Evaluation of threshold response and appropriate electrode placement site for electric pulp testing in fluorosed anterior teeth: An in vivo study

Abstract

Background:Accurate diagnosis is key to success. Diagnosing the pulpal status in varied clinical situations poses a challenge to the clinician. Electric pulp test (EPT) is one of the valuable attempts in evaluating the sensibility of pulp tissue. The aim of this study was to find out and compare the threshold levels and optimal electrode placement site for EPT in fluorosed and nonfluorosed anterior teeth.Materials and Methodology:Eighty volunteers recruited for this study were divided into two groups based on the incidence of dental fluorosis. Electric pulp testing was done on either of the central incisors in fluorosed and nonfluorosed group. Four sites on each crown were tested 4 times with digitest electric pulp tester, and the mean of the threshold responses was recorded. The data were analyzed with SPSS, version 11. Means of variables from each location were compared using one-way ANOVA and Tukey's post-hoc test while the critical level of significance was set at P < 0.05.Results:The mean and standard deviation of threshold levels in fluorosed teeth were greater when compared to that of nonfluorosed teeth at all sites with incisal edge showing the least mean threshold levels for both the groups (P > 0.05).Conclusion:Within the limitations of this study, it can be concluded that fluorosed teeth respond to higher threshold levels than the non-fluorosed teeth, and incisal edge was the optimal electrode placement site.

Diagnostic accuracy of three placement sites for the cold test in subjects amongst different age groups

“…Other variables to consider are: psychological and behavioral factors (apprehension or Hawthorne effect) and biological factors (hormonal levels and neurological differences). On the other hand, researchers did not report differences between genders [16, 25, 26]. In terms of age, the sites with predictive values ≥0.70 and accuracy ≥0.75 were observed in all the age groups, but the highest values of false positives were identified in the male group from 51 to 65 years (frequency = 15) and the false negatives in the female group from 51 to 65 years (frequency = 4).…”

Does dental fluorosis affect electric pulp test response and/or optimum probe placement site?

“…An inappropriate test site may reduce the specificity and sensitivity of the EPT (9), such as a false‐negative response in a tooth that is still vital. Several studies (6,7,9,10–13) have reported varying sites as appropriate and optimal for the least amount of electric current needed to elicit response from electric pulp testing on different teeth. There is, however, no consensus on this.…”

“…There is, however, no consensus on this. Like several others (6,9,10,21), the current study employed the maxillary central incisors. The choice was based on their location and ease of access, reduced incisal edge wear unlike what can be commonly seen with the posterior teeth and the pulp size reduction that follows secondary dentin deposition.…”

“…The latter reason also influenced the choice of enrolling subjects within a narrow age range of 20 to 40, where 85% of the subjects fell into the 21 to 30 years age range. Furthermore, these teeth are most predisposed to DF (9), an advantage for the comparison that was carried out in this study.…”

“…There is no consensus as to the optimal placement site, ranging from incisal edge (6–10), incisal third (11), occlusal two‐third (7), the middle third (12), or on the cervical third of the labial surface (13). As the resistance of the enamel and dentin and thus the threshold readings are affected by their thickness, and presence of cracks in their structure (14,15), threshold readings from teeth with a condition like dental fluorosis (DF) may be interesting.…”