Ingles

Review Article

Identify and Define All Diagnostic Terms for Pulpal Health and Disease States
Linda G. Levin, DDS, PhD,* Alan S. Law, DDS, PhD,† G.R. Holland, BSc, BDS, PhD, Cert Endo, CRSE,‡ Paul V. Abbott, BDSc, MDS, FRACDS(Endo),§ and Robert S. Roda, DDS, MSjj
Abstract
Introduction: Consensus Conference Subcommittee 2 was charged with the identification and definition of all diagnostic termsfor pulpal health and disease states by using a systematic review of the literature. Methods: Eight databases were searched, and numerous widely recognized endodontic texts were consulted. For each reference the level of evidence was determined, and the findings were summarized by members of the subcommittee. Highest levels of evidence were always included when available. Areas of inquiry includedquantification of pulpal pain, the designation of conditions that can be identified in the dental pulp, diagnostic terms that can best represent pulpal health and disease, and metrics used to arrive at such designations. Results and Conclusions: On the basis of the findings of this inquiry, specific diagnostic terms for pulpal health and disease are suggested. In addition, numerous areas for furtherstudy were identified. (J Endod 2009;35:1645– 1657)

A

n evidence-based practice centers on the integration of the best clinically relevant scientific information with the patient’s desires and the individual practitioner’s clinical practice abilities. Its ultimate goal is to enhance patient care through the development of appropriate treatment modalities for specific clinical presentations. Thedevelopment of standard terminology is at the center of patient care in that it facilitates communication between the patient and doctor as well as between dental health professionals. Presently in endodontics there is no standard diagnostic nomenclature consensus for pulpal status in health or disease. The objective of this analysis was the establishment of evidencebased diagnostic nomenclaturefor clinically encountered pulpal conditions.

Materials and Methods
The following databases were searched for literature pertaining to our charge: MEDLINE-Ovid, PubMed, Web of Knowledge, Cochrane Oral Health Group, EMBASE, SCOPUS, Google Scholar, and Medstory. Non–English language citations and nonhuman studies were excluded in searches for pain and pulpal metrics. Texts reviewed included thefollowing: Endodontics, 6th ed, Ingle JI, Bakland LK, BC Decker, Hamilton, Ontario, Canada, 2008; Pathways of the Pulp, 9th ed, Cohen S, Hargreaves KM, Mosby-Elsevier, St Louis, MO, 2006; Principles and Practice of Endodontics, 4th ed, Torabinejad M, Walton RE, Saunders, Philadelphia, PA, 2008; Encyclopedia of Pain, Schmidt RF, Willis WD, Springer, Berlin, Germany, 2006; Essential Endodontology:Prevention and Treatment of Apical Periodontitis, Ørstavik D, Pitt Ford TR, Blackwell Publishing, Oxford, United Kingdom, 2007. Problems were encountered in consistency of terminology, a lack of high levels of evidence, and inherent subjectivity in subject matter (diagnostic terminology). A lack of studies with high levels of evidence posed the most significant concern.

Key Words
Dental pulp,diagnosis, metrics

From the *School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; †Private Practice, Lake Elmo, Minnestoa; ‡School of Dentistry, University of Michigan, Ann Arbor, Michigan; §School of Dentistry, University of Western Australia, Perth, WA, Australia; and jjBaylor College of Dentistry, Dallas, Texas. Address correspondence to Linda G.Levin, DDS, PhD, Ste 106, 3624 Shannon Rd, Durham, NC 27707-3772. E-mail address: levinlg@mac.com. 0099-2399/$0 - see front matter Copyright ª 2009 American Association of Endodontists. doi:10.1016/j.joen.2009.09.032

Subquestion #1: How Should the Degree of Pulpal Pain Be Quantified Clinically? The absolute measurement of pain on a scale common to all patients is not possible as a result of the...