DISEASES OF THE PULP

Prepared by:Dr. Rea Corpuz

formative organ of tooth

builds primary dentin during development of tooth

secondary dentin after tooth eruption

reparative dentin in response to stimulation as long as odontoblast remain vital

Pulp

most common cause of dental pain

loss of teeth in younger persons

usual cause is caries penetrating the dentin

Pulpitis

Pulpitis

UNTREATED

Death of pulp

Spread of Infection throughapical foramina into periapical

tissues

Causes Periapical Periodontitis

(1) Mechanical Cause

(2) Thermal Cause

(3) Chemical Cause

(4) Bacterial Cause

Causes of Pulpal Inflammation

(1) Mechanical Cause

traumatic accident

iatrogenic damage for dental procedure

atrrition

abrasion

Causes of Pulpal Inflammation

(2) Thermal Cause

uninsulated metallic restoration

during cavity preparation

polishing

Causes of Pulpal Inflammation

(3) Chemical Cause

arise from erosion

or inappropriate use of acidic dental material

Causes of Pulpal Inflammation

(4) Bacterial Cause

can damage pulp through toxins secreted by bacteria from caries

Causes of Pulpal Inflammation

(1) Based on Severity of Inflammation

(2) According to Involvement

Classification

(1) Reversible Pulpitis

(2) Irreversible Pulpitis

(3) Pulp Degeneration

(4) Pulp Necrosis

(1) Based on Severity of Inflammation

(1) Reversible Pulpitis

Symptomatic (acute) Aysptomatic (chronic)

(2) Irreversible Pulpitis

Acute• Abnormally responsive to cold• Abnormally responsive to heat

(1) Based on Severity of Inflammation

(2) Irreversible Pulpitis

Chronic• Asymptomatic with pulp exposure• Hyperplastic• Internal resorption

(1) Based on Severity of Inflammation

(3) Pulp Degeneration

Calcific

(4) Pulp Necrosis

(1) Based on Severity of Inflammation

(1) According to Involvement

(2) According to Severity

(3) According to presence or absence of direct communication between dental pulp + oral environment

(2) According to Involvement

(1) According to Involvement

Focal or Subtotal or Partial Pulpitis

Total or Generalized Pulpitis

(2) According to Involvement

(2) According to Severity

Acute Chronic

(2) According to Involvement

(3) According to presence or absence of direct communication between dental pulp + oral environment

Pulpitis Aperts (open pulpitis)

Pulpitis Clausa (closed pulpitis)

(2) According to Involvement

mild to moderate inflammatory condition of pulp

caused by noxious stimuli

pulp is capable of returning to un-inflammed state

following removal of stimuli

Reversible Pulpitis

Causes

agent capable of injuring pulp like:

• trauma• disturbed occlusal relationship• thermal shock

Reversible Pulpitis

Clinical Features

sharp pain lasting for a moment

often brought on by cold than hot food or beverages and by cold air

Reversible Pulpitis

Clinical Features

does not continue when the cause has been removed

tooth responds to electric pulp testing at lower current

Reversible Pulpitis

Management

prevention

periodic care

early insertion of filling if a cavity has developed

removal of noxious stimuli

Reversible Pulpitis

earliest form

also known as pulp hyperemia

excessive accumulation of blood within pulp tissue

leads to vascular congestion

Focal Reversible Pulpitis

Clinical Features

sensitive to thermal changes

particularly to cold

application of ice or cold fluids to tooth result in pain

Focal Reversible Pulpitis

Clinical Features

disappears upon removal of thermal irritant or restoration of normal temperature

responds to electrical test stimulant at lower level of current

Focal Reversible Pulpitis

Clinical Features

indicates lower pain threshold than that of adjacent normal teeth

Focal Reversible Pulpitis

Clinical Features

teeth show:

• deep carious lesion

• large metallic restoration

• restoration with defective margins

Focal Reversible Pulpitis

Management

removal of irritants before the pulp is severely damaged

Focal Reversible Pulpitis

persistent inflammatory condition of pulp

may be symptomatic or asymptomatic

caused by noxious stimulus

Irreversible Pulpitis

Causes

bacteria involvement of pulp through caries

chemical

thermal

mechanical injury

Irreversible Pulpitis

Clinical Features

Early Stage

paroxysm of pain caused by:

• sudden temperature changes like cold, sweet, acid foodstuffs

Irreversible Pulpitis

Clinical Features

Early Stage

pain often continues when cause has been removed

may come and go spontaneously

Irreversible Pulpitis

Clinical Features

Early Stage

pain

• sharp• piercing• shooting• generally severe

Irreversible Pulpitis

Clinical Features

Early Stage

pain

• bending over exacerbates pain which• lying down is due to change in • change of position intrapulpal pressure

Irreversible Pulpitis

Clinical Features

Late Stage

pain

• more severe as if tooth is under • throbbing constant pressure

Irreversible Pulpitis

Clinical Features

Late Stage

pain

• patient is often awake at night due to pain

• increased by heat and sometimes relieved by cold, although continued application of cold may intensify pain

Irreversible Pulpitis

Management

complete removal of pulp or pulpectomy

placement of intracanal medicament

to act as disinfectant or obtundent• cresatin• eugenol• formocresol

Irreversible Pulpitis

Clinical Difference

Reversible Pulpitis Irreversible Pulpitis pain is generally traceable to a stimulus cold water air

more severe lasts longer pain may come without any apparent stimulus

extensive acute inflammation of pulp

frequent sequel of focal reversible pulpitis

Acute Pulpitis

Causes

tooth with large carious lesion

defective restoration where there has been recurrent caries

pulp exposure due to faulty cavity preparation

Acute Pulpitis

Clinical Features

severe pain is elicited by thermal changes

pain persists even after thermal stimulus disappears or been removed

Acute Pulpitis

Clinical Features

may be continuous

intensity may be increased when patient lies down

application of heat may may cause acute exacerbation of pain

Acute Pulpitis

Clinical Features

tooth reacts to electric pulp vitality tester at a lower level of current than adjacent normal teeth

Acute Pulpitis

Clinical Features

pressure increases because of lack of escape of inflammatory exudate

rapid spread of inflammation through pulp with pain + necrosis

Acute Pulpitis

Management

early stages of pulpotomy (removal of coronal pulp)

placing material that favors calcification such as: • calcium hydroxide over entrance of root canals

Acute Pulpitis

Management

root canal filing with inert material like gutta percha should be done

Acute Pulpitis

may develop with or without episodes of acute pulpitis

many pulps under large carious cavities die painlessly

1st indication is then development of periapical periodontitis, either with pain or seen by chance in radiograph

Chronic Pulpitis

Clinical Features

dull aching type

more often intermittent than continuous

Chronic Pulpitis

Management

root canal therapy

followed by crown restoration

Chronic Pulpitis

also called as pulp polyp or pulpitis aperta

essentially an excessive exuberant proliferation of chronically inflammed dental pulp tissue

Chronic Hyperplastic Pulpitis

pulpal inflammation due to an extensive carious exposure of a young pulp

development of granulation tissue

covered at times by epithelium

resulting from long standing low grade infection

Chronic Hyperplastic Pulpitis

Causes

slow progressive exposure of pulp

bacterial infection

Chronic Hyperplastic Pulpitis

Clinical Features

most commonly involved are deciduous molars + 1st permanent molar

• excellent blood supply• large root opening

Chronic Hyperplastic Pulpitis

Clinical Features

asymptomatic

seen only in teeth of children + young adults

Chronic Hyperplastic Pulpitis

Clinical Features

polypoid tissue appears

• fleshy • reddish pulpal mass filling most of pulp chamber or cavity• or even extend beyond confines of tooth

Chronic Hyperplastic Pulpitis

Clinical Features

polypoid tissue appears

• sometimes, if mass is large enough • interferes with closure of mouth

Chronic Hyperplastic Pulpitis

Clinical Features

polypoid tissue appears

• may cause discomfort during mastication• due to pressure of food bolus

Chronic Hyperplastic Pulpitis

Clinical Features

polypoid tissue appears

• tissue easily bleeds because of rich network of blood vessels

• tooth may respond or not at all to thermal test

Chronic Hyperplastic Pulpitis

Management

elimination of polypoid tissue

followed by extirpation of pulp

hyperplastic tissue bleeeding can be controlled by pressure

extraction of tooth can also be done

Chronic Hyperplastic Pulpitis

death of pulp

may be partial or total depending on whether part or the entire pulp is involved

Necrosis

Causes

sequeala of inflammation

can also occur following trauma

• pulp is destroyed before an inflammatory reaction

Necrosis

Types

(1) Coagulation Necrosis

(2) Liquefaction Necrosis

Necrosis

Types

(1) Coagulation Necrosis

• soluble portion of tissue is precipitated• or converted into a solid material

Necrosis

Types

(1) Coagulation Necrosis

• tissue is converted into tissue mass consisting chiefly of coagulated

proteins fats water

Necrosis

Types

(2) Liquefaction Necrosis

• results when proteolytic enzymes convert the tissue into softened mass liquid or amorphous debris

Necrosis

Clinical Features

no painful symptoms

discoloration of tooth

• 1st indication that the pulp is dead

Necrosis

Clinical Features

history of pain lasting from a few minutes to a few hours followed by complete + sudden cessation of pain

Necrosis

Management

preparation + obturation of root canals

Necrosis

References:References: BooksBooks

Cawson, R.A: Cawson’s Essentials of OralCawson, R.A: Cawson’s Essentials of Oral Oral Pathology and Oral Medicine,Oral Pathology and Oral Medicine, 88thth Edition Edition

• (page 60)(page 60) Ghom, Ali & Mhaske, Shubhangi: Textbook of Ghom, Ali & Mhaske, Shubhangi: Textbook of Oral PathologyOral Pathology

• (pages 420-425) (pages 420-425)