Correlation Between Pulp Sensibility Tests and Histologic Diagnosis

Introduction: Accurate diagnosis of dental pulp conditions plays a key role in selection of an appropriate treatment including conservative vital pulp therapy (treatable pulp) or root canal treatment (untreatable pulp). The purpose of this study was to assess the accuracy of sensibility tests and the correlation of pulp response to sensibility tests with histologic pulp condition. Material and Methods: Assessment of clinical signs and symptoms and sensibility test include thermal and electrical pulp tests were all performed for 65 permanent teeth. The normal pulp and reversible pulpitis were considered as treatable conditions while the irreversible pulpitis and necrosis ones were considered as untreatable condition. The teeth were then extracted and sectioned for histological analysis of dental pulp. Comparisons between histological treatable and untreatable pulp condition were performed with chi square analysis for sensibility test responses. Result: A significant difference was detected in the normal and a sharp lingered response to heat and cold tests with a marginally significant difference for no responses to cold test between two histological treatable and untreatable groups. There was significant difference in the negative response to electric pulp test (EPT) between histological groups. The kappa agreement between clinical and histological diagnosis of pulp condition was about 0.843(p<0.001). The accuracy of cold and heat tests and EPT to detect treatable pulp or untreatable pulp states were 78% and 74% and 62% respectively. The sensibility tests diagnosed untreatable pulpitis with a higher probability (NPV=63%-67% -54%, PPV=83%-91% -95% for heat, cold and EPT respectively). Conclusion: Sensibility test results had a higher likelihood to diagnose pulpal disease or untreatable pulp conditions. The result demonstrated a good agreement between clinical and histological pulp diagnoses