Pulpal Disease

Dr. Mohammed Alshehri BDS, AEGD, SSC-Resto, SF-DI

Pulpal Damage

• undiagnosed decay*.

• advanced periodontal disease .

• Trauma .

Living Non-Living

•Microorganisms•Viruses

•Mechanical •Chemical •Thermal

Irritant

• Streptococcus mutans • Lactobacilli • Actinomyces

• Pulp exposure to microorganisms is not a prerequisite for pulpal response

• Toxins produced , Pulp infiltrated by macrophages, lymphocytes, plasma cells

Microbial Irritant

Oral microorganismsOral microorganisms

As decay progress toward pulp character of infiltrate changes

Actual pulp exposure occurs

Polymorphonuclear lenkocytes infiltrate

Liquefaction necrosis

Rapid necrosis

Microbial Irritant

• Depends on virulence of bacteria

• Ability to release inflammatory fluids

• Host resistance

• Amount of circulation

• Lymph drainage

If this persist for long period of time the necrotic pulp diffuses

from canal periapically

Microbial Irritant

Deep cavity preparations

Removal of tooth structure without proper cooling

Impact trauma

Occlusal trauma

Deep periodontal curettage

Orthodontic movement

Mechanical

Dentin cleansing

Desensitizing agents

Cavity liners

Temporary and permanent restorative materials

Chemical

Pulpal injury results in cell death and inflammation.

Degree of inflammation is proportional to intensity and

severity of tissue damage.

Pulpal Pathosis

Pulpitis :

1. Reversible pulpits

» Symptomatic (acute)

» Asymptomatic (chronic)

2. Irreversible pulpits

Acute

» Responsive to cold

» Responsive to heat

Classification of pulpal disease

» Chronic

» Asymptomatic with pulp exposure

» Hyperplastic pulpitis

» internal resorption

3. Hyperplastic pulpitis

4. Necrosis

5. Calcification and resorption

Cont.

Moderate response to pulp test

Response subsides when stimulus is removed

Free of pain

Radiographs shows intact lamina dura, no pulpal

abnormality, no calcifications, no resorption

Normal Pulp

What is Pulpitis ?

Pulpitis

• Definition

A pulpal condition commonly induced by dental caries and

operative procedures, in which the patient responds to thermal

or osmotic stimuli, but the symptoms disappear when the

etiology is eliminated.

Reversible Pulpitis

Trauma

Thermal injury

• Cavity preparation

• During polishing restorations

Chemical stimulus

After insertion of deep restoration

Etiology

Symptomatic reversible pulpitis:

– Sharp pain, lasting for moment, caused by cold stimuli,

not spontaneous, doesn't continue when irritant removed.

Asymptomatic reversible pulpitis:

Symptomatic

resolved after removal of caries and restoration

Symptoms

Visual examination

Shows caries, traumatic occlusion

Radioghraph:

• Normal PDL, lamina dura

Diagnosis

No endodontic treatment

Removal of irritants;

Insulating the exposed dentin

Sedative dressing

If irritation continues results in irreversible pulpitis

Treatment

Definition

A pulpal condition, usually caused by deep dental caries or

restorations, in which spontaneous pain may occur or be

precipitated by thermal or other stimuli, and pain continues

even after removal of stimulus.

Irreversible Pulpitis

Pain remains even after removal of stimulus

Pain spontaneous in nature

Sharp , dull, throbbing pain

Can be localized or diffuse

Immediate response on application of heat

Pain increases on bending or lying

Symptoms

Extension of inflammation to PDL causes percussion

sensitivity

Pulpectomy

Treatment

Reversible VS Irreversible

Reversible VS Irreversible

Reversible VS Irreversible

Form of irreversible pulpitis

As overgrowth of chronically inflamed pulp into occlusal

surface

Hyperplastic pulpitis (Pulp Polyp)

Root canal treatment

Extraction

Treatment

PULP CALCIFICATION

Occurs in form of pulp stones, diffuse calcifications

Extensive formation of hard tissue on dentin walls often by

response to irritation and replacement of odontoblast

As irritation increase leads to complete obliteration of

chamber

Hard Tissue changes

Pulp transformed into inflammatory tissue with dentinoclastic activity

Asymptomatic

Pinkish discoloration on crown

Radiolucency shows irregular enlargement of root canal compartment

Treatment :- Pulpectomy

Internal resorption

Follows untreated pulpitis

Leads to liquefaction necrosis

May be partial or total depending on tissue involvement

Symptoms :-

Usually asymptomatic

Sometimes spontaneous pain on pressure

Discoloration of teeth

Pulpal Necrosis

Diagnosis :

Vitality test negative

Treatment:-

Pulpectomy

Extraction

Pulpal Necrosis

Partial or complete root canal treatment

Symptomatic or asymptomatic according to pulpal

conditions

Extraction

Previously initiated RCT

REFERENCE:REFERENCE:ENDODONTICS PRINCIPLES AND PRACTICE (ENDODONTICS PRINCIPLES AND PRACTICE (walton and torabinejad walton and torabinejad ))4TH EDITION4TH EDITIONCHAPTER -4CHAPTER -4Pg: 49-56Pg: 49-56