ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Laser Doppler Flowmetry and Pulse Oximetry are the Most Accurate Pulp Vitality Test after Trauma
Clinical Question In traumatized teeth, do laser doppler flowmetry and pulse oximetry, compared to conventional pulp vitality tests, produce more accurate and reliable results?
Clinical Bottom Line Evidence suggests that LDF (Laser Doppler Flowmetry) and Pulse Oximetry are highly sensitive and specific for pulpal vitality testing of traumatized teeth. They are the only tests that can confirm continued blood flow in the pulp tissue.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 23635978Levin/2013Literature Review
Key resultsCurrent clinical testing for pulp vitality consists of percussion, palpation, and thermal testing. These are all patient and clinician subjective. Percussion testing is influenced by a dentist’s acoustic perception, and is only specific to intrusion/ankylosis lesions. Palpation is the least accurate predictor of pulp vitality. EPT testing has a high rate of false positives but has high relative specificity. Refrigerant spray proved to be superior to EPT testing/ heat testing alone. The type of traumatic injury, the age of the patient, and the maturity of the apex is what determines the success rate of current clinical diagnostic tests. Current clinical tests are limited to the status of the nerves in the tooth. LDF and pulse oximetry show promising increased accurate diagnostic results due to testing of pulpal blood flow, which is diagnostic of pulp vitality.
#2) 22329525Mejare/2012155 reviewed studies, 2 moderate quality resultsSystematic Review
Key resultsPulpal Vitality results of different clinical testing methods were reviewed. Sensitivity refers to the ability of the test to identify a diseased pulp, where as specificity refers to test results which identify a healthy pulp. EPT results show 71% sensitivity, and 92% specificity. Heat testing showed high variability of sensitivity/specificity. Combined Heat and Cold testing had results of 96% sensitivity, and 92% specificity. LDF showed 88% sensitivity, and 100% specificity. Pulse Oximetry results of 100% sensitivity, and 95% specificity.
Evidence Search “Pulp vitality testing“ [MeSH], “traumatized teeth”[MeSH]
Comments on
The Evidence
Mejare, et al, adhered to strict inclusion criteria in their systematic review. None of the studies included in this systematic review reached “high quality”, and the authors state that “…there are major shortcomings in the design, conduct and reporting” of research in this area. With current clinical pulpal testing, half of traumatized teeth will show no immediate response; however, with LDF and pulse oximetry, pulpal blood flow can be determined. Studies show that current diagnostic measures, including LDF and pulse oximetry are limited to diagnosing the existence or nonexistence of pulpal blood flow, but cannot differentiate between reversible and irreversible pulpitis. Further research and studies need to focus on determining a more precise diagnosis for the traumatized pulp.
Applicability Applicable to clinicians treating traumatized teeth. The evidence indicates that traditional methods of vitality testing are inaccurate after trauma. Pulse oximetry and laser Doppler flow are able to demonstrate most reliably if there is blood flow in the pulp tissue, indicating continued vitality.
Specialty/Discipline (Endodontics) (General Dentistry) (Pediatric Dentistry)
Keywords pulp vitality, traumatic tooth injury, pulp testing, sensitivity, specificity, pulpal diagnosis, LDF, pulse oximetry, clinical diagnostic testing
ID# 2751
Date of submission: 08/09/2014spacer
E-mail emese.tokos@ucdenver.edu
Author Emese Tokos
Co-author(s) Helen Chase
Co-author(s) e-mail helen.chase@ucdenver.edu
Faculty mentor/Co-author Ethelyn Thomason, DMD
Faculty mentor/Co-author e-mail Ethelyn.thomasonlarsen@ucdenver.edu
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