Diseases of pulp

Diseases of dental Pulp

1. Diseases of pulp Prepared by :- Shagun Kumar (BDS, 2015-19) Guided by :- Dr. Sachin Mittal Dr. Shubhankar Dasgupta Dr. Zeba Rao 19-09-2020

2. Contents Introduction Etiology Classification Bibliography 19-09-2020

3. Introduction The  pulp  or  pulp  chamber is the soft area within the centre of the  tooth  and contains nerve, blood vessels, and connective tissue. Dental pulp is the formative organ of the tooth and responds to hot and cold stimulus, that are perceived as pain. The pulp’s sensory role is important, but it has other roles as well. The pulp functions to form dentin, among other things. It supplies nutrients and moisture the surrounding areas of the tooth. The pulp also helps protect the tooth. Pulpitis refers to the inflammation of pulp. It is mainly caused by an opportunistic infection of the pulp space with commensal oral microorganisms. 19-09-2020

4. NORMAL PULP 19-09-2020

5. Etiology of pulpal diseases According to Grossman , Physical Mechanical Trauma : - Accidental (E.g. - Contact sports) - Iatrogenic dental procedure. Pathological wear Cracked tooth syndrome Barometric changes 19-09-2020

6. Mechanical Trauma May be caused by a violent blow to the tooth during sports, accidents, fights etc. Pathologic wear of teeth leading to pulp exposure due to attrition and abrasion, or compulsive bruxism. 19-09-2020

7. Cracked tooth syndrome Incomplete fracture through body of the tooth, including cracked enamel that can be appreciated with the help of dye or by trans illumination. Diagnosed by reproducing the pain by asking patient to bite on rubber wheel. Mild to excruciating pain can be experienced on biting. 19-09-2020

8. Barodontalgia or Aerodontalgia is observed in altitudes above 50,000 ft. Usually occurs in patients with chronic pulpitis but not on ground level. During ascend, trapped gases expand and move into the dentinal tubules. Movement of contents from the pulp chamber to the apex causes pain. 19-09-2020

9. Thermal Heat from cavity preparation and Exothermic reactions from setting of cements. ( 20° and 30° rise in temperature at 1mm and 0.5mm from the pulp chamber, respectively.) Frictional heat from polishing a restoration. 19-09-2020

10. 2 . Electrical Galvanic current due to interaction of dissimilar metals 3. Chemical Erosion Dental materials, acrylic Monomer. 4. Bacterial Direct microbial invasion into the pulp. Microbial colonization by blood-borne microorganisms(anachoresis). Increased capillary permeability. 19-09-2020

11. PULPAL PATHOSIS Deep invasion by microbes and their byproducts into the dentin. The pulp is affected by byproducts first, before actual bacterial invasion. (Via exposed dentinal tubules) Local cellular invasion. When bacterial invasion occurs, Polymorphonuclear neutrophils are infiltrated in the pulp. (first line defense) This is followed by liquefaction necrosis of exposed site. Eventually, necrosis spreads through the pulp and if not treated, periapical tissue. 19-09-2020

12. Classification 19-09-2020

13. WHO CLASSIFICATION K04.0 : Pulpitis/pulpal hyperaemia/pulpal abscess/pulp polyp, acute/ chronic hyperplastic/ ulcerative pulpitis K04.1 : Necrosed pulp/pulp gangrene K04.2 : Pulp degeneration, denticles/ pulp calcification K04.3 : Abnormal hard tissue formation in pulp secondary or irregular dentin . 19-09-2020

14. Diseases of the pulp According to Grossman :- PULPITIS Reversible Pulpitis (Symptomatic, Asymptotic) Irreversible Pulpitis [ Acute—(a) Abnormally responsive to cold, (b) Abnormally responsive to heat. Chronic —–(a) Asymptotic with pulp exposure (b) Hyper-plastic pulpitis (c) Internal resorption. ] PULP DEGENERATION Calcific (Pulp stones or Denticles) Atrophic Fibrous NECROSIS OF PULP 19-09-2020

15. A. pulpitis 19-09-2020

16. DEFINITION : Reversible Pulpitis denotes a level of pulpal inflammation in which the tissue is capable of returning to the normal state if the noxious stimuli are removed. Also referred to as “ PULP HYPERAEMIA ”. Irreversible pulpitis is a persistent Inflammatory condition of the pulp, symptomatic or asymptomatic caused by a noxious stimulus. It may be acute or chronic. Reversible Pulpitis Irreversible Pulpitis 19-09-2020

17. Reversible Pulpitis Trauma, disturbed occlusal relationship. Thermal shock Excessive dehydration of cavity. Irritation of exposed dentin. Chemical stimulus. Divided into ACUTE – Occurs as a sequelae of reversible Pulpitis. Presents as an acute condition. An acute exacerbation of chronic pulpitis. CHRONIC – Inflammation due to long term low grade injury. Large cavity, Asymptomatic with pulp exposure . Irreversible Pulpitis Etiology Irreversible pulpitis 19-09-2020

18. SIGNS AND SYMPTOMS lead 19-09-2020

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20. Prevention Periodic care Carious lesion should be excised and restored or defective filling is replaced. Removal of noxious stimuli. If primary cause is not corrected, extensive pulpitis may result in the death of pulp. Chronic : Extraction of tooth And RCT treatment Reversible Pulpitis Irreversible Pulpitis Acute : Drainage of exudates from pulp chamber. Pulpotomy & placing calcium hydroxide over the entrance of the root canal. Root canal treatment. Extraction of tooth. 19-09-2020

21. Cap. Amoxicillin 500mg + clavulanic acid 125mg administered TDS for 5 days (Maximum dose : 40 mg/kg/day or 2-3 g/25hr) Tab. Diclofenac sod. 50mg + Paracetamol 500mg administered BD x 3 days Tab. Pantoprazol 40mg OD x 3 days 19-09-2020

22. CHRONIC HYPERPLASTIC PULPITIS Also known as pulp polyp or pulpitis aperta Overgrowth of pulp tissue outside the boundary of pulp chamber as protruding mass. A form chronic pulpitis. Occurs either as a chronic lesion from onset or as chronic stage of a previously ACUTE PULPITIS. 19-09-2020

23. Clinical features : Children and young adults with high degree of tissue resistance and reactivity and responds to proliferative lesions. Pulp – pinkish red globule of tissue protruding from chamber and extend beyond caries . Most commonly affected are deciduous molars and 1 st permanent molars . Lesion bleeds profusely on provocation. 19-09-2020

24. Pulp polyp 19-09-2020

25. Treatment Elimination of polypoid tissue followed by extirpation of pulp, provided the tooth can be restored. After the removal of the hyperplastic pulp mass with a curette or spoon excavator, bleeding is controlled with pressure. The pulp tissue of chamber is completely removed and a temporary dressing is sealed in contact with radicular pulp tissue. 19-09-2020

26. Internal resorption Idiopathic slow or fast progressive resorptive process occurring in the dentin of pulp chamber or root canals of teeth. When there is insult leading to inflammation (trauma, bacteria, tooth whitening, orthodontic movement, periodontal treatment) in the root canal/s or beside the external surface of the root, cytokines are produced, and osteoclasts are activated and resorb the root surface Such patients often have a history of trauma. SYMPTOMS : The root of the tooth is asymptomatic. In crown, it is manifested as a reddish area called as “ Pink tooth of mummery ” The reddish area represents the granulation tissue showing through the resorbed area of crown. 19-09-2020

27. TREATMENT Extirpation of pulp stops internal resorption. 19-09-2020

28. B. Pulp degeneration 19-09-2020 Pulp degeneration is usually present in teeth of old people. It may also result in persistent, mild irritation in teeth of young patients.

29. Types of pulpal degeneration 19-09-2020 Calcific degeneration :- In this, part of pulp is replaced by calcific material i.e., pulp stone or denticle. It may occur in the root canal or pulp chamber. : Atrophic/Resorptive degeneration : In atrophic degeneration fewer stellate cells are present in pulp and intercellular fluid is increased. Fibrous degeneration : In this type of degeneration, pulp is characterised by replacement of cellular elements fibrous connective tissue.

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31. C. Necrosis of pulp It is the death of pulp It may be partial or total, depending on whether part, or the entire pulp is involved . 19-09-2020

32. 19-09-2020 Death of pulp tissue may be with or without bacterial invasion. When the necrosis is due to ischemia with superimposed bacterial infection, it is referred to as pulp gangrene. When the necrosis is non-bacterial in origin, it is called pulp mummification.

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34. 19-09-2020 Causes : It can be due to any noxious insult injurious to the pulp, such as bacteria, trauma and chemical irritation. Dental caries Trauma Treatment Pulpitis Infection

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36. 19-09-2020 . Pulp necrosis following trauma Unrestored  anterior teeth  may require  endodontic  treatment because of  pulp necrosis  caused by traumatic injury

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38. bibliography Grossman’s endodontic practice 12 th edition Review article by Dan- Krister Rechenberg, Jonah C. Galacia, and Ove A. Peters. Burket’s Oral medicine 19-09-2020

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