Systemic and Psychological Influences on Pulp Vitality Testing: Implications for Diagnostic Accuracy in Endodontics—A Narrative Review

Dental pulp vitality is traditionally assessed using sensibility tests such as thermal and electrical methods, which primarily measure nerve function rather than pulpal blood flow. Other techniques, including pulse oximetry and laser Doppler flowmetry, offer information on tooth blood flow, potentially providing a more appropriate measure of pulp health. This review explores how psychological and systemic health conditions such as anxiety, depression, diabetes and hypertension, as well as factors like aging, hormonal changes, physical activity and bruxism, can affect pulp function and responses during testing. If not carefully considered, these influences may lead to misdiagnoses. While blood flow-related methods may help address these challenges, they are not yet commonly used in clinical practice. The findings emphasize the complexities of assessing pulp vitality in patients with underlying health conditions and suggest that this could improve clinical approaches to pulp testing.