Cold Test Signals Anesthesia Failure in Painful Pulpitis Treatments, reveals study
According to researchers, a cold test combined with an electric pulp testing (EPT) could more accurately assess the effectiveness of anesthesia in symptomatic irreversible pulpitis (SIP) patients undergoing dental treatment. While inferior alveolar nerve block (IANB) can induce effective anesthesia of the lip, it is extremely rare for them to ensure pain-free procedures in painful pulpitis cases. A recent study was conducted by Farzaneh and colleagues and was published in the Journal of Endodontics.
Fear of dental procedures, especially root canal, mostly emerges as a consequence of previous painful experience creating barriers to required dental visits. A satisfactory pain control is crucial in such cases; however, IANB is the gold standard for reduction of postoperative numbness of jaw, which also has a low success rate in patients with SIP. This study determined the diagnostic value of these tests in terms of the improvement of the validity of IANB among patients undergoing treatment of mandibular molars.
A cross sectional study involved 50 patients diagnosed with SIP in the mandibular first molar, all of whom exhibited lip numbness due to the injection of IANB. Both cold tests and EPT were carried out following confirmation of lip numbness; an access cavity preparation served as a "gold standard" test. For this procedure, the responses were either "presence of pain or discomfort" or "absence of pain or discomfort," thus denoting failure or success in IANB, respectively. SN, SP, PPV, NPV, LR+/-, and AC with 95% CI for each test performed individually as well as in combination
56% of patients failed IANB signifying necessity for more effective pain evaluation techniques.
Compared with EPT, cold test had high specificity (SP), PPV, and positive likelihood ratio (LR+); these are indicative of a strong signal of anesthesia failure when results are positive.
The accuracy between the cold test and EPT did not differ significantly for sensitivity, negative predictive value, or accuracy. However, the combination of both tests enhances the sensitivity, NPV, PPV, and LR-
The cold test is a good marker of the failure of anesthesia, and adding EPT to the test increases accuracy in clinical diagnosis. These results demonstrated that dual testing is important because it can significantly enhance the experiences of anxious patients about their fear of pain during dental procedures.
Reference:
Afkhami, F., Ghabraei, S., Hashemi, N., & Peters, O. A. (2024). Evaluation of cold and electric pulp tests for assessing the success of inferior alveolar nerve block for mandibular first molars diagnosed with symptomatic irreversible pulpitis. Journal of Endodontics. https://doi.org/10.1016/j.joen.2024.10.013
