Molecular biomarkers could improve accuracy of endodontic diagnosis
A new narrative review published in JADA Foundational Science suggests that molecular diagnostic methods may offer a more precise way to assess dental pulp inflammation, potentially reducing unnecessary root canal treatments.
Current endodontic diagnostic tests — such as thermal, electric, percussion and palpation methods — are widely used but remain subjective and do not directly measure inflammation. While histologic evaluation has been considered the gold standard, it requires pulp removal or tooth extraction, making it invasive and clinically impractical.
Researchers highlight that biomarkers, including cytokines such as IL-1, IL-6, IL-8, and TNF-α, as well as enzymes like MMP-9, show significant changes in inflamed pulp tissue and may serve as reliable indicators of disease progression. These biomarkers can often be collected noninvasively from gingival crevicular fluid, dentinal fluid, or pulpal blood.
Although early studies report high sensitivity and specificity for some biomarkers in distinguishing healthy pulp from irreversible pulpitis, no single marker has yet proven fully reliable for differentiating between reversible and irreversible pulpitis. The review emphasizes the need for larger-scale studies to validate biomarker cutoff points and diagnostic accuracy.
Advances in molecular tools such as ELISA assays, multiplex testing, and biosensor technologies may help integrate these methods into routine dental practice. The authors conclude that molecular diagnostics could enhance treatment planning, minimize overtreatment, and improve patient outcomes in endodontics.
Read more: JADA Foundational Science
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