Cold pulp testing is the simplest and most accurate of all dental pulp sensibility tests.

Data sources PubMed, Scopus and Web of Science.Study selection Cohort (retrospective and prospective) and cross-sectional clinical studies investigating the diagnostic accuracy of the cold pulp test (CPT), heat pulp test (HPT), electric pulp test (EPT), laser Doppler flowmetry (LDF) and pulp oximeter (PO). Pulpal diagnosis was confirmed by histological analysis, direct clinical observations (access cavity) or evidence of root canal filling (to confirm nonvital teeth).Data extraction and synthesis The diagnostic test's sensitivity (Sn), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted or calculated from the raw data of each included study. The test's outcomes were binary. A true positive (TP) was considered to have occurred when the diagnostic instrument correctly tested positive for a non-vital pulp and true negative (TN) when it correctly tested negative for a vital pulp based on a standard reference test. A false positive (FP) and false negative (FN) occurred when the test incorrectly tested positive on a vital pulp and incorrectly tested negative on a non-vital pulp, respectively. Accuracy, PPV and NPV were adjusted (Adj.Accuracy, Adj.PPV and Adj.NPV respectively) based on a standardised total disease (non-vital pulps) prevalence (Prev.) of 42.8%. Pool estimates for all five dental pulp vitality diagnostic variables (Sn, Sp, Adj.Accuracy, Adj.PPV and Adj.NPV) were generated with a meta-analysis using a random effects model. Included studies were assessed as either high, moderate or low quality based on the Quality Assessment of Diagnostic Accuracy Studies tool.Results Twenty-eight studies met the inclusion criteria. The pooled Sn, Sp, Adj.Accuracy, Adj.PPV and Adj.NPV for each test are given in the Table 1. Heterogeneity between studies was significant for CPT, HPT and EPT; it was mild to moderate for LDF and PO. All but three studies were determined to be of low quality, with only one assessed as high quality.Conclusions The most accurate dental pulp tests are the LDF and PO, with the HPT least accurate. CPT has generally high diagnostic accuracy and can be considered the primary pulp testing method in clinical practice.