EPT lit

Question 1

How does Weisleder 2009 define sensitivity?

Answer 1

The proportion of cases correctly identified by means of a diagnostic test (Percent of vital teeth that test positive to EPT or cold)

Question 2

How does Weisleder 2009 define specificity?

Answer 2

The proportion of non-cases correctly identified by means of a diagnostic test (Percent of necrotic teeth that do not respond to EPT cold)

Question 3

How does Weisleder 2009 define positive predictive value?

Answer 3

The proportion of positive test results that are cases (Percent of positive EPT or cold responses that are vital) Therefore, those that are positive to EPT or cold but are necrotic are false positives.

Question 4

How does Weisleder 2009 define negative predictive value?

Answer 4

The proportion of negative test results that are non-cases (Percent of negative EPT or cold responses that are necrotic) Threfore, those that are negative to EPT or cold but are vital are false negatives.

Question 5

What is a false negative according to Weisleder 2009?

Answer 5

When a tooth tests negative to cold or EPT, but is vital.

Question 6

What is a false positive according to Weisleder 2009?

Answer 6

When a tooth tests positive to cold or EPT, but is necrotic.

Question 7

Sensitivity of cold and EPT (according to Weisleder 2009)?

Answer 7

cold 76%, EPT 92% (vital teeth that test positive)

Question 8

Specificity of cold and EPT (according to Weisleder 2009)?

Answer 8

cold 92%, EPT 75% (necrotic teeth that test negative)

Question 9

PPV of cold and EPT (according to Weisleder 2009)?

Answer 9

cold 93%, EPT 83% (positive results that are vital)

Question 10

NPV of cold and EPT (according to Weisleder 2009)?

Answer 10

cold 74%, EPT 87% (negative results that are necrotic)

Question 11

According to Weisleder 2009, if both cold and EPT were used, PPV is?

Answer 11

97% (of teeth that test positive to both tests are vital)

Question 12

According to Weisleder 2009, if both cold and EPT were used, NPV is?

Answer 12

90% (of teeth that respond negatively to both tests are necrotic)

Question 13

How does Peters, Baumgartner, Lorton 1994 define a false positive?

Answer 13

A tooth that is non-vital or partially non-vital that responds positively to a test (cold or EPT).

Question 14

How does Peters, Baumgartner, Lorton 1994 define a false negative?

Answer 14

A tooth that is vital and responds negatively to a test (cold or EPT).

Question 15

Who did Peters, Baumgartner, Lorton 1994 study?

Answer 15

60 patients referred for endodontic evaluation (1488 teeth).

Question 16

Who showed that false pos. response to EPT significantly higher than cold. However, found that EPT false positives can be lowered if all responses above the tissue level are considered negative (to a percent that is not significantly different from cold)?

Answer 16

Peters, Baumgartner, Lorton 1994

Question 17

Who showed that false positives to EPT were spread evenly throughout the mouth, while false positives to cold were only in multi-rooted teeth?

Answer 17

Peters, Baumgartner, Lorton 1994

Question 18

Who showed a high incidence of probable false negatives to cold (no response to cold, but responses to both EPT’s), all but two of which were in patients over 60 years of age.?

Answer 18

Peters, Baumgartner, Lorton 1994

Question 19

Who showed a false negative incidence for cold in patients under 50 to be 0.2%, and 20.6% in patients over age 60?

Answer 19

Peters, Baumgartner, Lorton 1994

Question 20

Who showed when cold is applied to occlusal and cervical area, it usually responds to both, but if it responds to just one area, it is usually cervical (13.6%) rather than occlusal (0.4%)

Answer 20

Peters, Baumgartner, Lorton 1994

Question 21

Who said “if adult untraumatized teeth do not respond to both the electrical and cold tests, there is a high probability that the tooth is pulpless.

Answer 21

Peters, Baumgartner, Lorton 1994

Question 22

Who said it is much rarer to have a false positive to cold than EPT?

Answer 22

Peters, Baumgartner, Lorton 1994

Question 23

How does Petersson define accuracy?

Answer 23

The extent to which a test correctly classifies patients

Question 24

How many teeth did Petersson test?

Answer 24

46 teeth with vital pulps and 29 teeth with necrotic pulps (established by direct pulpal inspection).

Question 25

How does Petersson 1999 define sensitivity?

Answer 25

The ability of a test to identify teeth that really are diseased (diseased= teeth with necrotic pulps) TP/ (TP + FN)
This is the opposite of Weisleder and Peters.

Question 26

How does Petersson 1999 define specificity?

Answer 26

The ability of a test to identify teeth that are not diseased (vital pulps). TN/ (TN + FP)
This is the opposite of Weisleder and Peters.

Question 27

Overall accuracy of cold, hot and EPT, according to Petersson 1999?

Answer 27

Cold: 86%, Heat: 71%, EPT 81%

Question 28

How does Petersson 1999 define Positive predictive value?

cold? EPT?

Answer 28

The percent of positive test results (non-sensitive reactions) that are actually necrotic teeth.
cold: 89 EPT: 88

Question 29

How does Petersson 1999 define Negative predictive value? cold? EPT?

Answer 29

The percent of negative test results (sensitive reactions) that really are vital teeth.
cold: 80 EPT: 84

Question 30

According to Petersson 1999, what is the percent of necrotic teeth correctly identified as necrotic by cold and EPT?

Answer 30

Cold: 83%, EPT: 72%

Question 31

According to Petersson 1999, what is the percent of vital teeth correctly identified as vital by cold and EPT?

Answer 31

Cold: 93%, EPT 93%

Question 32

How does Petersson define false positive and false negative?

Answer 32

a false positive is a tooth that tests non-sensitive (necrotic) when it is actually vital.
a false negative is a tooth that tests sensitive (vital)
when it is actually necrotic

Question 33

Who showed no difference in interface media for EPT, as long as they were water or petroleum based?

Answer 33

Michaelson, Seidberg, Guttuso JADA 1975

Question 34

What percent of A fibers in the dental pulp are A delta?

Answer 34

90%

Question 35

Why are A beta and A delta fibers grouped together? Possible difference?

Answer 35

Both innervate the dentinal tubules and are stimulated by dentinal fluid movement. Possible difference: A-beta: slightly more sensitive to stimulation.

Question 36

According to Avery 1991, what is the last major structure to appear in the developing human pulp?

Answer 36

Myelinated nerve fibers.

Question 37

Why do we think that the electric pulp test is unreliable in young teeth?

Answer 37

At eruption, most nerves are unmylinated. (Johnson, 1983) Five years after eruption, A-fibers gradually increase from 400-700 in a human premolar. A-fibers are more easily electrically stimulated than C fibers.

Question 38

Two possible reasons why instrumentation of root canals in non-vital teeth is painful

Answer 38

1. C fibers can function in the presence of hypoxia
2. B/c some histologic studies failed to demonstrate much innervation in non-vital teeth, the pain may be due to the transfer of noxious chemicals to terminals located in periapical tissues.

Question 39

Difference between monopolar and bipolar EPTs? Which are used today?

Answer 39

Bipolar-two electrodes applied to one tooth, and stimulation passes through the tooth from one electrode to the other. Monopolar- one electrode on the tooth. Patient completes the circuit by holding the metallic handle of an EPT, or through a lip clip. Monopoly used today.

Question 40

Difference between alternating current (AC) and direct current (DC)?

Answer 40

Electricity or “current” is nothing but the movement of electrons through a conductor, like a wire. The difference between AC and DC lies in the direction in which the electrons flow. In DC, the electrons flow steadily in a single direction, or “forward.” In AC, electrons keep switching directions, sometimes going “forward” and then going “backward.”

Question 41

Downside of direct current?

Answer 41

Voltage cannot travel very far before it begins to lose energy.

Question 42

What type of current do batteries provide?

Answer 42

Direct current, generated from a chemical reaction inside the battery.

Question 43

What did Seltzer, Bender and Ziontz say about the pulp?

Answer 43

Status of pulp tissue can only be determined histologically. (There’s not a good correlation between pulpal health and clinical signs/symptoms or EPT results

Question 44

Who said the tip of the testing probe must be coated with a water or petroleum based medium?

Answer 44

Michaelson, Seidberg, Guttuso, 1975

Question 45

Who said incisal third of facial or buccal area of tooth is best?

Answer 45

Ant teeth? Bender, Landau, Fonsecca, Trowbridge 1989

Question 46

Who found that using EPT, the patient could only identify the tooth being tested 37.2% of the time. Could narrow location to three teeth 80% of time

Answer 46

Friend, Glenwright

Question 47

Who described A delta fibers, myelination in pulp etc.

Answer 47

Byers and Nahri

Question 48

Who stated that no correlation existed between the EPT values and a specific histopathologic state, but a negative reading does occur when the pulp is necrotic?

Answer 48

Lundy and Stanley 1969

Question 49

Who said fp for EPT significantly higher than fp for cold?

Answer 49

Peters

Question 50

Who said that the gold standard method for determining vitality is direct inspection of pulp chamber contents

Answer 50

Petersson

Question 51

Who said c fibers last longer in a hypoxic environment, so continue to function after a delta fibers don’t

Answer 51

Trowbridge

Question 52

Who showed that tooth should be completely dry when using pulp tester by applying the pulp tester to saline soln in the vestibule and allowing it to reach max stimulus-no sensation felt

Answer 52

Cooley and Lubow

Question 53

Who showed that a dry electrode tip results in no response

Answer 53

Michaelson, Seidberg, Guttuso

Question 54

Who showed that as the rate of current increases, sensation threshold increases

Answer 54

Wahab

Question 55

Who showed that as the rate of current increases, sensation threshold increases

Answer 55

Abdel Wahab

Question 56

At what stage do nerves enter the tooth

Answer 56

bell stage, says trowbridge

Question 57

who did a big review of histology and physiology of dentin pain

Answer 57

Trowbridge

Question 58

Who said that c fibers do not respond to EPT, which is why a tooth that fails to respond to ept may still be sensitive upon instrumentation

Answer 58

Trowbridge

Question 59

Who looked at 25 recently traumatized teeth, and found that they did not respond to EPT, but were still vital upon access? so concluded that our current “pulp vitality tests” should be pulp sensibility tests

Answer 59

Bhaskar and Rappaport

Question 60

Who found that it is important to determine that status of a traumatized pulp to evaluate the necessity for root canal tx, since delay in dx can lead to severe complications such as inflammatory root resorption?

Answer 60

Tronstad

Question 61

Who showed that cold and ept gave no response immediately following trauma, but by three months 94% of teeth tested vital

Answer 61

Gopikrishna

Question 62

who said the MB cusp tip is the best place to place EPT probe

Answer 62

Lin

Question 63

What makes electrons move in a closed circuit?

Answer 63

A power source such as a battery give them the force that they need to move

Question 64

Who found no consistent relationship between the electrical threshold and site of probe placement?

Answer 64

Matthews

Question 65

Who showed that a systemic dose of acetaminophen had an impact on the response to EPT

Answer 65

Carnes

Question 66

who experimentally assessed the risk of direct damage to the pulp by EPT and concluded that, in clinical situations, pulp damage is very unlikely, if not impossible

Answer 66

McDaniel 1973