Relationship Of Patient Complaints And Signs To Histopathologic Diagnosis Of Pulpal Condition

Abstract

The correlation between the histopathologic examination of pulp biopsy specimens and patients' complaints and signs was investigated. The sensitivity, specificity and reliability of each complaint and sign, and the characteristics of pain that are associated with treatable and untreatable pulp states is proposed. Pulp specimens were obtained from teeth that required endodontic treatment. Clinical data were recorded to identify each patient's complaints. The pulp specimens were processed and the histopathologic diagnoses were categorised and correlated with the patients' complaints. Of the 240 cases, 100 (41.7%) were diagnosed as atrophic pulp or pulposis; 4 (1.7%) as acute pulpitis; 64 (26.7%) as transitional stage; 56 (23.3%) as chronic pulpitis, and 16 (6.7%) as acute pulpitis superimposed on a chronic pulpitis. Results showed that previous pain (p < 0.05), spontaneous pain (p < 0.01), and prolonged pain on cold stimuli (p < 0.05), were significantly more frequent in the patients with chronic pulpitis compared to those with pulposis or transitional stage. We concluded that clinicians must consider the sensitivity and specificity of patient complaints and signs in order to perform a diagnosis based upon clinical evidence.

Dental Pulp: Correspondences and Contradictions between Clinical and Histological Diagnosis

“…In parallel, we underline the fact that the evaluation of the pathological status of the dental pulp without correlation with the clinical context seems not to yield reliable results. Similar but isolated observations were published in the literature of the ‘60s [ 8 , 11 ] and also recently [ 12 , 14 ]. Unfortunately, their scientific messages were not able to influence the strategy of pulp disease classification.…”

Criteria and treatment decisions in the management of deep caries lesions: Is there endodontic overtreatment?

“…Pulpal sensibility testing with cold combined with an electric pulp tester are accurate and reliable methods of determining pulpal vitality (92% sensitivity and 90% specificity) ( 18 ). However, when the relationship between patient complaints and histopathologic diagnosis of pulpal condition have been analyzed, results have shown that finding that pain on cold stimuli was present in 100% of patients with untreatable pulpal states (100% sensitivity) but also was present in 71% of patients with treatable pulpal states (28.6% specificity) ( 19 ). Although the pulp response to the cold does not differentiate accurately if an irreversible pulpitis already exists, in regular dental practice the cold test has validity to discriminate between vital and nonvital pulp ( 20 ).…”

A prospective study of the incidence of asymptomatic pulp necrosis following crown preparation

“…It is well known that pulp testing does not always give accurate information about pulp status (Seltzer et al 1963, Dummer et al 1980, Bender 2000, Cisneros-Cabello & Segura-Egea 2005, Mej are et al 2012). However, a major advantage of EPT is its ability to make accurate comparisons of the electric response threshold value of the same tooth over time that yields important diagnostic information.…”