Objectively Diagnosing Pulpitis - Opportunities and Methodological Challenges in the Development of Point-of-Care Assays

Sep 30, 2026

Uploaded by Eliana

Pulpitis is the dental pulp’s inflammatory response to microbial challenge and may progress from mild to severe, traditionally leading to pulp removal and root canal treatment (RCT). To support more conservative care, clinical guidelines emphasize preserving pulp vitality when feasible, which depends on more accurate, less subjective diagnosis. Existing point-of-care tools are limited by subjectivity and neuron stimulation. Molecular biomarker assessment could enable dynamic profiling of inflammation and align marker thresholds with treatment outcomes, though no commercial kits are available.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages22

Reading Time55 min

AccessFree to download

Introduction

Diagnostic challenges in pulpitis

Current vs emerging diagnostic–treatment workflows

Limitations of traditional pulp testing

Molecular biomarkers for objective diagnosis

Review Objectively Diagnosing Pulpitis: Opportunities and Methodological Challenges in the Development of Point-of-Care Assays Darren Walsh †, Ross Quigley †, Anthonia Ekperuoh and Henry F. Duncan * Academic Editor: Ludmilla A. Morozova-Roche Received: 17 November 2025 Revised: 23 December 2025 Accepted: 28 December 2025 Published: 29 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Lincoln Place, D02 F859 Dublin, Ireland; [darren.walsh@dental.tcd.ie](darren.walsh@dental.tcd.ie) (D.W.); [ross.quigley@dental.tcd.ie](ross.quigley@dental.tcd.ie) (R.Q.); [anthonia.ekperuoh@dental.tcd.ie](anthonia.ekperuoh@dental.tcd.ie) (A.E.) * [Correspondence: hal.duncan@dental.tcd.ie](Correspondence: hal.duncan@dental.tcd.ie); Tel.: +353-1-6127356 † These authors contributed equally to this work. Abstract Pulpitis is the inflammatory response of the dental pulp to microbial challenge and can range from mild to severe in nature, with severe pulpitis traditionally resulting in pulp removal and root canal treatment (RCT) . In the pursuit of more conservative treatments, recent clinical practice guidelines have recommended strategies that preserve the vitality of the dental pulp, rather than RCT, when possible. This has increased the focus on improving the accuracy of pulp diagnosis, which will direct treatment and improve management outcomes. Unfortunately, current point-of-care (PoC) tools are subjective, lack discrimination and rely on the stimulation of pulpal neurons, limiting dentists’ ability to objectively identify the level of inflammation. Molecular biomarker assessment has the potential to dynamically analyse pulpitis and correlate this with inflammatory thresholdsand treatment outcomes. Numerous chemokines, cytokines, proteases and growth factors exhibit altered expression during pulpitis and can be collected intraoperatively as part of routine dental treatment. Although current data indicate several markers that could be used as next-generation diagnostic chairside tools for pulpitis, there are currently no commercial kits. Considering the interest in vital pulp treatment, there is an urgent need to engage researchers, industry, dentists and other stakeholders in the development of PoC diagnostic assays for pulpitis. Keywords: pulpitis; next-generation diagnostics; caries; point-of-care assays; transcriptomics 1. Introduction Dental caries and pulpitis remain pervasive and present significant clinical challenges. According to the World Health Organization, dental caries is one of the most prevalent non-communicable diseases globally, affecting individuals across all age groups [1] . Inflammation of the dental pulp (or pulpitis) often occurs as a result of deep caries and can be managed by a range of treatments, including vital pulp treatment (VPT), root canal treatment (RCT) or even extraction [2] . Recent endodontic guidelines and position statements from both the European Society of Endodontology (ESE) and the American Association of Endodontists (AAE) have advocated for more minimally invasive therapies that maintain the pulp tissue rather than removing it in an RCT procedure [2–4] . However, in order to conservatively manage deep caries and the exposed pulp and preserve pulp vitality, an accurate assessment of the condition of the pulp is essential [5] . Unfortunately, current diagnostic methods for the assessment of pulpitis are often crude and rely heavily on subjective measures such as patient history and clinical examination. This subjectivity can lead to variability in diagnosis and treatment outcomes, with under-and overtreatment evident [6](Figure 1) . Without accurate and objective diagnostic tools, the develop

FAQs

Why is objective pulpitis diagnosis important for treatment decisions?

Accurate diagnosis helps guide whether vital pulp treatment (VPT) can preserve pulp vitality or whether RCT/extraction is needed, reducing under- and overtreatment caused by subjective methods.

What limitations affect current point-of-care pulpitis tools?

Current point-of-care tools are described as subjective, lacking discrimination, and relying on stimulating pulpal neurons, which restricts dentists’ ability to objectively identify inflammation severity.

How can molecular biomarker testing improve point-of-care diagnosis?

Biomarkers such as chemokines, cytokines, proteases, and growth factors may be collected intraoperatively and correlated with inflammatory thresholds and treatment outcomes, potentially distinguishing reversible from irreversible pulpitis—however, commercial kits are not yet available.

Sep 30, 2026

Uploaded by Eliana