Ishreen K. Dhillon
Recent graduate of a pediatric dentistry residency training programme
National University of Singapore
National University of Singapore
Singapore, Singapore
Catherine Hsu-Ling Hong, BDS, MS
Faculty of Dentistry, National University of Singapore
Shijia Hu, BDS, PhD
Faculty of Dentistry, National University of Singapore
Yu Fan Sim, MS
Faculty of Dentistry, National University of Singapore
Benny Kwee Chien Goh, BDS, MDS
Faculty of Dentistry, National University of Singapore
Mandeep Singh Duggal, BDS, MDS, PhD
College of Dental Medicine, QU Health, Qatar University
Gopu Sriram, BDS, MDS, PhD
Assistant Professor
National University of Singapore
Singapore, Singapore
Catherine Hsu-Ling Hong, BDS, MS
Faculty of Dentistry, National University of Singapore
Gopu Sriram, BDS, MDS, PhD
Assistant Professor
National University of Singapore
Singapore, Singapore
Aim: This study aimed to correlate the clinical diagnosis of reversible and irreversible pulpitis using the 2009 American Association of Endodontists (AAE) clinical diagnostic criteria with histological findings in primary teeth.
Methods: Eighty primary teeth that were clinically diagnosed with normal pulp (n=10), reversible pulpitis (n=30), irreversible pulpitis (n=30) and pulp necrosis (n=10) were collected. The teeth were histo-processed and pulp tissues diagnosed histologically as uninflamed pulp, reversible or irreversibly inflamed and necrosis based on a previously proposed criteria.
Results: The clinical diagnosis of pulp necrosis (sensitivity: 70%, specificity: 96%) and normal pulp (sensitivity: 91%, specificity: 100%) matched the histological diagnosis of necrosis and uninflamed pulp in 70% and 100% respectively of teeth evaluated. The clinical diagnosis of irreversible pulpitis matched the histological diagnosis of irreversible pulp inflammation for 47% of teeth evaluated (sensitivity: 64%, specificity: 72%). For the clinical diagnosis of reversible pulpitis, 80% matched the histological diagnosis of reversible pulp inflammation (sensitivity: 65%, specificity: 86%). Teeth with histologically diagnosed irreversible pulp inflammation were more likely to have lingering (OR 5.08; 95% CI: 1.48-17.46, P= .010) and nocturnal tooth pain (OR 15.86; 95% CI: 1.57-160.47, P= .019) when compared to teeth with reversible pulp inflammation. Using the CART model, the presence of widened periodontal ligament space and nocturnal tooth pain were useful predictors of irreversible pulp inflammation with an accuracy of 78%.
Conclusion: The 2009 AAE diagnostic criteria was accurate for primary teeth with pulp necrosis and normal pulp but less so for reversible pulpitis and irreversible pulpitis.