Accuracy of the dental pulp sensibility test using cold spray for the diagnosis of pulp diseases: an observational clinical study




Dental Pulp Necrosis, Dental Pulp Test, Endodontics, Oral Diagnosis, Pulpitis.


The dental pulp sensibility test is one of the main auxiliary resources for the diagnosis of pulp pathologies, and its accuracy is still debatable. This cross-sectional observational study evaluated the accuracy of the pulp sensibility test (PST) using cold spray (1,1,1,2-tetrafluoroethane) for the diagnosis of pulp diseases and determined the effect of individual and clinical variables on the reliability of this test. The paper was designed following the STROBE statement. Sixty patients with indications for primary endodontic treatment were selected and examined from August 2017 to July 2018. Data collection was performed through interviews, clinical/radiographic examinations and the PST. The results of the cold test, along with data on sex, age, the tooth type regarding the root number, and the presence of restorations and caries, as well as the recent consumption of analgesics, were recorded. The presence of bleeding within the pulp chamber was used as the gold standard to compare with the clinical diagnosis and to identify the true-positive, false-positive, true-negative, and false-negative responses. The accuracy of PST achieved in subgroups of individual and clinical variables was compared using the chi-square test with a significance level of 5% (p < 0.05). The PST with the use of cold spray showed a sensitivity of 0.88, a specificity of 1.00, a positive predictive value of 1.00, a negative predictive value of 0.86, and an accuracy of 0.93. The accuracy of the cold spray was not affected by individual or clinical variables. The PST with the use of cold spray is an accurate and reliable method for determining the diagnosis of pulp diseases, especially in cases of pulp vitality or irreversible pulpitis.


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ALGHAITHY, R.A. and QUALTROUGH, A.J.E. Pulp sensibility and vitality tests for diagnosing pulpal health in permanent teeth: a critical review. International Endodontic Journal. 2017, 50, 135–142.

American Association of Endodontics. Consensus conference recommended diagnostic terminology. Journal of Endodontics. 2009, 35, 1634.

CHEN, E. and ABBOTT, P.V. Evaluation of accuracy, reliability, and repeatability of five dental pulp tests. Journal of Endodontics. 2011, 37, 1619–1623.

DASTMALCHI, N., JAFARZADEH, H. and MORADI, S. Comparison of the efficacy of a custom-made pulse oximeter probe with digital electric pulp tester, cold spray, and rubber cup for assessing pulp vitality. Journal of Endodontics. 2012, 38, 1182–1186.

FARIAS, M.P., et al. Assessment of intracanal medications cytotoxicity ON L929 fibroblast cells. Bioscience Journal. 2016, 32, 566–573.

FOWLER, S., et al. Does acetaminophen/hydrocodone affect cold pulpal testing in patients with symptomatic irreversible pulpitis? a prospective, randomized, double-blind, placebo-controlled study. Journal of Endodontics. 2014, 40, 1958–1960.

HAHN, C.-L. and LIEWEHR, F.R. Innate immune responses of the dental pulp to caries. Journal of Endodontics. 2007, 33, 643–651.

JAFARZADEH, H. and ABBOTT, P. V. Review of pulp sensibility tests. Part I: general information and thermal tests. International Endodontic Journal. 2010, 43, 738–762.

JESPERSEN, J.J., et al. Evaluation of dental pulp sensibility tests in a clinical setting. Journal of Endodontics. 2014, 40, 351–354.

KARDELIS, A., et al. Effect of narcotic pain reliever on pulp tests in women. Journal of Endodontics. 2002, 28, 537–539.

KATAOKA, S.H.H., et al. Pulp vitality in patients with intraoral and oropharyngeal malignant tumors undergoing radiation therapy assessed by pulse oximetry. Journal of Endodontics. 2011, 37, 1197–1200.

LEVIN, L.G. Pulp and periradicular testing. Journal of Endodontics. 2013, 39, S13–S19.

LEVIN, L.G., et al. Identify and define all diagnostic terms for pulpal health and disease states. Journal of Endodontics. 2009, 35, 1645–1657.

MAINKAR, A. and KIM, S.G. Diagnostic accuracy of 5 dental pulp tests: a systematic review and meta-analysis. Journal of Endodontics. 2018, 44, 694–702.

MATOS, F.S., et al. Impact of different restorative techniques on the stress distribution of endodontically-treated maxillary first premolars: a 2-dimensional finite element analysis. Journal of Research and Knowledge Spreading. 2020, 1, 11761.

MILLER, S.O., et al. Cold testing through full-coverage restorations. Journal of endodontics. 2004, 30, 695–700.

MOUSAVI, E., et al. Comparative evaluation of pulpal vitality test accuracy in different groups of teeth. Bioscience Biotechnology Research Communications. 2017, 10, 178–183.

NASERI, M., et al. Correlation between histological status of the pulp and its response to sensibility tests. Iranian Endodontic Journal. 2017, 12, 20–24.

NG, Y.L., et al. Prevalence of and factors affecting post-obturation pain in patients undergoing root canal treatment. International Endodontic Journal. 2004, 37, 381–391.

RICUCCI, D., LOGHIN, S. and SIQUEIRA, J.F. Correlation between clinical and histologic pulp diagnoses. Journal of Endodontics. 2014, 40, 1932–1939.

SETZER, F.C., et al. Clinical diagnosis of pulp inflammation based on pulp oxygenation rates measured by pulse oximetry. Journal of Endodontics. 2012, 38, 880–883.

VILLA-CHÁVEZ, C.E., et al. Predictive values of thermal and electrical dental pulp tests: a clinical study. Journal of Endodontics. 2013, 39, 965–969.

WISE, E.A., et al. Gender role expectations of pain: relationship to experimental pain perception. Pain. 2002, 96, 335–42.




How to Cite

MATOS, F. de S.., CUNHA, T.C.., RIBEIRO, M.A.G.., ARAUJO, C.S.., BERNARDINO, Ítalo de M.., MOURA, C.C.G. and PARANHOS, L.R., 2021. Accuracy of the dental pulp sensibility test using cold spray for the diagnosis of pulp diseases: an observational clinical study. Bioscience Journal [online], vol. 37, pp. e37040. [Accessed14 August 2022]. DOI 10.14393/BJ-v37n0a2021-60365. Available from:



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