ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Electrical Pulp Testing Has Not Been Shown to Be Superior to Cold Test in Diagnosing Pulp Vitality
Clinical Question In adult patients with unknown pulpal status, is the Electrical pulp tester a more reliable predictor of pulp vitality in comparison to cold test when determining pulpal diagnosis?
Clinical Bottom Line Electrical pulp test has less validity and reliability in diagnosing pulpal vitality in comparison to cold test, but the difference was not clinically significant. The most accurate vitality test is the cold test.
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) 23880259 Villa-Chavez/2013110 Teeth from patients need root canal therapy-Mexico. Blind comparison with gold standard
Key resultsThe accuracy and reproducibility of electrical pulp tester was less than cold test. Positive predictive value (PPV) for both was 100% & Negative predictive value (NPV) was 83% for EPT vs 90% for cold test. Sensitivity of EPT was less than cold test (76% vs 88%). Specificity of both was 1.00. The results from this study showed that the probability that a nonsensitive reaction indicated necrotic pulp (positive predictive value) was 100%. We could rely on the results of EPT as well as cold test in determining necrotic pulp.
#2) 19654254Weisleder/2009150 Teeth from patients need root canal therapy- USA.Blind comparison with gold standard
Key resultsSpecificity for cold test and EPT were 76% vs. 92%, respectively (92 percent of vital teeth responded to EPT). Sensitivity for these tests, respectively, was 92% vs. 75% (75 percent of necrotic teeth did not respond to EPT). Negative predictive value was 93% for cold test vs. 83% for EPT (for example, 83 percent of teeth that responded to EPT were vital). Positive predictive value was 74 % for cold test vs. 87% for EPT (87 percent of teeth that did not respond to EPT were necrotic). [The definition of sensitivity; specificity & PPV; NPV were reverse in this study, therefore, we changed them above for better understanding and assimilate with the other studies’ results.]
#3) 10530156Petersson/199975 Teeth from patients need root canal therapy-Sweden.Blind comparison with gold standard
Key resultsFor the cold test (ethyl chloride), the sensitivity was 0.83 Vs. 0.72f or EPT and the specificity was 0.93 for both tests. This means that 83% of the teeth with a necrotic pulp were identified as necrotic by the cold test, while 93% of the teeth with vital pulp were identified as vital by the cold test. The positive predictive value (the probability of no sensitive reaction represented a necrotic pulp) was 0.89 for cold test vs. 0.88 for EPT and the negative predictive value (the probability of a sensitive reaction represented a vital pulp ) was 0.90 for cold test vs. 0.84 for EPT. The accuracy was 86% for the cold test and 81% for the electrical test.
Evidence Search Specificity [MeSH] AND sensitivity [MeSH] AND electrical pulp tester
Comments on
The Evidence
Validity: The studies were well design and the sample size was very good, although none of the articles had high level of evidence. Also all studies were done in humans teeth who need root canal therapy and all the results were judged with comparison to the visual inspection of pulp (no bleeding: necrosis, bleeding: vital). According to the search strategy, there were not any systematic reviews or clinical trials articles. All studies were done in blind manner. Particularly the first one was done blindly with randomization of assignment. Perspective: Use of both EPT and cold tests in a randomized controlled study would provide more validity.
Applicability The evidences presented in these clinical studies are applicable in clinical usage of vitality test. Overall these studies recommended that EPT has a high PPV and specificity, probability that a no sensitive reaction indicated necrotic pulp (positive predictive value) was very high. We could rely on the results of EPT as well as cold test in determining necrotic pulp. But the NPV and sensitivity is less than cold test, even though not significant. It is better to confirm EPT findings with cold test.
Specialty/Discipline (Endodontics) (General Dentistry) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords validity, reliability, sensitivity, specificity, accuracy, electrical pulp tester
ID# 2533
Date of submission: 08/05/2013spacer
E-mail fayazi@livemail.uthscsa.edu
Author Sara Fayazi, DDS
Co-author(s) Shelrethia Battle-Siatita, DDS
Co-author(s) e-mail sbattle02@yahoo.com
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
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