pulpal disease

Pulpal DiseaseDr. Mohammed Alshehri BDS, AEGD, SSC-Resto, SF-DI

Pulpal Damage undiagnosed decay*.advanced periodontal disease . Trauma .

Living Non-Living MicroorganismsViruses 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

As decay progress toward pulp character of infiltrate changesActual pulp exposure occursPolymorphonuclear lenkocytes infiltrateLiquefaction necrosisRapid necrosis

Microbial Irritant

Depends on virulence of bacteriaAbility to release inflammatory fluidsHost resistanceAmount 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 : Reversible pulpitsSymptomatic (acute)Asymptomatic (chronic) Irreversible pulpitsAcuteResponsive to coldResponsive to heat Classification of pulpal disease

ChronicAsymptomatic with pulp exposureHyperplastic pulpitisinternal resorption

Hyperplastic pulpitisNecrosisCalcification and resorption Cont.

Moderate response to pulp testResponse subsides when stimulus is removedFree of painRadiographs shows intact lamina dura, no pulpal abnormality, no calcifications, no resorptionNormal 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 injuryCavity preparationDuring polishing restorationsChemical stimulusAfter 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:Symptomaticresolved 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

DefinitionA 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 activityAsymptomatic Pinkish discoloration on crownRadiolucency shows irregular enlargement of root canal compartment

Treatment :- Pulpectomy Internal resorption

Follows untreated pulpitisLeads to liquefaction necrosisMay be partial or total depending on tissue involvementSymptoms :-Usually asymptomaticSometimes spontaneous pain on pressureDiscoloration of teeth

Pulpal Necrosis

Diagnosis : Vitality test negative

Treatment:-Pulpectomy Extraction Pulpal Necrosis

Partial or complete root canal treatmentSymptomatic or asymptomatic according to pulpal conditionsExtraction Previously initiated RCT

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

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