Diseases Of Diseases Of Pulp Pulp

By Mhmood M.H. Radhi

BDS- Final Year

Diseases Of Dental PulpDiseases Of Dental Pulp

Introduction• The pulp is the formative organ of the tooth.The pulp is the formative organ of the tooth.• The pulp has been described as highly resistant The pulp has been described as highly resistant

organ and as organ with little resistance or organ and as organ with little resistance or recuperating ability. recuperating ability.

• Its resistance depends on cellular activity, nutritional Its resistance depends on cellular activity, nutritional supply, age and other metabolic and physiologic supply, age and other metabolic and physiologic parameters.parameters.

Causes of pulp diseaseThe causes of pulp disease arePhysical, Chemical and Bacterial.

1.Physicala. Mechanical - Trauma: . Accidental . Iatrogenic dental procedures - Pathological wear - Crack through body of tooth b. Thermal - Heat from cavity preparation - Exothermic heat from setting of cementsc. Electrical ( galvanic current from dissimilar metallic filling)

2. Chemical

-Phosphoric acid, acrylic monomer, etc.

-Erosion (acids)

3. Bacterial -Toxin associated with caries

-Direct invasion of pulp from caries or trauma

-Microbial colonization in the pulp by blood-borne microorganisms.

Diseases of the pulp Diseases of the pulp Inflammation of the pulp or pulpitis

-Reversible pulpitis-Irreversible pulpitis (Acute & Chronic)

Pulp degeneration -Calcific degeneration-Atrophic degeneration-Fibrous degeneration

Necrosis of pulp

Reversible PulpitisReversible PulpitisIt is a mild to moderate inflammatory condition of the pulp caused by noxious stimuli in which pulp is capable of returning to uninflamed state following removal of the stimuli.

CLINICAL FEATURES:CLINICAL FEATURES:Tooth is sensitive to thermal changes, especially cold.

Pain - short duration, disappears on withdrawal of thermal irritant.

HISTOLOGICAL FEATURES:HISTOLOGICAL FEATURES:

There is reparative dentin disruption of the There is reparative dentin disruption of the odontoblast layer.odontoblast layer.

Dilation of pulp blood vessels.Dilation of pulp blood vessels.

Extravasation of edema fluid.Extravasation of edema fluid.

Presence of immunologically competent chronic Presence of immunologically competent chronic inflammatory cells. inflammatory cells.

causescauses::

TraumaTrauma

Thermal shockThermal shock

Chemical stimulusChemical stimulus

Placement of a fresh amalgam filling in Placement of a fresh amalgam filling in contact with, or occluding, cast restorationcontact with, or occluding, cast restoration

Excessive dehydration of cavity or irritation Excessive dehydration of cavity or irritation of exposed dentin at the neck of a toothof exposed dentin at the neck of a tooth

TREATMENT & PROGNOSIS:TREATMENT & PROGNOSIS:Carious lesion should be excised & restored or defective filling is replaced.

If primary cause is not corrected, extensive pulpitis may result in death of pulp.

Irreversible pulpitisIrreversible pulpitis

Irreversible pulpitis is a persistent inflammatory condition of the pulp ,symptomatic or asymptomatic, caused by a noxious stimulus.It may be acute or chronic.

Histopathology:Histopathology:The post capillary venules becomes congested, These attract the polymorph nuclear leukocytes, by chemotaxis and start an acute inflammatory reaction

This inflammatory reaction produces micro-abscesses(acute pulpitis).

Microscopically one sees area of abscess and a zone of necrotic tissue, with microorganisms present in the late carious state, along with lymphocytes, plasma cells and macrophages.

No microorganisms are found in the center of the abscess because of the phagocytic activity of the polymorph nuclear leukocytes.

Then the caries reaches the pulp , the histological picture changes , then sees an area of ulceration (chronic ulcerative pulpitis), zone of infiltration of PMNs leukocytes and zone of proliferating fibroblasts.

CausesBacterial involvement of pulp by caries Chemical Thermal Mechanical

Acute pulpitis withIntrapulpal abscess

Clinical futures

•Pain caused by sudden thermal change particularly cold or food stiff,

•Pain is boring, gnawing or throbbing or as if tooth under contact pressure,

•Pain is sharp, piercing, or shooting and is generally sever,

•It may be intermittent or continues

•Bending or lying down increase pain.

Diagnosis

•Pulp is already exposed and are may see layer of greyish , scum-like layer over the exposed pulp and surrounding dentin .

•Radiograph may show exposed pulp and caries under restoration .

TREATMENT & PROGNOSIS:TREATMENT & PROGNOSIS:

Complete removal of pulp (RCT)or pulpectomy.

Extraction of tooth, if tooth is not restorable.

PROGNOSISPROGNOSIS

-favorable.

Chronic Hyperplastic PulpitisChronic Hyperplastic Pulpitis It is also called as pulp polyp

It is a productive pulpal inflammation due to extensive carious exposure of a young pulp.

HISTOLOGIC FEATURES:HISTOLOGIC FEATURES:

The surface of the pulp polyp is usually covered by stratified squamous epithelium.

Such epithelium may be derived from gingiva or from freshly desquamated epithelial cells of mucosa and tongue .

The granulation tissue is young, vascular connective tissue containing polymorph nuclear neutrophils, lymphocytes and plasma cells.

Stratified sq. epithelium covering polyp

CAUSESCAUSES

Slow, progressive carious of the pulp is the causes .

For development of hyperplastic pulpitis, a For development of hyperplastic pulpitis, a large , open cavity :a young resistant pulp, large , open cavity :a young resistant pulp, and chronic , low-grade stimulus are and chronic , low-grade stimulus are necessary .necessary .

Mechanical irritation from chewing or Mechanical irritation from chewing or bacterial infection often provide the stimulus.bacterial infection often provide the stimulus.

symptomssymptoms

It is symptomless, except during It is symptomless, except during mastication, when the pressure of food bolus mastication, when the pressure of food bolus may cause discomfort.may cause discomfort.

TREATMENT & PROGNOSIS:TREATMENT & PROGNOSIS:

Extraction of tooth or pulp extirpation.

Internal resorption It is idiopathic slow or fast progressive resorption process occurring in dentin of pulp chamber or root canals of teeth.

HistopathologyHistopathology It is a result of osteoclast activity There is resorptive process is characterized by lacunae ,which may be by osteoid tissue.

Multinucleated giant cell dentinoclast are present.

Metaplasia of pulp.

CausesCauses It is unknown but may be there is history of It is unknown but may be there is history of trauma. trauma.

Symptoms In root of a tooth is asymptomatic.In crown it may be manifested as reddish area called “pink spot”.

DiagnosisIt is diagnosed during routine radiographic examination .The appearance of the “pink spot” occurs late in the resorptive process, when the integrity of the crown has been compromised . The radiograph usually show a change in the appearance of the wall in root canal or pulp chamber, with a round or ovoid radiolucent area.

Treatment and Treatment and prognosisprognosisRoutine endodontic treatment is indicated ,

BUT obturation of the defect requires a special effort ,preferred with a plasticized gutta-percha method .

When root is perforated, then mineral trioxide aggregate (MTA) is used to repair.

The prognosis is favorable before perforation of the root or crown occurs.

Pulp degenerationPulp degeneration is usually present in teeth of old people.

It may also result in persistent, mild irritation in teeth of young patients.

1.Calcific degeneration : In calcific degeneration part of pulp tissue is replaced by calcific material i.e., stone or denticles .

It may occur in root canal or pulp chamber .

The calcific material has a limitation structure, like the skin of an onion, and lies unattached within the body of pulp.

2. Atrophic degeneration In this type, observed histopathological in pulp of older people,

Fewer stellate cells are present and intercellular fluids is increased.

The pulp tissue is less sensitive than normal.

3. Fibrous degeneration In this type the pulp is characterized by replacement of the cellular elements by fibrous connective tissue .

On removal of root canal, such pulp has the characteristic appearance of leathery fibrous.

Necrosis of PulpNecrosis of Pulp It is death of pulp It may be partial or total, depending on whether part, or the entire pulp is involved.

Types :

1.Coagulation2.Caseation 3.Liquefaction

Causes It can be due to any noxious insult injurious to the pulp, such as bacteria, trauma and chemical irritation.

Clinical features no painful symptoms.

discoloration of tooth, tooth is grayish or brownish in color .

Pulp is dead .

Managementpreparation + obturation of root canals

PROGNOSISPROGNOSIS

-favorable.

Necrosis of pulp

References Grossman’s endodontic practice 12th edition