ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Evidence Suggests a Pulse Oximeter is More Accurate Than Cold Testing in Diagnosing Pulp Necrosis but Dental Adaptors are not Commercially Available at This Time
Clinical Question How does dental pulse oximeter compare to cold test in the diagnosis of pulpal necrosis in endodontic patients?
Clinical Bottom Line Evidence suggests a pulse oximeter is more accurate than cold testing in diagnosing pulp necrosis but dental adaptors are not commercially available at this time.
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) 19249589Jafarzadeh/2008Review
Key resultsSensor should conform to the tooth (not commercially available at this time). “Extrinsic interference’s may be caused by the probe movement, overhead Xenon arc lamps (because of electromagnetic interference), and problems within the probe itself.” Two of the studies reviewed showed, “100% correlation between histologic and clinical diagnosis of the pulp vitality.” One study reviewed “showed that conventional dual wavelength pulse oximetry could not precisely calculate the oxygen saturation.”
#2) 17368329Gopikrishna/2007Patient Group 80 patients with single rooted incisors, canines and premolars needing RCT. In vivo study
Key resultsPulse oximeter: Sensitivity- 100%, Specificity- 95%, PPV- 95%, NPV- 100%. Cold test: Sensitivity- 81%, Specificity- 92%, PPV- 92%, NPV- 81%. This indicates that the pulse oximeter is more accurate than cold testing in diagnosing pulp necrosis. Gold standard used was pulp status found upon endodontic access.
#3) 22892732Dastmalchi/2012Patient Group 24 patients with mandibular, single canal premolars with mature apices, no caries, extensive restorations or signs and symptoms. 012In vivo study
Key resultsPulse oximeter: Sensitivity- 93%, Specificity- 100%, PPV- 100%, NPV- 90%. Cold test: Sensitivity- 53%, Specificity- 66%, PPV- 72%, NPV- 46%. This indicates that the pulse oximeter is more accurate than cold testing in diagnosing pulp necrosis. Gold standard used was pulp status found upon endodontic access.
Evidence Search pulse oximeter dental pulp necrosis
Comments on
The Evidence
Validity: Neither of the studies was blinded and both had small sample sizes. They both involved the use of a custom-made pulse oximeter adaptor developed and built by the authors, which could have caused some bias. Perspective: Findings suggest that a dental pulse oximeter is more comfortable than a cold test and more accurate at detecting pulp necrosis; however, dental adaptors are not commercially available at this time. The sensitivity, specificity, PPV and NPV found for the cold test by Dastmalchi et al 2012 is lower than found in blinded studies (Villa-Chavez et al 2013; Weisleder et al 2009) as well as those reported by Gopikrishna et al 2007. Dastmalchi et al used a refrigerant soaked cotton pellet for a max of 7 seconds only one time. Villa-Chavez et al and Weisleder et al applied the cotton pellet for 15 seconds. Gopikrishna et al determined a negative response "if the patient felt no sensation after two 15-second applications." It is also important to note that these studies only address the ability of a dental pulse oximeter to diagnose pulp necrosis not reversible or irreversible pulpitis.
Applicability Dental adaptors for pulse oximeters are not commercially available at this time.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords Pulse oximeter; pulp necrosis; pulp vitality; cold test; thermal test
ID# 2516
Date of submission: 08/06/2013spacer
E-mail seibold@livemail.uthscsa.edu
Author Jelena Seibold, DDS
Co-author(s) Mohammed Abdulaziz Al Saati, DDS
Co-author(s) e-mail AlSaati@livemail.uthscsa.edu
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
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