THE CORRELATION BETWEEN CLINICAL DIAGNOSIS OF PULP INFLAMMATION AND HISTOLOGICAL FINDINGS OF INFLAMMATION IN PRIMARY TEETH

Abstract

Existing studies in primary teeth correlating clinical diagnosis of pulp status and histological findings is unclear and have considerable shortcomings due to the use of either outdated or non-validated clinical and histological criteria. This study aimed to evaluate the degree of correlation between the clinical diagnosis of reversible and irreversible pulpitis using the currently accepted 2013 American Association of Endodontists (AAE) classification of pulpal health with histological findings in primary teeth. This study involved 80 primary teeth collected from patients presenting to a tertiary centre over a 9-month period. The teeth were clinically diagnosed as having normal pulp (n=10), reversible pulpitis (n=30), irreversible pulpitis (n=30) and pulp necrosis (n=10) according to the currently accepted 2013 AAE diagnostic criteria. The teeth were histo processed and the pulp tissues were diagnosed histologically as intact uninflamed pulp, reversibly inflamed, irreversible inflamed and necrosis using a combination of the criteria used by Ricucci et al and Seltzer et al.3,14 A statistical grouping to dichotomise the histological findings of pulp inflammation into two groups, reversible pulp disease (inclusive of intact uninflamed pulp and reversibly inflamed) and irreversible pulp disease (inclusive of irreversibly inflamed and necrosis), were carried out not only to ease statistical analysis but also because the clinical management of the teeth within a group were the same. Sensitivity, specificity and predictive values were calculated for normal pulp, reversible pulpitis, irreversible pulpitis and pulp necrosis. The clinical diagnosis of pulp necrosis and normal pulp matched the vii histological diagnosis of irreversible pulp disease and intact uninflamed pulp respectively in 100% of the teeth evaluated (10 out of 10). The clinical diagnosis of irreversible pulpitis matched the histological diagnosis of irreversible pulp disease for 57% (17 out of 30) of teeth evaluated. The sensitivity and specificity for the clinical diagnosis of irreversible pulpitis were 53% and 73% respectively. For the clinical diagnosis of reversible pulpitis, 83% (25 out of 30) matched the histological diagnosis of reversible pulp disease. The sensitivity and specificity for the clinical diagnosis of reversible pulpitis were 52% and 86% respectively. While the accuracy of the clinical diagnosis of normal pulp and pulp necrosis utilising the 2013 AAE diagnostic criteria falls within an acceptable threshold for a diagnostic test to have appropriate clinical utility, it falls short for reversible and irreversible pulpitis. Existing studies in primary teeth correlating clinical diagnosis of pulp status and histological findings is unclear and have considerable shortcomings due to the use of either outdated or non-validated clinical and histological criteria. This study aimed to evaluate the degree of correlation between the clinical diagnosis of reversible and irreversible pulpitis using the currently accepted 2013 American Association of Endodontists (AAE) classification of pulpal health with histological findings in primary teeth. This study involved 80 primary teeth collected from patients presenting to a tertiary centre over a 9-month period. The teeth were clinically diagnosed as having normal pulp (n=10), reversible pulpitis (n=30), irreversible pulpitis (n=30) and pulp necrosis (n=10) according to the currently accepted 2013 AAE diagnostic criteria. The teeth were histo processed and the pulp tissues were diagnosed histologically as intact uninflamed pulp, reversibly inflamed, irreversible inflamed and necrosis using a combination of the criteria used by Ricucci et al and Seltzer et al.3,14 A statistical grouping to dichotomise the histological findings of pulp inflammation into two groups, reversible pulp disease (inclusive of intact uninflamed pulp and reversibly inflamed) and irreversible pulp disease (inclusive of irreversibly inflamed and necrosis), were carried out not only to ease statistical analysis but also because the clinical management of the teeth within a group were the same. Sensitivity, specificity and predictive values were calculated for normal pulp, reversible pulpitis, irreversible pulpitis and pulp necrosis. The clinical diagnosis of pulp necrosis and normal pulp matched the vii histological diagnosis of irreversible pulp disease and intact uninflamed pulp respectively in 100% of the teeth evaluated (10 out of 10). The clinical diagnosis of irreversible pulpitis matched the histological diagnosis of irreversible pulp disease for 57% (17 out of 30) of teeth evaluated. The sensitivity and specificity for the clinical diagnosis of irreversible pulpitis were 53% and 73% respectively. For the clinical diagnosis of reversible pulpitis, 83% (25 out of 30) matched the histological diagnosis of reversible pulp disease. The sensitivity and specificity for the clinical diagnosis of reversible pulpitis were 52% and 86% respectively. While the accuracy of the clinical diagnosis of normal pulp and pulp necrosis utilising the 2013 AAE diagnostic criteria falls within an acceptable threshold for a diagnostic test to have appropriate clinical utility, it falls short for reversible and irreversible pulpitis.

components of bimaxillary orthognathic surgery treatment planning. Skeletal cephalometry has historically been used but has been found to be unreliable and outcomes poorly correlated with facial esthetics. Despite multiple soft tissue cephalometric analyses proposed, there is no consensus on an analysis to predictably identify the ideal sagittal position of the maxilla. This thesis investigates the simulated esthetic outcomes of skeletal cephalometry based treatment planning versus various soft tissue based cephalometric analyses in the Chinese population of Singapore