Pulse oximetry better than Pulp Sensibility Tests for Assessing Pulpal Health in Permanent Teeth

In vivo observational studies and clinical trials assessing the diagnostic accuracy of pulp vitality tests and sensibility tests in adult human teeth were screened. Exclusion criteria included non-English articles, deciduous teeth, case reports and in vitro studies.

Data extracted included basic study location, sample size, age of participants, pathology of teeth, type of teeth and the vitality (pulse oximetry or Laser Doppler flowmetry) or sensibility test (cold, hot and electric pulp testing) used. Measures of diagnostic accuracy were synthesised (sensitivity, sensibility, predictive values, and likelihood ratios). Meta-analysis was performed using a bivariate random-effects model producing summary values for sensitivity and specificity. Results were presented as a ROC curve. Risk of bias and the quality of the studies were assessed using the QUADAS-2 tool.

Results:

A total of ten studies were included in the review, of which five were included in the meta-analysis. Overall risk of bias was unclear. Pulse oximetry showed higher diagnostic accuracy than electric pulp testing and thermal testing. Insufficient data precluded quantitative analysis for Laser Doppler flowmetry.

Pulse oximetry demonstrates greater diagnostic accuracy when compared to sensibility testing. Limited sample size and heterogeneity among the included studies limits their applicability. Clinicians should continue to use sensibility testing adjunctively to assess pulpal status, but should be aware of their limitations and interpret their results cautiously.

Further diagnosis of the state of the dental pulp should never be made solely based on the results of a single test but rather should originate from a thorough history, clinical examination, and adjunctive testing techniques.

Adam, M. 'Cold is gold'? The diagnostic accuracy of sensibility and vitality testing techniques. Evid Based Dent 23, 137 (2022). https://doi.org/10.1038/s41432-022-0847-5