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Unravelling Pulpal Health in Baby Teeth: A Step towards Better Dental Care for Children
Our research team led by Associate Professor Catherine Hong Hsu Ling, Assistant Professor Gopu Sriram, and Dr Ishreen Kaur Dhillon conducted a remarkable study to further understanding of pulpal health in baby teeth.
In the last few years, there has been a growing emphasis on improving dental care for children. A key determinant of the success of dental treatment in the paediatric population is an accurate diagnosis of the pulp health in baby teeth. Paediatric dentists can better improve the overall oral health and well-being of children by deepening their understanding of dental pulp condition in primary teeth.
Recently, a research team led by Associate Professor Catherine Hong Hsu Ling, Assistant Professor Gopu Sriram, and Dr Ishreen Kaur Dhillon conducted a study to assess the pulp health in baby teeth using the 2009 American Association of Endodontists (AAE) criteria. The criteria incorporates the history of tooth pain, clinical examination, and dental X-ray findings to determine the dental pulp condition. However, the effectiveness in diagnosing pulp health specifically in baby teeth has not been extensively studied. The study was published in a multidisciplinary oral medicine journal, Clinical Oral Investigations.
Dr Ishreen (left) and Asst Prof Gopu (right) discussing the key findings of the study.
With support from the NUS Faculty of Dentistry and partial funding from the Ministry of Education, Singapore’s Academic Research Fund Tier 1, the study sought to enhance understanding of pulpal health in baby teeth by comparing the clinical diagnosis of reversible and irreversible pulpitis using the 2009 AAE criteria. The study found that while the 2009 AAE criteria were reliable for recognising baby teeth with pulp necrosis and normal pulp, they were less accurate for diagnosing reversible and irreversible pulpitis.
The team used a novel prediction model called classification and regression tree (CART) to address this limitation. This model identified tooth pain that occurs at night and widened periodontal ligament space as the two most important factors for diagnosing irreversible pulpitis in baby teeth. Based on these factors, the prediction model achieved an accuracy of 78 per cent, surpassing the 2009 AAE criteria in distinguishing reversible and irreversible pulpitis. This model could be instrumental in guiding clinicians to differentiate reversible and irreversible pulpitis in primary teeth.
Dr Ishreen receiving the 2023 American Academy of Pediatric Dentistry (AAPD) Graduate Student
Research Award at the AAPD 2023 conference.
For its remarkable impact on research, the study was presented the 2023 American Academy of Pediatric Dentistry (AAPD) Graduate Student Research Award at the AAPD 2023 conference held in Orlando, Florida on 28th May 2023. Dr Ishreen, who conducted the study as part of her Master of Dental Surgery in Paediatric Dentistry thesis and was the presenter at the conference, shared that the study was inspired by the team's motivation to address the prevailing uncertainties that paediatric dentists face in diagnosing pulp health in baby teeth.
“The AAE criteria were established as a standard for diagnosing pulp health in teeth, yet research on its accuracy in assessing pulpal health in young children had not been assessed conclusively. The team hopes to break new ground through our study and advance investigations on the conditions of dental pulp in primary teeth, with the objective of ultimately optimising treatment for our paediatric patients,” shared Dr Ishreen.
Moving forward, the research team plans to further investigate pulp inflammation progression in baby teeth using a technique called ‘Fluorescence in Situ Hybridisation (FISH)’. This innovative approach aims to deepen understanding of the role of bacteria and viable cells in pulp tissues, thereby leading to more targeted interventions for preserving pulpal health.
“As a team, we strive to address unanswered questions and test new frameworks to further our understanding of pulpal health in baby teeth. These will hopefully lead to novel discoveries which could impact and enhance dental care for children in the near future,” added Dr Ishreen.