pulpitis (pulp inflammation) - dentistry

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PULPITISDr. Sarang Suresh Hotchandani

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Pulpitis is Most Common Cause of;

Dental Pain

Loss of tooth in

younger age

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Causes of Pulpitis

Dental Caries (Most Common)

Trauma

Cracked tooth syndrome

Thermal

Chemical

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If Pulpitis Not Treated this will happen!

Pulpitis

Pulp Necrosis

Periapical Periodontitis

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Clinical Features of Pulpitis

Patient unable to localize from which tooth

pain is originating.

Because pulps of individual teeth are not sensed

precisely on Sensory Cortex.

Sometimes pulpitis pain is referred;

E.g. mandibular molars to ear.

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Clinical Features of Pulpitis

There is no any pain on applying

pressure/palpation/percussion on tooth in

pulpitis.

If pain is present on pressure it is always periapical

periodontitis; inflammation of PDL.

But sometimes, when there is frank cavity in tooth, the

impacted food particles sometimes apply pressure

through soft & thin dentine.

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Clinical Classification of Pulpitis

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Acute Pulpitis (Early Stage Acute Pulpitis)

Tooth is hypersensitive

Very cold/hot stimuli cause stabbing

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Acute Pulpitis(Late Stage Acute Pulpitis)

Duration of pain increases & it is

persistent.

Pain starts spontaneously often

when patient try to sleep.

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Pain of Pulpitis Occurs due to;

Presence of inflammatory infiltrate in

closed pulp chamber on irritated nerve

endings.

Pain producing substances from

damaged pulp.

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Characteristics of Acute Pulpitis Pain

Sever

Sharp

Stabbing

Can’t relieved by simple analgesics.

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Clinical Classification of Acute Pulpitis

Acute Pulpitis

Irreversible Acute Pulpitis

Reversible Acute Pulpitis

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Characteristics of Irreversible Acute Pulpitis

Constant sever pain even after

removal of stimuli.

Treatment; Root Canal Therapy

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Outcome of untreated Acute Pulpitis!

Chronic Pulpitis

Pulp Necrosis

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Chronic Pulpitis

Spontaneous attack of dull pain for

hours or more

It may or may not be due to acute

pulpits.

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Acute Closed Pulpitis (Histologic Findings)

Pulp hyperemia

Infiltration of inflammatory exudate

Some areas of necrosis leading to micro

abscesses

If left untreated for long time can lead to

Pulp Necrosis

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Chronic Closed Pulpitis(Histologic Factors)

Mononuclear macrophage cell infiltrate

Vigorous connective tissue response

Small areas of pulp necrosis

Small areas of minute abscesses

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Factors Which Prevent Survival of Pulp

Pulp is enclosed within rigid walls of pulp

chamber

Only one small opening at apex for blood

supply to tooth

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Death of Pulp

Blood Supply Cut off to Tooth

Compression of Apical Vessels

Inflammation

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Open Pulpitis (Pulp Polyp)

Pulp grown through cavity opening.

This may be due to large open

apices & good blood flow.

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20

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Clinical Features of Open Pulpitis (Pulp Polyp)

Dusky red/ pinkish soft tissue nodule protruding in

to cavity opening.

Painless

Bleed on probing

Tender to palpation

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Histological Features of Open Pulpitis (Pulp Polyp)

Few odontoblast present

Pulp tissue is replaced by granulation tissue

Proliferated mass of pulp polyp is covered by stratified

squamous epithelium

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Management of Pulpitis

If cause is fracture/ cracked tooth, stabilize & seal the pulp temporarily.

If cause is caries, pulp capping, caries removal.

Pulpotomy in deciduous teeth

Endodontic treatment

Extraction

Analgesic are ineffective against pulpitis pain

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THE END

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