Pulp Diagnosis: Current guidelines, shortcomings, and future developments

Statement of the problem: Accurate diagnosis of the inflammatory condition of the dental pulp is at the core of endodontics and is essential in selecting the most appropriate treatment option. Available pulpal sensibility tests are useful adjuncts in the formulation of a pulpal diagnosis. However, these tests are associated with a degree of uncertainty and have known limitations. Purpose of the review: The aim of this review manuscript is to analyse current diagnostic systems, discuss their use and limitations as well as highlight future areas of development. Methods: A search strategy was conducted in the MEDLINE Ovid and Embasse databases and the Cochrane Library. No time limit was applied. The search results were limited to those in the English language. Discussion: Sensibility tests, including thermal and electrical stimuli, measure the condition of the neurovascular supply of the tooth, thus providing only a proxy measure of the health of the pulp. In comparison, vitality tests, including pulse oximetry and laser Doppler flow provide a more objective and quantitative measure of the condition of the pulp. However, these latter tools are not accessible clinically. Sensibility testing remains our current gold standard of providing information relating to the health of the pulp and combined with history, examination, and radiographic tests, allows the formulation of a diagnosis to guide treatment. Future trends promise more objective measures of the state of the dental pulp, but further, evidence-based research and non-cost-limiting equipment need to be produced. Conclusions: There is currently no pulpal diagnostic test that is ideal. Despite the limitations outlined, these tools remain essential in the endo diagnostic arsenal. Understanding the accuracy and limitations of current gold standard pulp tests will aid practitioners in accurately diagnosing the degree of pulpitis, thereby facilitating the selection of the most appropriate and effective treatment for dental pulp.