The dynamics of pulp inflammation: Correlations between diagnostic data and actual histologic findings in the pulp

Seltzer, Samuel; Bender, I.B.; Ziontz, Murray

doi:10.1016/0030-4220(63)90201-9

Cited by 212 publications

(156 citation statements)

References 9 publications

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“…This is in contrast to guidelines in relevant literature, indicating that an inflamed pulp has the potential to heal and teeth should preferably be restored vitally [9,25]. However, the presence of symptoms might indicate a more severe pulpal inflammation, even if pain is an uncertain diagnostic criterion [26]. This might be the reason why more than one third of the participants were reluctant to choose the vital treatment modality in the presence of symptoms.…”

Section: Discussionmentioning

confidence: 74%

Treatment preferences of deep carious lesions in mature teeth: Questionnaire study among dentists in Northern Norway

Stangvaltaite‐Mouhat

Kundzina

Eriksen

et al. 2013

Acta Odontologica Scandinavica

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Section: Discussionmentioning

confidence: 74%

Treatment preferences of deep carious lesions in mature teeth: Questionnaire study among dentists in Northern Norway

Stangvaltaite‐Mouhat

Kundzina

Eriksen

et al. 2013

Acta Odontologica Scandinavica

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“…Differences in testing technique/examiner are other possible explanations; we found higher specificity when specialists did the testing in regular dental practice, and the other study collected data in a university clinic using specialists or students supervised by specialists. Other studies using different testing methodology and with histology as the reference standard reported slightly lower sensitivity (68–78%)(4, 7, 23) and lower or similar specificity (70–81%)(4, 7, 23). In our study the procedure was not operationalized, and there are no guidelines or general consensus favoring any specific cold testing method.…”

Section: Discussionmentioning

confidence: 89%

“…However, periapical inflammatory changes may occur also when the pulp is relatively superficially inflamed (4). Our clinical reference standard did not rule out pulpal inflammation extending to the periapical tissues.…”

Section: Discussionmentioning

confidence: 99%

“…pulp vitality tests and pain provocation) to determine the pulp status and condition in teeth affected by deep caries, trauma or other types of injury (3). Cold testing, defined as the responsiveness of pulpal sensory nerves to cold stimulus, has showed fairly high sensitivity (usually >75%), with variable specificity (12–98%)(4–10). The evidence for cold test validity has recently been rated as insufficient because published studies have several limitations (3).…”

Section: Introductionmentioning

confidence: 99%

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Validity of Preoperative Clinical Findings to Identify Dental Pulp Status: A National Dental Practice-Based Research Network Study

Pigg

Nixdorf

Nguyen

et al. 2016

Journal of Endodontics

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Introduction Endodontic diagnostic tests are often used clinically to assess pulp status as a basis for diagnosis and determination of whether root canal treatment (RCT) is indicated. Response to cold and pain on percussion are two common tests, yet their validity in identifying non-vital pulp in regular dental practice has not been reported. Methods We assessed the validity of cold and percussion tests to identify non-vital pulp in teeth requiring RCT in a dental practice setting, performed by 46 general dentists and 16 endodontists in the National Dental Practice-Based Research Network. The influence of patient-, tooth- and dentist-related characteristics was investigated. Observed bleeding from the pulp chamber was the clinical reference. Sensitivity (SN), specificity (SP), overall test accuracy (TA), positive (PPV) and negative (NPV) predictive values, and likelihood and diagnostic odds ratios (LR+, LR−, dOR) were calculated for each single test and the combined cold and percussion tests. Results 708 patient-teeth were included. Cold test showed high validity to identify a non-vital pulp status (SN 89%, SP 80%, TA 84%, PPV 81%, NPV 88%, LR+ 4.35, LR− 0.14, dOR 31.4), while pain on percussion had lower validity (SN 72%, SP 41%, TA 56%, PPV 54%, NPV 60%, LR+ 1.22, LR− 0.69, dOR 1.78). Combining the two tests did not increase validity, while preoperative pain, medication intake, patient age and gender, and dentist training level affected test validity significantly. Conclusion In regular dental practice, cold test exhibits higher validity to discriminate between vital and non-vital pulp than does tooth percussion test.

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“…Symptoms of odontogenic pain can vary greatly, in some cases pulpal necrosis occurs without any prior symptomatic pulpitis 12. Studies have shown that clinical pain symptoms do not necessarily correlate with histological findings in pulp 13, 14, 15…”

Section: Mechanisms Of Orofacial Painmentioning

confidence: 99%

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

Dabiri

Harper

Kapila

et al. 2018

Special Care in Dentistry

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Dentists regularly employ a variety of self‐report and sensory techniques to aid in the diagnosis and treatment of tooth‐related disease. Many of these techniques leverage principles borrowed from psychophysics, the quantitative measurement of the relationship between stimuli and evoked sensations, which falls under the larger umbrella of quantitative sensory testing (QST). However, most clinicians fail to meet the bar for what could be considered quantitative sensory testing, and instead focus on qualitative and dichotomous “yes/no” aspects of sensory experience. With our current subjective measurements for pain assessments, diagnosis and treatment of dental pain in young children and individuals (any age) with severe cognitive impairment rely extensively on third‐party observations. Consequently, the limitation of inadequate pain diagnosis can lead to poor pain management. In this review, it discusses mechanisms that underlie acute and chronic dental pain. It details the measurement of somatosensory responses and pulpal blood flow as objective measures of tooth health and pain. It proposes that bridging these varied methodologies will significantly improve diagnosis and treatment of orofacial pain and pathology. It concludes that improving the precision of sensory measurements could yield important improvements in diagnostic challenges in pulpal pathology for noncommunicative and cognitively impaired individuals.

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The dynamics of pulp inflammation: Correlations between diagnostic data and actual histologic findings in the pulp

Cited by 212 publications

References 9 publications

Treatment preferences of deep carious lesions in mature teeth: Questionnaire study among dentists in Northern Norway

Treatment preferences of deep carious lesions in mature teeth: Questionnaire study among dentists in Northern Norway

Validity of Preoperative Clinical Findings to Identify Dental Pulp Status: A National Dental Practice-Based Research Network Study

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

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