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Background/Objective <p>Conventional endodontic diagnostic modalities predominantly depend on subjective clinical evaluations, which may engender inconsistencies between clinical impressions and definitive histopathological findings. The present investigation sought to assess salivary tumor necrosis factor-alpha (TNF-α) as a quantitative biomarker for pulpal inflammation and to elucidate its association with distinct stages of pulpal pathosis.</p> Methods <p>In this observational case-control study, eighty participants were stratified into four cohorts (<i>n</i> = 20 per group) according to rigorously defined diagnostic criteria: normal pulp (control), reversible pulpitis, symptomatic irreversible pulpitis, and pulpal necrosis. Unstimulated whole saliva specimens were procured in accordance with a standardized collection protocol. Quantification of salivary TNF-α concentrations was performed utilizing enzyme-linked immunosorbent assay (ELISA). Statistical analyses comprised one-way analysis of variance (ANOVA) with Welch’s correction for heteroscedasticity, followed by Dunnett’s T3 post hoc test to accommodate multiple comparisons.</p> Results <p>Salivary TNF-α concentrations exhibited a marked and statistically significant stepwise elevation commensurate with the severity of pulpal pathology. The mean (± SD) TNF-α levels were as follows: normal pulp (4.60 ± 1.16 pg/mL), reversible pulpitis (10.06 ± 1.41 pg/mL), symptomatic irreversible pulpitis (17.60 ± 2.87 pg/mL), and pulpal necrosis (27.74 ± 3.51 pg/mL). All intergroup comparisons yielded statistically significant differences (<i>p</i> &lt; 0.001). The most pronounced mean difference was observed between the normal pulp and pulpal necrosis groups (-23.69 [95% CI: -25.51 to -20.78]). Pairwise analyses revealed significant differences among all study groups (<i>p</i> &lt; 0.001), with the smallest mean difference noted between the normal pulp and reversible pulpitis cohorts (-5.46 [95% CI: -6.65 to -4.28]).</p> Conclusion <p>Salivary TNF-α demonstrates considerable promise as a non-invasive diagnostic biomarker for pulpal pathosis, displaying a robust correlation with disease progression. The discernible and quantifiable variations in TNF-α concentrations across the spectrum of pulpal conditions underscore its potential as an objective adjunct to conventional clinical diagnostic protocols in endodontics.</p>

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Salivary TNF-α concentrations as an objective biomarker for pulpal inflammation severity: insights from an observational case-control study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月30日

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  • Mudit Sharma,
  • Dax Abraham,
  • Anjana Goyal,
  • Alpa Gupta,
  • Mrinalini Mrinalini,
  • Lubhansha Kumar,
  • Unnati Soma

摘要

Background/Objective

Conventional endodontic diagnostic modalities predominantly depend on subjective clinical evaluations, which may engender inconsistencies between clinical impressions and definitive histopathological findings. The present investigation sought to assess salivary tumor necrosis factor-alpha (TNF-α) as a quantitative biomarker for pulpal inflammation and to elucidate its association with distinct stages of pulpal pathosis.

Methods

In this observational case-control study, eighty participants were stratified into four cohorts (n = 20 per group) according to rigorously defined diagnostic criteria: normal pulp (control), reversible pulpitis, symptomatic irreversible pulpitis, and pulpal necrosis. Unstimulated whole saliva specimens were procured in accordance with a standardized collection protocol. Quantification of salivary TNF-α concentrations was performed utilizing enzyme-linked immunosorbent assay (ELISA). Statistical analyses comprised one-way analysis of variance (ANOVA) with Welch’s correction for heteroscedasticity, followed by Dunnett’s T3 post hoc test to accommodate multiple comparisons.

Results

Salivary TNF-α concentrations exhibited a marked and statistically significant stepwise elevation commensurate with the severity of pulpal pathology. The mean (± SD) TNF-α levels were as follows: normal pulp (4.60 ± 1.16 pg/mL), reversible pulpitis (10.06 ± 1.41 pg/mL), symptomatic irreversible pulpitis (17.60 ± 2.87 pg/mL), and pulpal necrosis (27.74 ± 3.51 pg/mL). All intergroup comparisons yielded statistically significant differences (p < 0.001). The most pronounced mean difference was observed between the normal pulp and pulpal necrosis groups (-23.69 [95% CI: -25.51 to -20.78]). Pairwise analyses revealed significant differences among all study groups (p < 0.001), with the smallest mean difference noted between the normal pulp and reversible pulpitis cohorts (-5.46 [95% CI: -6.65 to -4.28]).

Conclusion

Salivary TNF-α demonstrates considerable promise as a non-invasive diagnostic biomarker for pulpal pathosis, displaying a robust correlation with disease progression. The discernible and quantifiable variations in TNF-α concentrations across the spectrum of pulpal conditions underscore its potential as an objective adjunct to conventional clinical diagnostic protocols in endodontics.