Intraoral Somatosensory Alterations Impact Pulp Sensibility Testing in Patients with Symptomatic Irreversible Pulpitis

Introduction: This case-control study aimed to compare trigeminal somatosensory sensitivity between patients with a clinical diagnosis of symptomatic irreversible pulpitis (n = 33) and healthy participants (n = 33) and to evaluate the impact of somatosensory stratification of symptomatic irreversible pulpitis on pulp sensibility testing. Methods: A standardized battery of qualitative sensory assessment measured intra- and extraoral sensitivity to touch, cold, and pinprick stimuli. Dental pain intensity (0-100, numeric rating scale) and duration (seconds) evoked by cold stimuli (refrigerant spray) were applied to, respectively, the nonaffected and affected tooth (cases) and the upper right and left premolars (controls); z score transformation, analysis of variance (ANOVA), and chi-square tests were applied to the data (P <.050). Results: Patients with irreversible pulpitis reported intraoral hypersensitivity more frequently than healthy participants (58% and 33%, respectively; P<.05). In addition, patients with irreversible pulpitis reported higher z scores of pain intensity (ANOVA main effects, F = 37.10, P<.05, partial eta(2) = 0.37) and duration (ANOVA main effects F = 23.3, P<.05, partial eta(2) = 0.27) after the pulp sensibility test compared with healthy participants. Nevertheless, subgroup analysis taking into account the presence of intraoral hypersensitivity indicated that the pain lingered most for patients with symptomatic irreversible pulpitis who also presented intraoral hypersensitivity (Tukey test, P<.05) but with no differences between patients with irreversible pulpitis without intraoral hypersensitivity and healthy participants (Tukey test, P<.05). Conclusions: QualST is able to detect intraoral alterations in patients with symptomatic irreversible pulpitis that seem useful to stratify the patients into distinct subgroups. Therefore, somatosensory assessment of the adjacent tissues may provide diagnostic fine-tuning of dental pulp diseases.