Can Digitest 3 Be Used on Oral Cancer Patients?

 

When treating oral cancer patients, can dentists safely rely on Parkell Digitest 3 pulp vitality tester to assess tooth health? Oral cancer treatments, including mandibulectomy and mandibulotomy, often raise questions about the vitality of adjacent teeth. Accurate pulp vitality testing plays a vital role in diagnosis, treatment planning, and prevention of post-surgical complications. So, under these circumstances Digitest 3 pulp vitality tester has been used as a reliable diagnostic tool.  

In this blog, we will discuss oral cancer treatment and its impact on the patient’s tooth health. Followed by the role of pulp vitality testing in oral cancer patients. Moreover, we will also highlight key findings from the studies conducted and clinical implications for dentists. 

Oral Cancer Treatment and Its Impact on Teeth 

Head and neck cancers (HNC) are the seventh most common cancer worldwide, with oral cancers making up around 40% of all cases. Furthermore, surgery, often combined with radiotherapy (RT) or chemotherapy (CT), remains the most common treatment approach for oral cancer. The following are the main surgeries used in oral cancer treatment. 

• Mandibulotomy- it allows access to deep tumors in the posterior oral cavity and oropharynx. 

• Mandibulectomy (segmental or marginal) – it involves removing parts of the mandible, sometimes requiring reconstruction plates for stability. 

While these procedures are crucial for cancer control, they may compromise the vitality of teeth located near surgical sites. Further, we will talk about the role of pulp vitality testing in oral cancer patients. 

The Role of Pulp Vitality Testing in Oral Cancer Patients

After major oncologic surgery, dental teams closely monitor oral health to prevent complications. Teeth adjacent to mandibulectomy or mandibulotomy sites are often tested using: 

• Cold Sensitivity Testing (CPT) – using a cotton pellet with cold spray. 

• Electric Pulp Testing (EPT) – when cold testing is uncertain or negative, electric pulp vitality testing can be of help to measure pulp responses accurately. 

This two-step testing helps identify whether teeth remain vital or have undergone necrosis following surgery. It is important to highlight how these two tests complement each other. A recent study confirms EPT’s high accuracy when testing vital teeth due to its high specificity (= 0.93) while CPT has moderate accuracy when evaluating vital (specificity = 0.84) and nonvital (sensitivity = 0.87) teeth. 

Study Findings: Tooth Vitality After Surgery 

The School of Dentistry and the Institute of Otolaryngology of the Policlinico Universitario A. Gemelli in Rome recently published a joint study wherein a case series of 14 oral cancer patients treated between 2017–2022, 23 teeth were evaluated using cold and electric pulp testing performed with Digitest 3. 

• 65.2% of teeth showed a negative response to sensitivity tests. 

• When cold testing had a negative response, EPT was performed. 

• No significant difference was found between mandibulectomy and mandibulotomy groups. 

• During follow-up, 9 out of 15 nonvital teeth required treatment: 6 underwent root canal therapy, while 3 were extracted. All the extracted teeth were negative at the sensitivity testing. 

These findings suggest that surgical trauma significantly impacts pulp vitality. The authors also conclude that the electric pulp test shows greater accuracy than cold testing, mostly in teeth with canal obliteration and teeth of old patients, and that because of its low sensitivity it should be used together with cold testing.  

Clinical Implications for Dentists 

The main implication for the dentist is that loss of pulp vitality can lead to apical periodontitis, dental abscesses, and impaired healing of surgical sites. For oral cancer patients, preventive strategies may include: 

• Considering pre-surgical root canal therapy on teeth near surgical sites. 

• Coordinating closely between surgeons and dental professionals. 

• Using electric pulp tests like Digitest 3 in combination with cold testing for consistent and accurate post-surgical pulp assessment.  

Such proactive measures may reduce complications like osteoradionecrosis (ORN), which is a known risk following radiotherapy. 

Conclusion 

Tooth vitality loss is a common event in patients undergoing oral cancer surgery, regardless of the technique used. Digitest 3 pulp vitality tester proves to be a valuable diagnostic tool, helping dental professionals evaluate pulp status accurately and plan preventive strategies. In this blog, we highlighted the outcomes of the conducted study that tooth necrosis is a frequent finding after mandibulectomy and mandibulotomy. Preventive endodontic treatment may be advisable in certain cases.  

For dental professionals, Digitest 3 pulp vitality tester remains a valuable tool to evaluate pulp vitality in oral cancer patients, ensuring safer treatment outcomes and improved long-term care.  Further, to learn more about using Digitest 3 pulp vitality tester and its accessories. And to read our latest resources on Digitest 3 and discover how it can support safe, accurate, and reliable pulp vitality testing in your practice. For more information, please visit our website.