Estimates of sensitivity and specificity of electric pulp testing depend on pulp disease spectrum: a modelling study

Abstract

Aim: To demonstrate how the spectrum of diseased pulps may influence sensitivity and specificity in diagnostic studies on pulp status.

Methodology: An original sample from a previous study consisting of 59 teeth scheduled for root canal treatment was used where the relationship between the response to electric pulp testing and the visual status of the pulp was evaluated. To alter the spectrum of diseased pulps, a hypothetical sample of asymptomatic teeth with deep caries lesions was added to the original sample. Sensitivity and specificity were then compared for the two samples.

Results: In the original sample of 59 teeth, sensitivity was 72% and specificity 90%. When the spectrum of diseased pulps was altered, sensitivity decreased to 67% and specificity increased to 97%. The change in disease spectrum also decreased the prevalence of necrotic pulps.

Conclusions: The spectrum of diseased pulps included in a diagnostic study on the accuracy of electric pulp testing, and indirectly also disease prevalence (here pulp necrosis), influences estimates of sensitivity and specificity. This implies that estimates of diagnostic accuracy from one study with a particular tooth population spectrum may not apply to another tooth population with a different disease spectrum.

Keywords: diagnosis; diagnostic accuracy; endodontic treatment; endodontics; pulp necrosis.