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Title Pulse Oximetry is More Reliable (but currently less practical) for Determining Pulp Vitality than Cold Testing
Clinical Question Since cold testing is not reliable in determining pulp vitality in recently traumatized teeth, can the use of pulse oximetry reliably determine pulp vitality in these cases?
Clinical Bottom Line Pulse oximetry provides an accurate method of determining pulp vitality but some limitations remain; currently there is no device available to conveniently enable pulse oximetry testing clinically. Furthermore, higher levels of evidence to include randomized controlled trials are needed to substantiate the use of this diagnostic device. (See Comments on the CAT below)
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) 17368329Gopikrishna/200780 patients requiring endodontic therapyIn vivo controlled trial
Key resultsPulse oximetry was compared blindly to the gold standard of cold testing to determine pulp vitality. The sensitivity and negative predictive value of the pulse oximeter was 1.00 compared to 0.81 with the cold test; specificity and positive predictive values were 0.95 for oximetry vs. 0.92 for cold testing.
Evidence Search PubMed: “Endodontics” AND “pulse oximetry” AND (clinical trial[ptyp] OR Meta-analysis[ptyp] OR randomized controlled trial[ptyp] OR review[ptyp])
Comments on
The Evidence
Gopikrishna had a small sample size, but showed great results for pulse oximetry using a blind comparison to a gold standard. The positive and negative predictive values were both better for pulse oximetry than for cold testing to determine pulp vitality. Cold testing measures neuronal response, often not present in cases of recent trauma due to temporary parasthesia of pulpal nerves; a more accurate test would consider pulpal blood flow. The overall consensus of articles reviewed by Jafazadeh was that although several studies show positive results with pulse oximetry in determining pulp vitality, more practical means need to be available and more randomized controlled trials need to be conducted before we deviate from the gold standard: the cold test.
Applicability Since all dentists will undoubtedly encounter patients with recently traumatized teeth with temporary nerve parasthesia, an alternative diagnostic method determining pulpal blood flow as a determinant of pulp vitality is very practical.
Specialty/Discipline (Endodontics) (General Dentistry) (Basic Science)
Keywords pulse oximetry, pulp vitality, Endodontics
ID# 289
Date of submission: 11/11/2009spacer
E-mail schmoldt@livemail.uthscsa.edu
Author Steven J. Schmoldt, DDS
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Basic Science Rationale
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Comments and Evidence-Based Updates on the CAT
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by Matthew Carraway (San Antonio, Texas) on 04/02/2012
I conducted a pubmed search on this topic in March 2012 and found a more recent publication: PubMed ID 18554185. This CCT of 17 adult patients further strengthens the conclusions of this CAT.
by Allen Pratt (San Antonio, TX) on 07/22/2011
Additional case studies using lower levels of evidence have been performed which verify these findings. PMID: 21342436

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