Pulipitis
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Transcript of Pulipitis
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)