Scope of diagnosis and determination of pulp vitality for proper pulp therapeutic approach in deciduous teeth

Pulp therapy in deciduous teeth plays a critical role in maintaining dental function, guiding normal occlusal development, and safeguarding the underlying permanent tooth germ. Accurate diagnosis of pulpal status and determination of pulp vitality remain fundamental yet challenging aspects of pediatric endodontic practice, owing to anatomical differences of primary teeth, physiological root resorption, and behavioral limitations in young patients. This review discusses the biological characteristics of the dental pulp in primary teeth and examines current diagnostic approaches used to assess pulpal health and vitality. Clinical signs and symptoms, pain history, intraoral findings, and radiographic features are evaluated in relation to their diagnostic reliability and limitations. The diagnostic value and constraints of conventional pulp vitality tests in primary teeth are reviewed, along with emerging non-invasive techniques aimed at assessing pulpal blood flow. Additionally, key patient-related, behavioral, medical, and dental factors influencing treatment decisions are discussed. Understanding these parameters is essential for selecting appropriate pulp therapeutic interventions, including pulpotomy, pulpectomy, or extraction, while minimizing the risk of adverse effects on permanent successors. A comprehensive and evidence-based diagnostic approach remains necessary for achieving long-term outcomes in pediatric pulp therapy.