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Accuracy of the American Association of Endodontists diagnostic criteria for assessing pulp health in primary teeth

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Abstract

Objectives

There is a lack of studies evaluating the accuracy of the 2009 American Association of Endodontists (AAE) diagnostic criteria for diagnosing pulpal health in primary teeth. This study aimed to estimate and correlate the diagnostic accuracy of clinical diagnosis of reversible and irreversible pulpitis using the 2009 AAE 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 were diagnosed histologically as uninflamed pulp, reversible or irreversibly inflamed and necrosis based on 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. The clinical diagnosis of irreversible pulpitis (sensitivity 64%, specificity 72%) matched the histological diagnosis of irreversible pulp inflammation for 47% of teeth evaluated. For the clinical diagnosis of reversible pulpitis (sensitivity: 65%, specificity: 86%), 80% matched the histological diagnosis of reversible pulp inflammation. Teeth with histologically diagnosed irreversible pulp inflammation were more likely to have lingering (OR 5.08; 95% CI 1.48–17.46, P = 0.010) and nocturnal tooth pain (OR 15.86; 95% CI 1.57–160.47, P = 0.019) when compared to teeth with reversible pulp inflammation. Using the classification and regression tree 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 criteria was acceptable for primary teeth with pulp necrosis and normal pulp but poor for reversible pulpitis and irreversible pulpitis.

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Data availability

The data that support the findings of this study are available on request from the corresponding author (IKD).

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Acknowledgements

The authors would like to thank Ms. Rubing Liu from the Faculty of Dentistry for her invaluable assistance in the histology laboratory.

Funding

This study was supported by a post-graduate grant from the Faculty of Dentistry, National University of Singapore, and partially supported by Singapore Ministry of Education Academic Research Fund Tier 1 (A-8000071–00-00).

Author information

Authors and Affiliations

  1. Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, 9 Lower Kent Ridge Road, Singapore, 119085, Singapore

    Ishreen Kaur Dhillon, Catherine Hsu-Ling Hong & Shijia Hu

  2. Faculty of Dentistry, National University of Singapore, 9 Lower Kent Ridge Road, Singapore, 119085, Singapore

    Yu Fan Sim

  3. Department of Endodontics, Operative Dentistry & Prosthodontics, Faculty of Dentistry, National University of Singapore, 9 Lower Kent Ridge Road, Singapore, 119085, Singapore

    Benny Kwee Chien Goh

  4. College of Dental Medicine, QU Health, Qatar University, Doha, Qatar

    Mandeep Singh Duggal

  5. Discipline of Oral Sciences, Faculty of Dentistry, National University of Singapore, 9 Lower Kent Ridge Road, Singapore, 119085, Singapore

    Gopu Sriram

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  1. Ishreen Kaur Dhillon
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Contributions

Ishreen Kaur Dhillon: methodology, validation, formal analysis, investigation, resources, review, editing and funding acquisition; Catherine Hsu-Ling Hong: conceptualisation, methodology, validation, review, editing, supervision and funding acquisition; Shijia Hu: conceptualisation, methodology, validation, review, editing; Yu Fan Sim: investigation, review, editing; Benny Kwee Chien Goh: review, editing; Mandeep Singh Duggal: conceptualisation, review, editing; Gopu Sriram: methodology, validation, investigation, resources, review, editing, supervision and funding acquisition

Corresponding authors

Correspondence to Ishreen Kaur Dhillon, Catherine Hsu-Ling Hong or Gopu Sriram.

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Competing interests

The authors declare no competing interests.

Ethics approval

Ethics approval was obtained prior to study commencement (National Healthcare Group Domain Specific Review Board study reference code 2020/00216).

Consent to participate

An information sheet that explained the objective of the study was provided to the patients’ parent or guardian. Informed consent was obtained prior to collection of the tooth/teeth for the study.

Conflict of interest

The authors declare no competing interests.

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Dhillon, I.K., Hong, C.HL., Hu, S. et al. Accuracy of the American Association of Endodontists diagnostic criteria for assessing pulp health in primary teeth. Clin Oral Invest 27, 6043–6053 (2023). https://doi.org/10.1007/s00784-023-05217-6

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