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Hosseinzadehfard P, Skučaitė N, Maciulskiene-Visockiene V, Lodiene G. Blood pH Changes in Dental Pulp of Patients with Pulpitis. Diagnostics (Basel) 2024; 14:1128. [PMID: 38893654 PMCID: PMC11171864 DOI: 10.3390/diagnostics14111128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
The severity of pulpitis is a crucial factor in determining the suitable treatment. There are no clear objective indicators to assess the stage of pulp inflammation that could be used in clinical practice. The change in blood pH of the pulp during the inflammatory phase could hypothetically serve as an indicator of the pulp inflammation severity. The aim of this study was to assess the pH values in the pulpal blood of mature teeth in patients with symptomatic pulpitis, in comparison with the healthy controls. The study included patients with symptoms of pulpitis in premolar or molar teeth (Test group; n = 24, mean age 36.04, SD 7.10), and healthy controls (Control group, n = 6, mean age 24.5, SD 5.94) referred for extraction of premolars or third molars, for orthodontic reasons. The pulpal blood was taken at the opening of the endodontic access cavity, and the pH value was measured in both groups. Statistical analysis was performed using the SPSS 27.0 program with a significance level of p ≤ 0.05. The Mann-Whitney test for dependent samples was performed to evaluate the statistical difference between the groups. The patients with symptomatic pulpitis had significantly decreased pulpal blood pH compared to the healthy controls (p ≤ 0.05). The mean pulpal blood pH was 7.27 (SD 0.06) and 7.40 (SD 0.02) in Test and Control groups, respectively. In the Test group, the pulpal blood pH values were significantly lower in the patients who had symptoms for 3 days or more (7.25, SD 0.05) than in those who had symptoms for up to 3 days (7.33, SD 0.03) (p < 0.001). The pH value of the pulpal blood gradually declines in cases of symptomatic pulpitis, along with increasing duration of the symptoms.
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Affiliation(s)
- Pedram Hosseinzadehfard
- Department of Dental & Oral Pathology, Faculty of Odontology, Academy of Medicine, Lithuanian University of Health Sciences, Eiveniu g.2, 50009 Kaunas, Lithuania
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Kasper RH, Coelho MR, Miguens-Jr SAQ, Grazziotin-Soares R, Barletta FB. Pulse oximetry as a dental pulp test: A scoping review to identify barriers hindering the use of oximeters in clinical practice. Saudi Dent J 2024; 36:262-269. [PMID: 38419999 PMCID: PMC10897589 DOI: 10.1016/j.sdentj.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/27/2023] [Accepted: 11/05/2023] [Indexed: 03/02/2024] Open
Abstract
Background and Objective Although medical pulse oximeters are considered effective for endodontic diagnoses, the method remains uncommon in current dental practice. The aim of the present scoping review was to investigate clinical factors that exert a negative impact on the use of pulse oximeters in dental practice. Methods This study followed the PRISMA-ScR guidelines and the protocol was prospectively registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/3GQCE). A comprehensive search of the MEDLINE (via PubMed), Cochrane Library, and Web of Science databases was performed in December 2022 for articles published in English or Spanish. All types of clinical studies were included, except comments, letters to the editor, and abstracts. Two independent investigators analyzed 45 full-text articles. Data extraction included general characteristics, oxygen saturation levels, and limiting factors/barriers to the use of oximeters as pulp testers. Results The search of the databases yielded 1,300 records and 38 were included (quantitative data extraction was performed for 35 and three articles were systematic reviews). Publications were highest in number between 2016 and 2017, with an evident reduction occurring after 2021. The oxygen saturation level for sound/vital maxillary anterior teeth was 84.99% (overall mean). The main limiting factors/barriers were i) the difficulty in maintaining the two light-emitting diodes parallel during pulp tests, ii) infrared light diffraction by enamel/dentin/gingiva, and iii) the diversity of patient ages in studies. Conclusion This scoping review encountered noteworthy findings associated with the impracticability of using medical pulse oximeters as dental pulp testers. The recent decrease in the frequency of published studies compared to approximately seven years ago may imply a negative trend in the use of the method.
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Age-Related Variation of Pulpal Oxygen Saturation in Healthy Primary and Permanent Teeth in Children: A Clinical Study. J Clin Med 2022; 12:jcm12010170. [PMID: 36614971 PMCID: PMC9821562 DOI: 10.3390/jcm12010170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
(1) Background: Pulse oximetry (PO) is an effective method of dental pulp status monitorization but still lacks practical implementation in dentistry, as well as clear reference values for different tooth types. The study’s aim was to investigate the age-related variation of blood oxygen saturation (SpO2) from the dental pulp during different stages of tooth development in all types of primary and permanent teeth of children. (2) Methods: The pulps of 600 healthy primary and permanent teeth (incisors, canines, premolars, and molars) of patients aged 2−15 years were tested with an adapted PO device, and the results were statistically analyzed; (3) Results: Statistically significant differences (p < 0.05) were found between open-apex and closed-apex teeth and between the canines and other tooth types in both primary and permanent dentitions. (4) Conclusions: Values of SpO2 tended to decrease with age progression in both primary and permanent dentitions. Enamel and dentine thickness and their optical properties and the shape and volume of coronal pulp, which differed among tooth types, seemed to have some influence on the reading as well. The study indicates that factors such as the root development and the tooth type must be taken into account when establishing reference SpO2 values for the dental pulp.
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Wali R, Sacco R, Singh G, Patel V. The clinical effect of radiotherapy on pulpal microvasculature: a systematic review. Br Dent J 2022:10.1038/s41415-022-5301-8. [PMID: 36473977 DOI: 10.1038/s41415-022-5301-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/29/2022] [Indexed: 12/12/2022]
Abstract
Introduction/objectives Radiotherapy (RT) has a detrimental effect on the histomorphology of oral tissues. Patients undergoing RT are at risk of developing macrovascular and microvascular changes, which can lead to significant clinical consequences. Despite advances in RT delivery systems, radiation injury remains a modern-day clinical problem. The aim of this systematic review is to investigate the available evidence regarding the impact of RT to the dental pulp and the clinical manifestations of these effects.Data and sources A multi-database search (PubMed, Medline, Embase and CINAHL) was performed to identify related papers published from inception until November 2021. An additional manual search was performed to identify further articles. The data extracted from relevant papers were analysed according to the outcomes selected in this review.Study selection The search generated seven articles eligible for analysis with a total of 2,709 teeth included. RT dose exposure ranged from 30-71.2 Gray with a common finding that RT decreases the number of teeth responding to pulp sensibility testing.Conclusions Knowledge related to the impact of RT on dental pulp is limited and based on weak evidence and a low-level quality of studies. Future studies should incorporate exact RT doses to the teeth and use replicable pulpal testing methods. Understanding the pulpal status post-RT remains an important consideration as dental extractions should be avoided in this cohort due to the risk of osteoradionecrosis.
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Affiliation(s)
- Rana Wali
- Oral Surgery Registrar, Oral Surgery Department, Guy´s and St Thomas´ Hospital, London, UK
| | - Roberto Sacco
- Clinical Lecturer, Division of Dentistry, School of Medical Sciences, Oral Surgery Department, University of Manchester, Manchester, UK; 3Clinical Teacher, Oral Surgery Department, King´s College Hospital, London, UK
| | - Gurpreet Singh
- Managed Clinical Network Chair, Restorative Dentistry, NHS England and NHS Improvement East of England, UK
| | - Vinod Patel
- Oral Surgery Consultant, Oral Surgery Department, Guy´s and St Thomas´ Hospital, London, UK.
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Igna A, Igna C, Miron MI, Schuszler L, Dascălu R, Moldovan M, Voicu AA, Todea CD, Boariu M, Mârțu MA, Stratul ȘI. Assessment of Pulpal Status in Primary Teeth Following Direct Pulp Capping in an Experimental Canine Model. Diagnostics (Basel) 2022; 12:diagnostics12082022. [PMID: 36010372 PMCID: PMC9407383 DOI: 10.3390/diagnostics12082022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: This study aimed to assess the pulpal response of primary teeth by pulse-oximetry (PO) in a canine model, following direct pulp capping (DPC). (2) Methods: Forty-eight primary teeth from eight canine subjects were divided into three treatment groups, based on the DPC material—calcium hydroxide (CH), MTA, BiodentineTM)—and three corresponding control groups. Data from PO pulp testing were correlated with laser Doppler flowmetry (LDF) testing, computer tomographic (CT) densitometry and histological analysis; the experiment lasted 14 days. (3) Results: SpO₂ recordings revealed statistically significant differences (p = 0.002, <0.05) between the treatment and control groups, and no significant differences (p = 0.257, >0.05) were observed between treatment groups. LDF recordings showed significant differences (p = 0.002, <0.05) between the treatment and control groups and identified significant differences between materials (p = 0.001, <0.05). CT densitometry indicated vital pulps in all teeth, with pulpal inflammation detected in 6/8 CH-capped teeth and 2/8 MTA-capped teeth. Histologic evaluation confirmed vital pulp in all specimens, with different degrees of inflammation. (4) Conclusions: Within its limitations, the present study confirms the diagnostic value of PO evaluation of pulpal status in primary teeth with histologic means after pulp-capping procedures in a canine model. However, various degrees of pulpal inflammation elicited by different pulp-capping materials seem not to correlate with the obtained PO values.
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Affiliation(s)
- Andreea Igna
- Department of Pediatric Dentistry, Pediatric Dentistry Research Center, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence: (A.I.); (M.I.M.)
| | - Cornel Igna
- Department of Surgery, Faculty of Veterinary Medicine, Banat University of Agricultural Sciences and Veterinary Medicine “Regele Mihai I al Romaniei”, 300645 Timisoara, Romania
| | - Mariana Ioana Miron
- Department of Oral Rehabilitation and Dental Emergencies, Interdisciplinary Research Center for Dental Medical Research, Lasers and Innovative Technologies, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence: (A.I.); (M.I.M.)
| | - Larisa Schuszler
- Department of Surgery, Faculty of Veterinary Medicine, Banat University of Agricultural Sciences and Veterinary Medicine “Regele Mihai I al Romaniei”, 300645 Timisoara, Romania
| | - Roxana Dascălu
- Department of Imagistic Diagnosis, Faculty of Veterinary Medicine, Banat University of Agricultural Sciences and Veterinary Medicine “Regele Mihai I al Romaniei”, 300645 Timisoara, Romania
| | - Mihaela Moldovan
- Department of Pathological Anatomy, Municipal Emergency Clinical Hospital, 300231 Timisoara, Romania
| | - Adrian Aristide Voicu
- Department of Functional Sciences, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Carmen Darinca Todea
- Department of Oral Rehabilitation and Dental Emergencies, Interdisciplinary Research Center for Dental Medical Research, Lasers and Innovative Technologies, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Marius Boariu
- Department of Endodontics, Faculty of Dental Medicine, TADERP Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Maria-Alexandra Mârțu
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ștefan-Ioan Stratul
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Igna A, Mircioagă D, Boariu M, Stratul ȘI. A Diagnostic Insight of Dental Pulp Testing Methods in Pediatric Dentistry. Medicina (B Aires) 2022; 58:medicina58050665. [PMID: 35630082 PMCID: PMC9145630 DOI: 10.3390/medicina58050665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/14/2022] [Accepted: 05/15/2022] [Indexed: 12/04/2022] Open
Abstract
The accurate diagnosis of pulpal pathology in pediatric dentistry is essential for the success of vital pulp therapy. Pulp testing is often a challenging task due to understanding and cooperation issues of pediatric patients, as well as the particularities of pulpal physiology encountered in primary and immature permanent teeth. Sensibility tests, although still widely used by dental practitioners, are no longer recommended by pediatric specialists mainly due to their subjective nature. Vitality pulp tests have gained popularity in the last decade in light of some encouraging results of clinical studies. However, their use is not a routine practice yet. This paper is a literature review aimed to guide dental practitioners towards selecting the appropriate pulp testing method for their pediatric cases. It provides an overview on a multitude of pulp testing methods and an update in recommendations for primary and immature permanent teeth.
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Affiliation(s)
- Andreea Igna
- Department of Pediatric Dentistry, Pediatric Dentistry Research Center, Faculty of Dental Medicine, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Correspondence: (A.I.); (M.B.)
| | - Doina Mircioagă
- Department of Physical Education, University Sport Research Center for Evaluation of Fitness Level—CUSENF, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Marius Boariu
- Department of Endodontics, Faculty of Dental Medicine, TADERP Research Center, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Correspondence: (A.I.); (M.B.)
| | - Ștefan-Ioan Stratul
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
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Evaluation of the Pulp Oxygen Saturation Reading after Tooth Bleaching: A Randomized Clinical Trial. Int J Dent 2022; 2022:1598145. [PMID: 35531572 PMCID: PMC9072050 DOI: 10.1155/2022/1598145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives The purpose of this clinical trial was to evaluate the influence of in-office dental bleaching on the pulp oxygen saturation (SpO2p) reading. Material and Methods. SpO2p was measured using a pulse oximeter in 112 upper and lower anterior teeth (canines and incisors) of patients submitted to bleaching. Whitegold Office 35% (WGO) (upper and lower left hemiarch) and Whiteness HP Auto Mixx 35% (WHP) (upper and lower right hemiarch) bleaching agents were used. SpO2 measurements (teeth and index finger) were taken before and after each of the three application sessions of the agents. In the 4th session, in which no bleaching gel was used, only SpO2 was measured. Before and after the bleaching sessions, a colorimetric device performed the teeth color reading. The waiting time between sessions was 7 days. Data were analyzed by the Friedman, Kruskal–Wallis, and Mann–Whitney U tests (α = 0.05). Color change (ΔE) data were correlated (Spearman's Rho test) with the SpO2p levels. Results Neither of the two bleaching agents showed significant differences between the readings when evaluated individually (WGO, P=0.780, and WHP, P=0.494). When taken together, the results showed significant difference between the readings performed, with higher median values after bleaching sessions: before (97.3) and after (98.6) 1st session; before (98.3) and after (98.3) 2nd session; before (98.3) and after (99.0) 3rd session; and after 1 week (98.3). The dental groups formed by maxillary lateral incisors (P=0.012) and mandibular incisors (P < 0.001) showed a significant difference. Spearman's Rho test showed a nonsignificant and weak correlation between ΔE and SpO2p in most comparisons. Conclusions The in-office dental bleaching influenced the SpO2p reading, regardless of the dental group evaluated or the bleaching agent used. Clinical Relevance. This study provides information about the influence of in-office tooth whitening on the pulp SpO2p levels. The observation of pulp vitality during and after the use of bleaching agents is important for the follow-up of patients undergoing tooth whitening. The use of a pulse oximeter may be a viable and painless alternative to perform this monitoring. The clinical trial was registered with the Brazilian Registry of Clinical Trials (ReBEC; registration number: https://clinicaltrials.gov/ct2/show/RBR-68xbth).
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Vu TT, Nguyen MT, Sangvanich P, Thunyakitpisal P. Pulse Oximetry and Three-Dimensional Analysis in Evaluating Immature Permanent Teeth Apexogenesis: Two Case Reports. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2112271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Apexogenesis is a vital pulp therapy that aims to preserve pulp vitality and maintain root formation in not-fully-formed permanent teeth with exposed pulp from trauma or caries. To achieve success, reliable diagnostic tools are required to assess the pulp health and tooth development stage, design an appropriate treatment plan and evaluation, and follow-up. Pulse oximetry is a non-invasive method for monitoring pulp oxygen saturation, which corresponds to pulp vitality.
Case Presentation:
This case report describes the successful apexogenesis of two pulp exposure-immature permanent teeth treated with acemannan, an implantable natural biomaterial extracted from aloe vera. Based on pulp oxygen saturation level, clinical evaluation, and radiographic examination, the teeth were asymptomatic with preserved pulp vitality and continued root development.
Conclusion:
Therefore, as an auxiliary tool, pulse oximetry could be useful for diagnosis, treatment, and follow-ups of apexogenesis therapy.
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Histological Aspects Regarding Dental Pulp of Diabetic Patients. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11209440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: The possible histological changes in dental pulp in teeth of diabetic patients are important to be understood, as the clinician will consider the best treatment choice for those teeth, especially if they are affected by decay. The aim of this paper is to assess if there are effects of diabetes-associated hyperglycemia on the nervous and vascular system of the dental pulp. Methods: Twenty-three dental pulp specimens of patients aged 36–70 years old were analyzed. All patients had been diagnosed with type 2 diabetes for at least 5 years. Results: Most of the patients had poorly controlled hyperglycemia, deep caries, but no clinical signs of pulpitis. The histological aspects of pulp specimens included frequently seen inflammatory infiltrate, degeneration of the nerves, thickened blood vessel walls, pulp sclerosis and frequent pulp calcifications, and even small necrotic areas. Conclusion: The analyzed dental pulp specimens of carious teeth of type 2 diabetic patients show fibrotic transformation of the dental pulp, with the presence of calcifications, arteriosclerosis and inflammatory infiltrate. In this situation, the attitude of the dentist in pulp vitality preservation in the case of carious teeth of diabetic patients should be limited.
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