status plays a vital role in diagnosis and treatment planning in dentistry especially in children, who may not be able to verbalize their dental symptoms. Pulp sensibility test is used as a valuable investigation to evaluate the state of pulp. The aim of this study is to assess the efficiency and reliability of thermal and electrical pulp tests in primary teeth and to rule out the anxiety level involved in each tests. STUDY DESIGN: 30 children aged between 6 to 8 years with carious primary molar teeth in need of conservative pulp therapy were included in this study. 3 tests at random were employed on each tooth which includes cold, heat, electrical pulp test. The sensitivity, specificity, positive predictive value and negative predictive value were evaluated based on the clinical visual examination on access opening and the accuracy for each test was calculated. The Facial Image Scale (FIS) was used to assess the state of dental anxiety in children due to these pulp sensibility tests. RESULTS: The highest accuracy rate was calculated for EPT (0.814) followed by cold test (0.777) and heat test (0.759). CONCLUSION: No significant association was found between the accuracy of all the three tests. (P value > 0.05). Cold test is the most reliable test due to its simplicity and ease to perform. (FIS -1.53).

Electrical Pulp Testing: Sources of Error.

INTRODUCTION: Accurate identification and assessment of an inflamed or necrotic tooth is essentialfor endodontic treatment. The purpose of this research was to investigate possible sources of error associated with the use of the electric pulp tester (EPT). METHODS: Forty-six intact teeth (23 tooth pairs) in 22 patients were evaluated in vivo. For the tooth pairs, one tooth had to have been previously endodontically treated and restored with a class II amalgam restoration. The restoration was required to have proximal contact with a class II amalgam of another vital posterior tooth. EPT was performed on pulpless and vital teeth for experimental groups (enamel, restoration, contacting, or isolated). RESULTS: The highest rate of false positive responses (82%) was found in the pulpless restored contacting group, suggesting that EPT impulses are able to travel through proximal metallic contacts and stimulate teeth distant from the EPT probe. All vital tooth groups had a high rate of positive responses with no significant diferences. CONCLUSIONS: If a tested tooth contains an interproximal restoration contacting adjacent restorations or the gingival, the teeth must be isolated (rubber dam) and the EPT probe should be placed in a region suspected to have uninterrupted tubule paths to the pulp.

Predictive values of thermal and electrical dental pulp tests: a clinical study.

INTRODUCTION: For a diagnostic test to be useful, it is necessary to determine the probability that the test will provide the correct diagnosis. Therefore, it is necessary to calculate the predictive value of diagnostics. The aim of the present study was to identify the sensitivity, specificity, positive and negative predictive values, accuracy, and reproducibility of thermal and electrical tests of pulp sensitivity. METHODS: The thermal tests studied were the 1, 1, 1, 2-tetrafluoroethane (cold) and hot gutta-percha (hot) tests. For the electrical test, the Analytic Technology Pulp Tester (Analytic Technology, Redmond, WA) was used. A total of 110 teeth were tested: 60 teeth with vital pulp and 50 teeth with necrotic pulps (disease prevalence of 45%). The ideal standard was established by direct pulp inspection. RESULTS: The sensitivities of the diagnostic tests were 0.88 for the cold test, 0.86 for the heat test, and 0.76 for the electrical test, and the specificity was 1.0 for all 3 tests. The negative predictive value was 0.90 for the cold test, 0.89 for the heat test, and 0.83 for the electrical test, and the positive predictive value was 1.0 for all 3 tests. The highest accuracy (0.94) and reproducibility (0.88) were observed for the cold test. CONCLUSIONS: The cold test was the most accurate method for diagnostic testing.

The variability of electric pulp response threshold in premolars: a clinical study.

INTRODUCTION: This study was designed to determine the variability of the electric pulp response threshold in premolars and the relationship between the response threshold and age. METHODS: Ninety-seven volunteers were recruited, ranging from 20-72 years old. The volunteers were categorized into 6 age groups: group 1, 20-29 years; group 2, 30-39 years; group 3, 40-49 years; group 4, 50-59 years; group 5, 60-69 years; and group 6, 70-79 years. All intact premolars present in each dental arch were tested. Three sites (the tip of the buccal cusp, the center of the middle, and cervical third of the buccal surface) on each tooth crown were tested. RESULTS: In total, 1965 measurements were done. A progressive increase of mean threshold value was observed from groups 1 to 6. The response threshold value showed significant differences among the 6 age groups. The effect of age was more intense in mandibular premolars. In first and second mandibular premolars the cusp tip required the lowest current to evoke a response. In maxillary premolars no significant differences among the sites were found. Also, the mean threshold value of the mandibular premolars was lower than that of the maxillary premolars in subjects of the same age, and the mean threshold value of the first premolars was lower than that of the second premolars. The buccal cusp tip of the first mandibular premolars responded more quickly than any other tested site. CONCLUSIONS: Age is related with higher response threshold values. The optimum site for testing the lower premolars is the buccal cusp tip.

Evaluation of accuracy, reliability, and repeatability of five dental pulp tests.

INTRODUCTION: The aim of this study was to compare the clinical accuracy, reliability, and repeatability of laser Doppler flowmetry (LDF), an electric pulp test (EPT), and various thermal pulp sensibility tests. METHODS: Pulp tests were done on 121 teeth in 20 subjects by using LDF, EPT, and thermal pulp testing (CO(2), Endo Frost [EF], Ice) during 2 or 3 test sessions with at least 1-week intervals. The order of testing was reversed on the second visit. A laser Doppler flowmeter was used to measure mean pulp blood flow (Flux) calibrated against a brownian motion medium and zeroed against a static reflector. The laser source was 780 nm, with 0.5-mm fiber separation in the probe, 3.1 kHz as the primary bandwidth for filter set to 0.1-second time output constant. Customized polyvinylsiloxane splints were fabricated for each participant, and a minimum of 90-second recording time was used for each tooth. Raw data were analyzed by using repeated measure analysis of variance, pairwise comparisons, and interclass correlations (ICC). RESULTS: The accuracy of EPT, CO(2), and LDF tests was 97.7%, 97.0%, and 96.3%, respectively, without significant differences (P > .3). Accuracy of EF and Ice was 90.7% and 84.8%, respectively. EPT (P = .015) and CO(2) (P = .022) were significantly more accurate than EF. LDF was more accurate than EF, but this was not statistically significant (P = .063). Ice was significantly less accurate than EPT (P = .004), CO(2) (P = .005), LDF (P = .006), and EF (P = .019). With the exception of Ice (effect of visit: F(2,38) = 5.67, mean squared error = 0.01, P = .007, η(2)(p) = 0.23), all tests were reliable. Ice (ICC = 0.677) and LDF (ICC = 0.654) were the most repeatable of the tests, whereas EPT (ICC = 0.434) and CO(2) (ICC = 0.432) were less repeatable. CONCLUSIONS: CO(2), EPT, and LDF were reliable and the most accurate tests, but CO(2) and EPT were less repeatable yet less time-consuming than LDF. EF was reliable but not as accurate as EPT and CO(2) and less repeatable than Ice and LDF. Ice was the most repeatable but the least accurate and least reliable test.

Review of pulp sensibility tests. Part II: electric pulp tests and test cavities.

The electric pulp test (EPT) is one type of pulp sensibility test that can be used as an aid in the diagnosis of the status of the dental pulp. However, like thermal pulp sensibility tests, it does not provide any direct information about the vitality (blood supply) of the pulp or whether the pulp is necrotic. The relevant literature on pulp sensibility tests in the context of endodontics up to January 2009 was reviewed using PubMed and MEDLINE database searches. This search identified articles published between November 1964 and January 2009 in all languages. The EPT is technique sensitive, and false responses may occur. Various factors can affect the test results, and therefore it is important that dental practitioners understand the nature of these tests and how to interpret them. Test cavities have been suggested as another method for assessing the pulp status; however, the use of this technique needs careful consideration because of its invasive and irreversible nature. In addition, it is unlikely to be useful in apprehensive patients and should not be required because it provides no further information beyond what thermal and electric pulp sensibility tests provide - that is, whether the pulp is able to respond to a stimulus. A review of the literature and a discussion of the important points regarding these two tests are presented.

The validity of pulp testing: a clinical study.

OBJECTIVE: In this article, the authors report on an in vivo study in which they assessed the validity of two commonly used cold pulp tests (carbon dioxide [CO(2)]and 1,1,1,2-tetrafluoroethane) and an electrical pulp tester (EPT) in determining pulp vitality by using direct inspection of the pulp as the reference standard. METHODS: One hundred fifty patients undergoing endodontic therapy at the University of North Carolina School of Dentistry (Chapel Hill) undergraduate clinic participated in this study. Before routine endodontic treatment, the authors classified participants by means of EPT, CO(2) and tetrafluoroethane as having either vital or necrotic pulps. Students recorded true pulpal status (vital/necrotic) by observing blood within the pulp chamber after an access cavity was made. The authors calculated the sensitivity, specificity and positive and negative predictive values of each test and the test combinations to describe their validity and clinical usefulness. RESULTS: Ninety-seven percent of teeth responding positively to all three tests contained vital pulps, whereas 90 percent of the teeth that failed to respond to any of the tests contained necrotic pulps. Ten percent of the teeth not responding to any of the tests contained vital pulps. For all other combinations of test results, 54 percent of teeth contained vital pulps, and 46 percent contained necrotic pulps. CONCLUSIONS: These findings support the use of either of the cold tests and the EPT for diagnosis of pulpal status. CLINICAL IMPLICATIONS: Cold test and EPT used in conjunction resulted in a more accurate method for diagnostic testing.

Assessment of pulp vitality: a review.

BACKGROUND: One of the greatest diagnostic challenges in clinical practice is the accurate assessment of pulp status. This may be further complicated in paediatric dentistry where the practitioner is faced with a developing dentition, traumatized teeth, or young children who have a limited ability to recall a pain history for the tooth in question. A variety of pulp testing approaches exist, and there may be confusion as to their validity or appropriateness in different clinical situations. AIM: The aim of this paper is to provide the clinician with a comprehensive review of current pulp testing methods. A key objective is to highlight the difference between sensitivity testing and vitality testing. A biological basis for pulp testing is also provided to allow greater insight into the interpretation of pulp testing results. The rationale for, and methods of, assessing pulpal blood flow are described.

Evaluation of efficacy of a new custom-made pulse oximeter dental probe in comparison with the electrical and thermal tests for assessing pulp vitality.

Pulse oximetry is a noninvasive method of measuring vascular health by evaluating oxygen saturation. This study evaluated the efficacy of a new custom-made pulse oximeter dental probe in comparison with the electrical and thermal tests for assessing pulp vitality. Sensitivity, specificity, negative predictive value, and positive predictive value for each test were calculated by comparing the test results with the actual pulpal status, as evaluated by direct visual inspection. The sensitivity of the pulse oximeter was found to be 1.00, as compared to 0.81 with the cold test and 0.71 with the electrical test. The specificity of the pulse oximeter was 0.95, as compared to 0.92 with the cold and electrical pulp tests. Thus, the custom-made pulse oximeter dental probe is an effective, accurate, and objective method of evaluating pulp vitality.

Efecto de cinco analgésicos en la respuesta pulpar. Segunda parte / Effect of five analgesics in pulp response. Second part

El presente trabajo tuvo como objetivo establecer la influencia de la administración de los siguientes analgésicos no esteroideos el ibuprofeno, el ketoprofeno, el paracetamol, el ketorolaco trometamina y el clorixinato de lisina, en la respuesta de la pulpa dental a las pruebas térmica y eléctrica. El estudio se desarrolló en alumnos voluntarios de la Clínica Odontológica Almaráz. Los resultados muestran que la ingesta de estos analgésicos no modifica la respuesta pulpar en forma significativa. Se discute la metodología y los resultados obtenidos y se plantea la posibilidad de continuar con esta línea de investigación

Anesthetic efficacy and heart rate effects of the intraosseous injection of 3% mepivacaine after an inferior alveolar nerve block.

OBJECTIVE: The purpose of this study was to determine the anesthetic efficacy and heart rate effects of an intraosseous injection of 3% mepivacaine after an inferior alveolar nerve block. STUDY DESIGN: Through use of a repeated-measures design, each of 48 subjects randomly received 2 combinations of injections at 2 separate appointments. The combinations were (1) an inferior alveolar nerve block (with 1.8 mL of 3% mepivacaine) + intraosseous injection with 1.8 mL of 3% mepivacaine and (2) an inferior alveolar nerve (with 1. 8 mL of 3% mepivacaine) + mock intraosseous injection. The first molar was blindly pulp tested at 2-minute cycles for 60 minutes postinjection. Anesthesia was considered successful with 2 consecutive 80 readings. Heart rate (pulse rate) was measured with a pulse oximeter. RESULTS: All subjects had lip numbness with both of the inferior alveolar nerve + intraosseous techniques. Anesthetic success for the first molar was significantly increased for 30 minutes with intraosseous injection of mepivacaine in comparison with the inferior alveolar nerve block alone (mock intraosseous injection). Subjects receiving the intraosseous injection of mepivacaine experienced minimal increases in heart rate. CONCLUSIONS: The intraosseous injection of 1.8 mL of 3% mepivacaine, when used to augment an inferior alveolar nerve block, significantly increased anesthetic success for 30 minutes in the first molar. The 3% mepivacaine had a minimal effect on heart rate and would be useful in patients with contraindications to epinephrine use.

Pulse oximetry evaluation of vitality in primary and immature permanent teeth.

Present methods of assessing pulp vitality (electric and thermal testing) are of limited use with children, often resulting in false positive or false negative results. Pulse oximetry is a proven, atraumatic method of measuring vascular health by evaluating oxygen saturation (SaO2). This pilot study explores the use of a modified pulse oximetry ear probe to assess pulpal vascular oxygen saturation in primary and immature permanent teeth. Pulse oximetry readily differentiated between known vital and nonvital teeth. Vital teeth consistently provided SaO2 values that were lower than the values recorded on the patients' fingers. Further study of the SaO2 changes in traumatized teeth, with a probe designed specifically for teeth, is warranted by these initial results. Although additional research is indicated, pulse oximetry is already an objective, atraumatic clinical alternative to the present electrical and thermal methods of assessing pulp vitality in children's teeth.

Evaluation of a laser Doppler flowmeter to assess blood flow in human primary incisor teeth.

PURPOSE: This study determined whether the portable Advance Laser Flowmeter Model 21, a clinical instrument, would indicate significant values when pulpal blood flow was present or absent; whether the analog output of the flowmeter was time-linked to the heart rate; and whether labial and lingual crown surfaces produced different flow values. METHODS: Teeth were tested under two conditions: with the teeth in situ and extracted, or with the pulp present and removed. RESULTS: Values before and after the teeth were extracted, and those before and after pulpectomy with the tooth in situ were significantly different. These findings verified that the flowmeter measured the presence of bloodflow. Peaks of the electrocardiogram waves and the regular signal fluctuations of the flowmeter were time-linked and verified the measurement of the heart rate from the dental pulp. Differences in the values for the lingual and labial surfaces of individual teeth were not significant. CONCLUSIONS: This instrument proved a valid means of determining the presence of pulpal blood flow in primary incisors.

Demonstration of a possible source of error with an electric pulp tester.

The purpose of this study was to determine whether electrical current can travel between adjacent teeth through contacting interproximal amalgam restorations. Twenty-two extracted human premolars were restored with class II amalgam restorations. They were then mounted in pairs in self-curing resin, simulating adjacent teeth. Only their restorations were allowed to contact. An electrical multimeter was used to supply electrical current and to measure any current passing through the mounted teeth. One current measurement was made from the buccal enamel of a tooth to the occlusal surface of the filling in that tooth. A second measurement was made from the buccal enamel of the same tooth to the occlusal surface of the adjacent filling. These two measurements were made for all 11 trials. Statistically, all current that entered the first tooth passed to the adjacent tooth. This finding suggests a potential source of error when using an electric pulp tester.

The diagnosis, classification and treatment of acute pulpal pain by UK general dental practitioners: results of a survey.

There are several problems related to the diagnosis and treatment of the acute painful tooth associated with a deep carious lesion, including the fact that there is little or no correlation between the clinical signs and symptoms and also that the diagnostic tools are not reliable. It is important to understand the problems experienced by dental practitioners and how they routinely make diagnosis and formulate treatment plans. The way general dental practitioners diagnosed, categorised and treated teeth with acute pain was ascertained by a questionnaire completed by practitioners attending postgraduate courses. The results indicate that dental radiographs and the dental history were most frequently used and that few practitioners had, and fewer used electric pulp testers. The concept of using simple clinical categories which correspond to treatment categories does not seem to be in widespread use, though the generally accepted role of calcium hydroxide as an indirect and direct capping material is widespread. The use of corticosteroid materials is not as widespread in younger practitioners as in their older colleagues and the use of emergency pulpotomy is infrequent.

[The use of a calcium phosphate ceramic in treating deep caries]. / Primenenie kal'tsii-fosfatnoi keramiki pri lechenii glubokogo kariesa.

Clinical examinations of 36 teeth with deep caries were carried out in patients aged 16 to 38. Therapy with hydroxyl apatite and tricalcium phosphate was carried out and with calmecine for control. Additional methods for objective examination were assessment of pulp electric excitability and of dentin electric conduction. Repeated examinations of patients 1 and 6 months after treatment showed that hydroxyl apatite and tricalcium phosphate normalized the function of the pulp, caused remineralization of dentin in the bottom of carious cavity, and were effective in the treatment of deep caries.