Diseases of pulp

A concise information on diseases of pulp

1. DISEASES OF DENTAL PULP DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS SHUBHAM PARMAR intern

2. CAUSES OF PULP DISEASE PHYSICAL CAUSES A) Mechanical 1)Trauma – Accidental Iatrogenic during dental procedures 2) Pathologic wear – Attrition Abrasion Bruxism Abfraction 3) Crack through body of tooth ( cracked tooth syndrome) 4) Barometric changes (Barodontalgia)

3. CAUSES OF PULP DISEASE B) Thermal 1) Heat from cavity preparation, at either low or high speed 2) Exothermic heat from the setting of cement 3) Conduction of heat and cold through deep fillings without a protective base 4) Frictional heat caused by polishing a restoration C) Electrical (galvanic current from dissimilar metallic fillings)

4. CAUSES OF PULP DISEASE CHEMICAL CAUSES A) Phosphoric acid, acrylic monomer, etc. B) Erosion (acids) BACTERIAL CAUSES A) Toxins associated with caries B) Direct invasion of pulp from caries or trauma C) Microbial colonization in the pulp by bloodborne microorganisms (Anachoresis)

5. CLASSIFICATION OF THE DISEASES OF THE PULP INFLAMMATORY DISEASES OF THE DENTAL PULP 1) Reversible pulpitis 2) Irreversible pulpitis a) Symptomatic irreversible pulpitis (previously known as acute irreversible pulpitis) b) Asymptomatic irreversible pulpitis (previously known as chronic irreversible pulpitis) c) Chronic hyperplastic pulpitis d) Internal resorption

6. PULP DEGENERATION 1) Calcific degeneration (radiographic diagnosis) 2) Atrophic degeneration (histopathologic diagnosis) 3) Fibrous degeneration PULP NECROSIS

7. SEQUELAE OF PULPAL DISEASES

8. Reversible Pulpitis Definition - Reversible pulpitis is a mild-to-moderate inflammatory condition of the pulp caused by noxious stimuli in which the pulp is capable of returning to the uninflamed state following removal of the stimuli Cause - any agent that is capable of injuring the pulp (Trauma, Thermal shock, excessive dehydration of a cavity, Chemical stimulus, as from sweet or sour foodstuffs or from irritation of a filling; or bacteria, as from caries

9. SYMPTOMS – Characterized by short, sharp pain lasting for a moment Pain is specific to a stimulus Pain is instantly relieved on removal of the stimulus More often brought on by cold than hot food or beverages and by cold air Does not occur spontaneously Does not continue when the stimulus has been removed Cause of the pain is generally traceable to a stimulus, such as cold water DIAGNOSIS – Diagnosis is by a study of the patient’s symptoms and by clinical tests A pplication of cold is an excellent method of locating and diagnosing the involved tooth

10. Treatment – prevention is the best treatment for reversible pulpitis Periodic care Early insertion of filling if a cavity has developed Removal of noxious stimuli

11. Irreversible Pulpitis Definition - Irreversible pulpitis is a persistent inflammatory condition of the pulp, symptomatic or asymptomatic in nature with the pulp becoming incapable of healing Types - Asymptomatic irreversible pulpitis Symptomatic irreversible pulpitis Cause - Bacterial involvement of the pulp through caries Reversible pulpitis may deteriorate into irreversible pulpitis

12. Symptoms – Sharp, piercing, or shooting type of pain May be intermittent or continuous In the early stages pain may be caused by sudden temperature changes Pain due to packing food into a cavity or suction exerted by the tongue or cheek Prolonged painful response to heat relieved by cold Pain occurs spontaneously Pain often continues even after stimulus has been removed Postural pain may also be seen ( nocturnal pain) In later stages pain is boring, gnawing, or Throbbing type

13. Diagnosis – Deep cavity extending to the pulp Grayish, scum-like layer over the exposed pulp Odour of decomposition Radiograph may also show exposure of the pulp Thermal test may elicit pain that persists after removal of the thermal stimulus Treatment – Root Canal Treatment Pulpectomy Pulpotomy Extraction of tooth if tooth is not restorable

14. Chronic Hyperplastic Pulpitis (Pulp Polyp) Definition - Chronic hyperplastic pulpitis or pulp polyp is a productive pulpal inflammation due to an extensive carious exposure of a young pulp Characterized by the development of granulation tissue Cause - Slow, progressive carious exposure of the pulp Young resistant pulp Low grade stimulus Symptom- Symptomless, except during mastication

15. Diagnosis – Seen in children and young adults Reddish fleshy pulpal mass fills the pulp chamber Polyp tissue is less sensitive than normal pulp and more sensitive than gingival tissue Bleeds easily if cut Treatment – Elimination of polyp tissue followed by pulp extirpation Bleeding should be controlled with pressure

16. Internal Resorption Definition - Internal resorption is an idiopathic slow or fast progressive resorptive process occurring in the dentin of the pulp chamber or in the root canals of the teeth Cause – Patients have a history of trauma Symptoms – Asymptomatic if occurs in root Manifest as a reddish area called PINK SPOT in the crown Treatment – Root Canal treatment using thermoplasticized gutta percha

17. Pulp Degeneration Calcific Degeneration - Pulp tissue is replaced by calcific material pulp stones or denticles Calcification are generally present in the pulp chamber Calcified material has a laminated structure like the skin of an onion Lies unattached within the body of the pulp Pulp stones are present in more than 60% of adult teeth

18. Diagnosis – Clinically asymptomatic Crown may exhibit discoloration Obliteration of the pulp space is evident radiographically Treatment Asymptomatic Tooth - Aesthetic management of the discoloured tooth with a full-coverage restoration or laminate restoration Symptomatic Tooth - Endodontic therapy using a microsurgical retrograde approach Endodontic therapy is not recommended unless the tooth is symptomatic

19. Pulp Degeneration Atrophic Degeneration – Seen in pulps of older people Observed histopathologically Fewer stellate cells are present and intercellular fluid is increased Pulp tissue is less sensitive than normal No clinical diagnosis exists Fibrous Degeneration - Characterized by replacement of the cellular elements by fibrous connective tissue Pulp has the characteristic appearance of a leathery fibre

20. Necrosis of Pulp Necrosis is death of the pulp May be partial or total Seen as a sequalae of inflammation or trauma Types - Coagulation necrosis - soluble portion of tissue is converted into a solid material Liquefaction necrosis – proteolytic enzymes convert the tissue into a softened mass, a liquid, or amorphous debris

21. Symptoms – Asymptomatic Discoloration of the tooth Diagnosis – Radiographs show thickening of the periodontal ligament History of severe pain lasting from a few minutes to a few hours and sudden cessation of pain T ooth does not respond to cold, electric pulp test, or the test cavity Treatment – Root Canal Treatment

22. References Grossman’s Endodontic Practice 13e Cohen’s Pathways of Pulp 11e Google Images