Assessment of Pulp Oxygen Saturation Levels by Pulse Oximetry for Pulpal Diseases -A Diagnostic Study

Oxygen as obturation biomaterial in endodontic treatment: development of novel membranous dental restoration system

Complexities in obturation and difficulties in disinfection represent significant issues that render endodontic treatment notably time-consuming. A new perspective is essential to reduce both working time and address these two challenges. To date, none of the established techniques for root canal obturation can assure a perfect seal. Solid materials are not easily manipulated to hermetically fill the intricate branches of the root canal system. Concurrently, anaerobic and facultative anaerobic bacteria, particularly Enterococcus faecalis, are predominant in discussions surrounding endodontic infections. Numerous studies have demonstrated that achieving complete disinfection of Enterococcus faecalis is exceedingly difficult, even with the use of irrigating solutions that possess strong antibacterial properties. Under anaerobic conditions, the invasion efficiency of facultative anaerobes is heightened. If irrigation and disinfection fail to entirely eliminate anaerobes and facultative anaerobes, a novel strategy is required to address the bacteria that persist within the root canal. Oxygen can easily permeate the root canal system, eradicate anaerobes, and inhibit facultative anaerobes from becoming pathogenic. Therefore, employing oxygen as a biomaterial for obturation following appropriate cleaning and shaping procedures is anticipated to address the two primary endodontic issues. This article aims to explore a new potential concept for a dental restoration system that utilizes an oxygen-permeable membrane to reduce the time required for endodontic treatment. The membrane is positioned at the orifice of a duct designed to connect the entire root canal system with ambient air outside the restoration. The function of the membrane is somewhat analogous to the masks used during the COVID-19 pandemic, as it allows for the circulation of oxygen while preventing the passage of fluids, debris, and microorganisms. We hypothesize that the oxygen circulating within the root canal system will also function as a continuously renewing antimicrobial agent.

Analysis of the Pulp Oxygenation Rate by Pulse Oximeter in Children with Pulpal Diseases

Background and objective

Deciduous teeth portray less pain sensitivity in comparison to permanent teeth. Conventional vitality tests depend on the stimulation of nerve fibers. Loss of sensory function due to trauma can result in negative responses. Unpleasant painful stimuli may lead to apprehensiveness and require behavior management in children. This study is a genuine attempt to compare pulp oxygen saturation levels of deciduous posterior teeth clinically or radiographically diagnosed as reversible pulpitis (RP), irreversible pulpitis (IRP), and pulpal necrosis (PN) with healthy teeth using a pulse oximeter with probes in preoperative and postoperative conditions.

Methods

A total of 120 deciduous posterior teeth from participants aged 4-9 years were evaluated using random stratified sampling, divided into four groups with 30 teeth each based on clinical and radiological interpretation-group I: noncarious (NC) (control group); group II: RP; group III: IRP; group IV: PN. Teeth from children meeting the inclusion criteria were recorded and examined. The data obtained were sent for statistical analysis.

Results

A significant difference in pulp oxygenation rates was observed between teeth with pulpal pathologies and healthy teeth in both preoperative and postoperative conditions.

Interpretation and conclusion

Pulpal diseases cause a reduction in oxygen saturation of the pulp vasculature, thereby affecting the vitality of the tooth. The pulse oximeter used in the neonatal intensive care unit (ICU) was suitable for determining SpO2% in children.

Clinical significance

Pedodontists face challenges in making diagnoses because children may provide false-positive or false-negative responses to stimuli or questions. Pulse oximetry is a boon as it is highly efficient, can be used chairside, is completely atraumatic, and eco-friendly.

How to cite this article

Betal SK, Singh S, Dasgupta B. Analysis of the Pulp Oxygenation Rate by Pulse Oximeter in Children with Pulpal Diseases. Int J Clin Pediatr Dent 2024;17(5):576-579.

Pulse oximetry as a dental pulp test: A scoping review to identify barriers hindering the use of oximeters in clinical practice

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.

Evaluation of the Effect of Antihypertensive Drugs on the Values of Dental Pulp Oxygen Saturation in Hypertension Patients: A Case-Control Study

Purpose This study aimed to know about the positive or negative effect of antihypertensive drugs of different groups on the values of dental pulp oxygen saturation in hypertension patients. Materials and Methods A case-control study to evaluate the impact of the antihypertensive drugs on the values of dental pulp oxygen saturation in hypertension patients. The studied sample consisted of 40 participants, and they were distributed into two groups: Group I (n=20): Hypertension patients treated with antihypertensive drugs, and Group II (n=20): Healthy participants. A finger pulse oximeter was recorded after a rest period of 15 minutes by BCI® Advisor® vital signs monitor. The patient was then asked to use a chlorhexidine digluconate mouth rinse for five minutes, and the two dental pulp pulse oximeters for the central upper incisors were also recorded for all participants. Data were analyzed using the Mann-Whitney U test. Results ​​​​​​The results showed that there was no significant difference between the finger pulse oximeters of the two studied groups (P-value = 0.421). The two dental pulp oxygen saturation was higher than the control group with statistically significant (P-value = 0.043, P-value = 0.002). Conclusions Within the limitation of this study, it can be concluded that antihypertensive drugs increase the dental pulp oxygen saturation in patients with hypertension who are treated with antihypertensive drugs, and thus there is a positive effect of these drugs in stimulating the dental pulp.

Assessment of Pulpal Status in Primary Teeth Following Direct Pulp Capping in an Experimental Canine Model

(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.

A Diagnostic Insight of Dental Pulp Testing Methods in Pediatric Dentistry

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.

Relationship between the difference in electric pulp test values and the diagnostic type of pulpitis

BACKGROUND

According to the diagnosis criteria of the American Association of Endodontists (AAE), sensitive responses to cold and/or heat tests of suspected teeth compared with those of control teeth can be used for the diagnosis of pulpitis, but the role of electric pulp test (EPT) is not mentioned. It is believed that EPT has some limitations in determining the vitality of the pulp. The aim of this study was to explore the association between the difference in EPT values and the differential diagnoses of reversible pulpitis (RP) and symptomatic irreversible pulpitis (SIRP) caused by dental caries.

METHODS

A total of 203 cases with pulpitis caused by dental caries were included. A diagnosis of pulpitis was made on the basis of the diagnostic criteria of AAE. Patient demographic and clinical examination data were collected. The EPT values of the suspected teeth and control teeth were measured, and the differences between them were calculated. The correlation between the difference in the EPT values and diagnosis of pulpitis was analyzed using univariate and multivariate logistic regression.

RESULTS

In the 203 cases (78 males and 125 females; 115 cases of RP, 88 cases of SIRP; 9 anterior teeth, 59 premolars, and 135 molars), the mean patient age was 34.04 ± 13.02 (standard deviation) years. The unadjusted (crude) model, model 1 (adjusted for age), model 2 (adjusted for age and sex), and model 3 (adjusted for age, sex, and tooth type) were established for the statistical analyses. In model 3 [odds ratio (OR) = 1.025; 95% confidence interval (CI) 1.002-1.050; P = 0.035], the difference in EPT values between RP and SIRP was statistically significant. However, the areas under the curve of predictive probability of the crude model, model 1, model 2, and model 3 were 0.565, 0.570, 0.585, and 0.617, respectively, showing that the model accuracy was low. The P-value for the trend in differences between the EPT values as a categorical variable showed that the differences in the EPT values, comparing RP and SIRP, were not statistically significant.

CONCLUSIONS

Based on the present data, the difference in EPT values was not sufficient to differentiate RP from SIRP.

Machine Learning Approach to Predicting COVID-19 Disease Severity Based on Clinical Blood Test Data: Statistical Analysis and Model Development

Background

Accurate prediction of the disease severity of patients with COVID-19 would greatly improve care delivery and resource allocation and thereby reduce mortality risks, especially in less developed countries. Many patient-related factors, such as pre-existing comorbidities, affect disease severity and can be used to aid this prediction.

Objective

Because rapid automated profiling of peripheral blood samples is widely available, we aimed to investigate how data from the peripheral blood of patients with COVID-19 can be used to predict clinical outcomes.

Methods

We investigated clinical data sets of patients with COVID-19 with known outcomes by combining statistical comparison and correlation methods with machine learning algorithms; the latter included decision tree, random forest, variants of gradient boosting machine, support vector machine, k-nearest neighbor, and deep learning methods.

Results

Our work revealed that several clinical parameters that are measurable in blood samples are factors that can discriminate between healthy people and COVID-19–positive patients, and we showed the value of these parameters in predicting later severity of COVID-19 symptoms. We developed a number of analytical methods that showed accuracy and precision scores >90% for disease severity prediction.

Conclusions

We developed methodologies to analyze routine patient clinical data that enable more accurate prediction of COVID-19 patient outcomes. With this approach, data from standard hospital laboratory analyses of patient blood could be used to identify patients with COVID-19 who are at high risk of mortality, thus enabling optimization of hospital facilities for COVID-19 treatment.

A Clinical Study Determining Pulp Vitality in Oropharyngeal Cancer Patients Undergoing Radiotherapy Using Diagnostic Tool-Pulse Oximetry

Pulse oximetry is an equipment that evaluates pulp vitality for concrete endodontic diagnosis and treatment plan. One of the treatment methods of oropharyngeal cancer is radiotherapy. Radiotherapy has some harmful effects on dental pulp that affects pulp vitality. The objective of study was to assess pulp vitality before, at the end of radiotherapy and six months after radiotherapy (RT) in oropharyngeal cancer patients undergoing radiotherapy. 25 patients who were diagnosed with oropharyngeal cancer having asymptomatic intact crowns were selected for the study. Pulp vitality was checked before the commencement of radiotherapy (PV1), immediately after radiotherapy (PV 2) and six months post radiotherapy (PV 3). Pulp vitality of first posterior tooth was selected of each patient and was checked with pulse oximetry. Paired t-test was used as statistical analysis. Statistically significant difference was observed when PV 1 and PV 2, PV 1 and PV 3 and PV 2 and PV 3 were compared amongst each other. There was reduction noted in mean SpO2 value when groups PV 2 and PV1 were compared. This was statistically significant. Statistically significant increase in mean SpO2 value was observed six months post radiotherapy (PV 3). Thus, it can be concluded that statistically significant reduction in mean SpO2 level post radiotherapy recovers after six months.

Pulse Oximetry as a Diagnostic Tool to Determine Pulp Vitality: A Systematic Review

Pulse oximetry (PO) can be used as a technique to assess vascularization. Although it is commonly used in the field of medicine, it still has limited use in dentistry. The aim of this study is to evaluate, by means of a systematic review, if pulse oximetry is a viable and effective system to determine pulp vitality and assess the clinical criteria for its use. A literature search was performed in Medline, Scopus, Embase, and Web of Science databases. Clinical studies using pulse oximetry as a tool to determine pulp vitality in permanent teeth were eligible. Quality assessment of the included studies was performed following the Quality Assessment for Diagnostic Accuracy Studies (QUADAS-2) guidelines. A total of 24 articles were included in the review. The subjective test most compared to PO was the cold test. PO has shown a good sensibility and specificity, and it has been used in different clinical situations. Pulse oximetry has a high potential as a tool for the diagnosis of pulp vitality. However, the absence of a specific pulse oximeter for a dental practice, among other limitations, added to the lack of evidence on how different systemic and oral pathologies may affect the pulp’s oxygen saturation levels, which hinders its clinical use.

Pulp Vitality Testing with a Developed Universal Pulse Oximeter Probe Holder

Background and Objectives An accurate determination of the pulp status is relevant for a proper endodontic diagnosis. Objectives: The aim was to develop a universal pulse oximeter probe holder for measuring the oxygen saturation and to evaluate the use of pulse oximetry as a test for pulp vitality, by comparing the levels of oxygen saturation in the index finger and in the healthy dental pulp. Materials and Methods The universal holder was designed with software and printed with a 3D printer. The study was carried out on 128 healthy teeth. They were divided into eight groups according to tooth type. Ten root canal treated teeth served as a negative control group. For each patient, a pulse oximeter was first applied on the tooth followed by the index finger. The significance level (α) was set at 0.05. Results: The developed and manufactured universal pulse oximeter probe holder was suitable to measure the pulp vitality of all types of teeth. The handle allowed for holding the pulse oximeter on the tooth in parallel, firmly and securely. Significantly higher oxygen saturation was observed in the index finger (97.22%) compared to the dental pulp (93.17%) (p < 0.001). No correlation was observed between the maxillary teeth and index finger oxygen saturation values (r = 0.05, p = 0.72), whereas, between the mandibular teeth and index finger, a positive correlation was detected (r = 0.29, p = 0.02). There were no significant differences in the pulp oxygen saturation values between different teeth groups. Conclusion: The newly developed universal pulse oximeter probe holder is an effective device for pulp vitality testing.

Efficiency of new custom-made pulse oximeter sensor holder in assessment of actual pulp status

Aim

This study aims to assess the diagnostic accuracy of new custom-made pulse oximeter sensor holder in assessment of actual pulp status with three pulp sensibility tests.

Materials and Methods

Seventy-nine single canal teeth requiring endodontic therapy was included in the study. The tooth that was requiring root canal treatment was tested with heat test, cold test, electric pulp test, and pulse oximeter. Between each test, a time period of 2 min was allowed. The response from three pulp sensibility tests and the reading from pulse oximeter were recorded. Following which root canal treatment was performed. The result obtained from four pulp tests were correlated with the clinical finding after access cavity preparation. The data obtained was statistically assessed. Receiver operator characteristic (ROC) curve analysis was performed to assess the efficacy of the pulp tests. In the above statistical tools, the probability value. 05 is considered as significant level.

Results

The overall diagnostic accuracy was found to be significantly higher with pulse oximeter when compared with other three pulp sensibility tests. The ROC curve demonstrates the results obtained from pulse oximeter was found to be more reliable than other pulp tests.

Conclusion

Within the limitation of the study, diagnostic accuracy of pulse oximeter with custom made sensor holder was reliable and accurate in assessment of actual pulp status.