Validity of Preoperative Clinical Findings to Identify Dental Pulp Status: A National Dental Practice-Based Research Network Study.
BACKGROUND
Endodontic diagnostic tests are often used clinically to assess pulp status as a basis for the diagnosis and determination of whether root canal treatment (RCT) is indicated. Response to cold and pain on percussion are 2 common tests, yet their validity in identifying nonvital pulp in regular dental practice has not been reported.


METHODS
We assessed the validity of cold and percussion tests to identify nonvital pulp in teeth requiring RCT in a dental practice setting performed by 46 general dentists and 16 endodontists in the National Dental Practice-Based Research Network. The influence of patient-, tooth-, and dentist-related characteristics was investigated. Observed bleeding from the pulp chamber was the clinical reference. Sensitivity (SN), specificity (SP), overall test accuracy (TA), positive (PPV) and negative (NPV) predictive values, and likelihood and diagnostic odds ratios (LR+, LR-, dORs) were calculated for each single test and the combined cold and percussion tests.


RESULTS
Seven hundred eight patient teeth were included. Cold test showed high validity to identify a nonvital pulp status (SN = 89%, SP = 80%, TA = 84%, PPV = 81%, NPV = 88%, LR+ = 4.35, LR- = 0.14, dOR = 31.4), whereas pain on percussion had lower validity (SN = 72%, SP = 41%, TA = 56%, PPV = 54%, NPV = 60%, LR+ = 1.22, LR- = 0.69, dOR = 1.78). Combining the 2 tests did not increase validity, whereas preoperative pain, medication intake, patient age and sex, and dentist training level affected test validity significantly.


CONCLUSIONS
In regular dental practice, the cold test exhibits higher validity to discriminate between vital and nonvital pulp than the tooth percussion test.
Department of Endodontics, Faculty of Odontology, Malmo University, Malmo, Sweden; Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmo University, Malmo, Sweden. Electronic address: maria.pigg@mah.se.
Maria
M
Pigg
Division of TMD and Orofacial Pain, University of Minnesota, Minneapolis, Minnesota; Department of Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota; HealthPartners Institute for Education and Research, Bloomington, Minnesota.
Donald R
DR
Nixdorf
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
Ruby H N
RH
Nguyen
Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, Minnesota; Private Practice, The Dental Specialists, Lake Elmo, Minnesota.
Alan S
AS
Law
D000328:Adult; D000367:Age Factors; D000368:Aged; D003080:Cold Temperature; D003718:Denmark; D003782:Dental Pulp / Q000503:physiopathology*; D003786:Dental Pulp Cavity / Q000473:pathology; D003790:Dental Pulp Necrosis / Q000175:diagnosis*; D003791:Dental Pulp Test / Q000379:methods* / Q000592:standards; D018865:Dental Research; D003807:Dentin Sensitivity / Q000175:diagnosis; D003815:Dentists / Q000193:education; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000706:statistics & numerical data; D000072218:Endodontists / Q000193:education; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010146:Pain; D010474:Percussion / Q000379:methods* / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012390:Root Canal Therapy / Q000379:methods; D012680:Sensitivity and Specificity; D012737:Sex Factors; D013548:Sweden; D000070260:Teacher Training; D014481:United States
Dental pulp necrosis; dental pulp test; diagnostic test validity; endodontics; root canal therapy; sensitivity and specificity