ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Patients Suffering From Dental Trauma May Have Altered Responses to Vitality Tests and Extended Follow up is Recommended
Clinical Question In an adult patient with dental trauma, are common vitality tests (EPT and Cold) as accurate as in a non-traumatized patient?
Clinical Bottom Line Altered response to cold and EPT tests after trauma is common. In the absence of symptoms, teeth showing a negative response should be given 3 months to confirm necrosis. Traumatized teeth showing a vital response should be followed up for 1 year to confirm continued healthy response.
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) 23439039Levin/2013Review Article
Key results“Immediately after trauma, teeth are often unresponsive to testing. This is due to neuronal degeneration that is characterized by intramyelin edema, axonal swelling, and a partial loss of the myelin sheath.” “Baseline vitality testing should be conducted at the earliest possible time… Vitality testing should be completed for all teeth in the maxillary and mandibular field of trauma… All testing results should be recorded and repeated at 2, 4, and 6–8 weeks and then 6 and 12 months.” “In mature permanent teeth after luxation injuries and certain types of fractures, a continued negative response to vitality tests after 3 months is considered a strong indication of pulp necrosis.”
Evidence Search “Pulp testing trauma”
Comments on
The Evidence
Validity: The article is a very well constructed review detailing the effects trauma can have on different regularly used pulpal and periradicular tests. Although it is not a systematic review of randomized controlled trials (RCTs), it is a comprehensive (the article references eighty scientific articles) current look at many issues the clinician will encounter when addressing trauma. Perspective: Trauma is not something most dentists deal with on a regular basis, so it is not uncommon to be out of practice. This article is a great reference for clinicians to review when the rare trauma case presents.
Applicability Nearly every dentist will encounter dental trauma however infrequent. It is important to understand how this trauma can affect our commonly used clinical tests, so that treatment is rendered in a conservative and appropriate manner.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords Pulp, vitality test, trauma
ID# 2530
Date of submission: 08/01/2013spacer
E-mail balldds@gmail.com
Author James Ball
Co-author(s) Sara Shayan
Co-author(s) e-mail Shayan@livemail.uthscsa.edu
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
Basic Science Rationale
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