sequle of pulpitis.pptx

sequle of pulpitis- Dr.Divya R

1. DIVYA.R SEQUELAE OF PULPITIS

2. CONTENTS Introduction Sequelae of pulpitis Focal reversible pulpitis Acute pulpitis Chronic pulpitis Chronic hyperplasic pulpitis Apical periodontitis Acute apical periodontitis

3. Chronic apical periodontitis Apical periodontal cyst Periapical abscess Osteomyelitis Acute suppurative osteomyelitis Chronic suppurative osteomyelitis Chronic focal sclerosing osteomyelitis Chronic diffuse sclerosing osteomyelitis Chronic osteomyelitis with proliferating periostitis conclusion

4. INTRODUCTION Dental pulp is a delicate connective tissue interspersed with tiny blood vessels,lymphatics,nerves and undifferentiated connective tissue cells. Reaction to bacterial infection or to other irritant by inflammatory response - pulpitis

5. SEQUELAE OF PULPITIS Pulpitis Acute chronic Apical periodontitis Acute Chronic Periapical abscess Periapical granuloma Acute Chronic Periodontal cyst Osteomyelitis Acute Chronic Focal Diffuse Periosteitis Cellulitis Abscess

6. FOCAL REVERSIBLE PULPITIS CLINICAL FEATURES Sensitive to thermal changes Respond to electric pulp tester at lower level of current Teeth shows deep carious lesion or large metallic restorations with defective margin TREATMENT Carious lesion extracted/ defective filling replaced

7. ACUTE PULPITIS Extensive acute inflammation of dental pulp Etiology Immediate sequela of focal reversible pulpitis Acute exacerbation of chronic inflammatory process

8. CLINICAL FEATURES large carious lesion or defective restoration with recurrent caries Severe pain elicited by thermal changes Pain persists even after thermal stimulus has disappeared Pulpal pain is poorly localized any teeth of upper and lower jaw of affected side

9. Lancinating/throbbing type of pain Pain lasts for 10-15min Intensity of pain increase when patient lies down When cavity is small, Lancinating pain Extend to apex Sensitive to percussion

10. When large open cavity is present No pressure built up No rapid spread of inflammatory process Pain is a dull,throbbing ache Mobility and sensitivity to percussion absent

11. TREATMENT Pulpotomy-removal of coronal pulp Placing a bland material that favours calcification like calcium hydroxide over entrance of root canal Filling root canals with inert material , provided pulp chamber and root canals can be sterilized

12. CHRONIC PULPITIS Etiology Quiescence of previous acute pulpitis Occurs as chronic type of disease from onset

13. CLINICAL FEATURES Pain is not a prominent feature mild,dull ache Pain often intermittent than continuous Reaction to thermal change reduced Pulp may become totally necrotic without pain

14. TREATMENT Root canal therapy

15. CHRONIC HYPERPLASTIC PULPITIS Unique form of pulpitis Inflammed pulp,instead of perishing by continued suppuration reacts by excessive and exuberant proliferation Children and young adults- high degree of tissue resistance and reactivity. Teeth with large, open carious lesions

16. pulp appears as pinkish red globule of tissue protruding from pulp chamber deciduous molars and 1 st permanent molars Treatment extraction of tooth/pulp extirpation

17. APICAL PERIODONTITIS Inflammation of periodontal ligament around root apex Resorption of periapical bone and sometimes root apex May be acute or chronic

18. Etiology Spread of infection following pulp necrosis Occlusal trauma from high restoration or biting suddenly on a hard object Pushing infected material into apical portion Chemical irritation from root canal medicaments

19. ACUTE APICAL PERIODONTITIS History of previous pulpitis Thermal changes does not induce pain as in pulpitis due to collection of inflammatory oedema in PDL t ooth is slightly elevated in its socket cause tenderness while biting/even to mere touch severe pain

20. TREATMENT If inflammation caused by occlusal trauma-relieved by selective occlusal grinding If it is due to spread of pulpal infection-extraction/endodontic treatment to drain the exudate

21. CHRONIC APICAL PERIODONTITIS Also called periapi c al granuloma Low grade infection Most common sequelae of pulpitis localized mass of chronic granulation tissue formed in response to infection Spread of infection usually in a periapical direction

22. CLINICAL FEATURES Involved tooth is nonvital Slightly tender on percussion Percussion produce a dull sound Mild pain on biting/chewing Sensitivity is due to hyperaemia,oedema and inflammation of apical periodontal ligament

23. TREATMENT Extraction of involved tooth Root canal therapy with /without subsequent apicoectomy If left untreated ,it may undergo transformation into apical periodontal cyst

24. APICAL PERIODONTAL CYST Most common odontogenic cyst Other names-radicular cyst,periapical cyst,root end cyst Result of bacterial infection and necrosis of dental pulp following caries

25. asymptomatic 20 and 60 years maxillary anteriors followed by mandibular premolars and molars tooth is nonvital / shows deep cariouslesion or a restoration which is seldom painful

26. TREATMENT Root canal therapy of involved tooth along with periapical surgery or extraction of involved tooth followed by periapical curettage Cyst does not recur if surgical removal is thorough

27. PERIAPICAL ABSCESS Other names-dentoalveolar abscess,alveolar abscess acute / chronic suppurative process of periapical region Develop from acute periapical periodontitis / from a periapical granuloma Acute exacerbation of chronic periapical lesion is known as phoenix abscess

28. CLINICAL FEATURES ACUTE PERIAPICAL ABSCESS Tenderness of tooth Extremely painful Slightly extruded from its socket Rapid extention to adjacent bone marrow spaces-produce osteomyelitis CHRONIC PERIAPICAL ABSCESS No clinical features since it is a mild ,well circumscibed area of suppuration that shows little tendency to spread from local area

29. TREATMENT Drainage Opening the pulp chamber / extracting the tooth In some cases tooth is retained and root canal therapy is carried out if lesion can be sterilized

30. OSTEOMYELITIS Defined as inflammation of bone and its marrow contents Predisposing factors Fractures due to trauma Road traffic accidents Gunshot wounds Radiation damage Paget disease and osteoporosis Systemic conditions

31. ACUTE SUPPURATIVE OSTEOMYELITIS Serious sequele of periapical infection diffuse spread of infection throughout the medullary spaces subsequent necrosis of variable amount of bone Polymicrobial Most common cause-dental infection Other causes-infection due to fracture of jaw,gunshot or hematogenous spread

32. CLINICAL FEATURES Maxilla-localized; mandible-diffuse and widespread Severe pain Trismus Paraesthesia of lips in case of mandibular involvement Elevation of temperature Loosening of teeth and exudation of p us from gingiva no swelling and redness till periostitis develop

33. TREATMENT 3D-debridement drainage drugs(antimicrobial) When intensity of disease become attenuated,sequestrum begins to separate from living bone Sequestrum-if small, exfoliates through mucosa if large, surgical removal Untreated cases may proceed to development of periostitis,soft tissue abscess /cellulitis

34. CHRONIC SUPPURATIVE OSTEOMYELITIS CLINICAL FEATURES Pain is less severe Temperature is slightly elevated Leucocytosis slightly greater Fistulous tract may form which open to surface TREATMENT Surgery with sustained bacteriocidal antibiotic therapy

35. CHRONIC FOCAL SCLEROSING OSTEOMYELITIS (CONDENSING OSTEITIS) Unusual reaction of bone to infection High degree of tissue resistance and tissue reactivity Young adults and children Mandibular molars commonly affected Symptoms-mild pain due to infected pulp Treatment-extraction / endodontic treatment

36. CHRONIC DIFFUSE SCLEROSING OSTEOMYELITIS Proliferative reaction of bone to low grade infection CLINICAL FEATURES Occur at any age, more predominence in older age group Common in mandible Insidious in nature, no clinical indication of its presence Acute exacerbations results in vague pain,unpleasant taste, mild suppuration ,many times drainage through fistulous tract

37. TREATMENT Lesion is too extensive to be removed surgically Sclerotic bone is hypovascular and resistant to antibiotics Extraction by surgical approach with removal of liberal amounts of bone to facilitate increased bleeding Antibiotic administration during acute exacerbation may occur

38. CHRONIC OSTEOMYELITIS WITH PROLIFERATIVE PERIOSTITIS Focal gross thickening of periostium with peripheral reactive bone formation resulting from mild reaction or infection CLINICAL FEATURES Children and young adults Mandible-bicuspid and molar region Tooth ache / pain in jaws Bony hard swelling on outer surface of jaw TREATMENT Extraction / endodontic treatment

39. CONCLUSION Establishment of proper diagnosis is of at most important to carry out the effective clinical procedure for the benefit of patient Review after the treatment is also to be given importance

40. REFERENCES Shafers textbook of oral pathology , 8 th edition