Electric pulp test response threshold in anterior teeth of patients with and without a history of COVID-19: an analytical cross-sectional study
DOI:
https://doi.org/10.20453/reh.v36i2.7176Keywords:
COVID-19, dental pulp test, dental sensitivity, incisors, caninesAbstract
Objective: To compare the electric pulp test (EPT) response threshold in anterior teeth of adults with and without a history of COVID-19. Materials and methods: An observational, cross-sectional, analytical study conducted in 2024. Eighty-nine adults were evaluated (48 women and 41 men): 49 with no history of COVID-19 and 40 with a confirmed diagnosis recorded in medical record. No uniform interval was established between infection and clinical evaluation. A standardized EPT protocol based on prior recommendations for pulp sensitivity testing was applied to the upper and lower incisors and canines: electrode placement on the middle third of the buccal surface, use of a conductive medium, isolation with a dry field, and two measurements per tooth to obtain an mean. The primary variable was the individual mean EPT response threshold, and the exposure variable was history of COVID-19 (yes/no). Descriptive statistics, Student's t-test for independent samples, and chi-square tests were used, with a 95% CI. The primary analysis accounted for tooth-within-subject nesting using a linear mixed model (random intercept per subject; fixed effects for COVID-19, tooth type, age, and sex). Results: The response threshold showed a mean of 25.29 s (SD = 23.42) in the group without COVID-19 and 42.29 s (SD = 28.58) in the group with COVID-19, representing a mean difference of 17 s (95% CI [5.80–28.20]; p = 0.003). Descriptively, the group with a history of infection showed higher response thresholds across all anterior teeth evaluated. In the adjusted linear mixed model, history of COVID-19 remained significantly associated with a higher EPT response threshold (adjusted β = 15.9 s; p = 0.005). Conclusions: In this clinical sample, having had COVID-19 was associated with an increase in the EPT response threshold in anterior teeth. These findings should be considered preliminary and require confirmation in longitudinal studies incorporating variables such as severity, time since infection, and potential confounders.
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Arriola LF, Palomino KR. Manifestaciones neurológicas de COVID-19: una revisión de la literatura. Neurolog Argent. 2020;12(4):271-4. doi:10.1016/j.neuarg.2020.07.005
Alarco R, Huarcaya-Victoria J. Potenciales mecanismos de neuroinvasión del SARS-CoV-2: una revisión de la literatura actual. Rev Neuropsiquiatr. 2021;84(1):25-32. doi:10.20453/rnp.v84i1.3935
Desforges M, Le Coupanec A, Dubeau P, et al. Human coronaviruses and other respiratory viruses: underestimated opportunistic pathogens of the central nervous system? Viruses. 2020;12(1):14. doi:10.3390/v12010014
Netland J, Meyerholz DK, Moore S, et al. Severe acute respiratory syndrome coronavirus infection causes neuronal death in the absence of encephalitis in mice transgenic for human ACE2. J Virol. 2008;82(15):7264-75. doi:10.1128/jvi.00737-08
Gu J, Gong E, Zhang B, et al. Multiple organ infection and the pathogenesis of SARS. J Exp Med. 2005;202(3):415-24. doi:10.1084/jem.20050828
Bohmwald K, Gálvez NM, Ríos M, et al. Neurologic alterations due to respiratory virus infections. Front Cell Neurosci. 2018;12:386. doi:10.3389/fncel.2018.00386
Serafini RA, Frere JJ, Giosan IM, et al. SARS-CoV-2-induced sensory perturbations: a narrative review of clinical phenotypes, molecular pathologies, and possible interventions. Brain Behav Immun Health. 2025;45:100983. doi:10.1016/j.bbih.2025.100983
Chen E, Abbott PV. Dental pulp testing: a review. Int J Dent. 2009;2009:365785. doi:10.1155/2009/365785
Ono M. Advances in electric pulp testing using dental instrument. J Dentistry. 2025;15:721. doi:10.35248/2329-9088.25.15.721
Afkhami F, Ghabraei S, Hashemi N, et al. Evaluation of cold and electric pulp tests for assessing depth of anesthesia in patients with symptomatic irreversible pulpitis. J Endod. 2025;51(1):28-34. doi:10.1016/j.joen.2024.10.013
Eitner L, Maier C, Brinkmann F, et al. Somatosensory abnormalities after infection with SARS-CoV-2 – A prospective case-control study in children and adolescents. Front Pediatr. 2022;10:977827. doi:10.3389/fped.2022.977827
Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-90. doi:10.1001/jamaneurol.2020.1127
Ozal MA, Petrocco C. Pruebas térmicas de sensibilidad pulpar en dientes: actualización y desafíos diagnósticos. Rev Odontopediatr Latinoam. 2024;14:e-235652 . doi:10.47990/etpeqz19
Donnermeyer D, Dammaschke T, Lipski M, et al. Effectiveness of diagnosing pulpitis: a systematic review. Int Endod J. 2023;56(S3):296-325. doi:10.1111/iej.13762
Jamil H, Noor M, Hollinger J, et al. Isolated trigeminal mononeuropathy: a possible COVID-19 sequelae. Cureus. 2024;16(9):e68522. doi:10.7759/cureus.68522
Patro S, Meto A, Mohanty A, et al. Diagnostic accuracy of Pulp vitality tests and pulp sensibility tests for assessing pulpal health: a systematic review and meta-analysis. Int J Environ Res Public Health. 2022;19(15):9599. doi:10.3390/ijerph19159599
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Copyright (c) 2026 Renán Lázaro Liebano Segura, Jorge A. Manrique-Guzmán, Karla Alessia Coronado Miranda, Miguel Antonio Canchis Meza, Roberto Veiga Sierra, Jorge E. Manrique-Chávez
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