The validity of pulp testing: a clinical study.

OBJECTIVE In this article, the authors report on an in vivo study in which they assessed the validity of two commonly used cold pulp tests (carbon dioxide [CO(2)]and 1,1,1,2-tetrafluoroethane) and an electrical pulp tester (EPT) in determining pulp vitality by using direct inspection of the pulp as the reference standard. METHODS One hundred fifty patients undergoing endodontic therapy at the University of North Carolina School of Dentistry (Chapel Hill) undergraduate clinic participated in this study. Before routine endodontic treatment, the authors classified participants by means of EPT, CO(2) and tetrafluoroethane as having either vital or necrotic pulps. Students recorded true pulpal status (vital/necrotic) by observing blood within the pulp chamber after an access cavity was made. The authors calculated the sensitivity, specificity and positive and negative predictive values of each test and the test combinations to describe their validity and clinical usefulness. RESULTS Ninety-seven percent of teeth responding positively to all three tests contained vital pulps, whereas 90 percent of the teeth that failed to respond to any of the tests contained necrotic pulps. Ten percent of the teeth not responding to any of the tests contained vital pulps. For all other combinations of test results, 54 percent of teeth contained vital pulps, and 46 percent contained necrotic pulps. CONCLUSIONS These findings support the use of either of the cold tests and the EPT for diagnosis of pulpal status. CLINICAL IMPLICATIONS Cold test and EPT used in conjunction resulted in a more accurate method for diagnostic testing.