PULPITISPULPITIS Inflammation of dental pulpInflammation of dental pulp Main source for dental painMain source for dental pain

Causes Causes Dental caries- the Dental caries- the most commonmost common cause cause Traumatic exposure to pulpTraumatic exposure to pulp # of crown# of crown Repeated dental procedureRepeated dental procedure

Pathogenesis Pathogenesis

Any causes aboveAny causes above

Exposure to pulpExposure to pulp

Invasion by bacteria- StreptococusInvasion by bacteria- Streptococus

Inflammation of pulpInflammation of pulp

pathogenesispathogenesis

Types Types Acute (rapid, severe onset, short duration)Acute (rapid, severe onset, short duration)

Open – communication between pulp cavity & oral cavity)Open – communication between pulp cavity & oral cavity) closedclosed

Chronic (slow , long duration, mild pain)Chronic (slow , long duration, mild pain) Open Open ClosedClosed

Acute-ClosedAcute-ClosedMicro organism- virulent & large no.Micro organism- virulent & large no.

Clinical featuresClinical features Early stage - Hypersensitivity to hot & coldEarly stage - Hypersensitivity to hot & cold Later more persistentLater more persistent Pain- sharp, severe & stabbingPain- sharp, severe & stabbing Sometimes not localizedSometimes not localized TenderTender Tooth discolorationTooth discoloration Swelling of gum Swelling of gum

Acute-OpenAcute-Open Common Common Acute exposure with micro organismsAcute exposure with micro organisms Occurs at late stage of cariesOccurs at late stage of caries Abscess formed drain out of cavityAbscess formed drain out of cavity

Clinical featuresClinical features Hypersensitivity hot & cold in early stageHypersensitivity hot & cold in early stage Less painLess pain Slight tenderSlight tender

Chronic-closedChronic-closedNo communication B/W pulp & oral cavityNo communication B/W pulp & oral cavityPulp tissue destruction at the site of micro Pulp tissue destruction at the site of micro

organism entryorganism entry Infection remains localized for long time with Infection remains localized for long time with

remaing pulp tissue intact or destruction occurs remaing pulp tissue intact or destruction occurs slowlyslowly

Clinical features Clinical features HypersensitivityHypersensitivity

Early stage- to hot n coldEarly stage- to hot n coldLate stage- only to hot but relieved by coldLate stage- only to hot but relieved by cold

Chronic-openChronic-open Usually occurs on widely opened cavityUsually occurs on widely opened cavity Pulp is destroyed & replaced by Pulp is destroyed & replaced by

granulation tissue & become epithelialised granulation tissue & become epithelialised to form polypto form polyp

PAINLESS PAINLESS

DiagnosisDiagnosis

Test of healthy pulpTest of healthy pulp Tapping of tooth directlyTapping of tooth directly

Sensitivity if present indicates the spread of Sensitivity if present indicates the spread of inflammation to surrounding tissueinflammation to surrounding tissue

hot & cold sensitivityhot & cold sensitivity If pain persists even after stimulus removal orIf pain persists even after stimulus removal or Pain persists spontaneouslyPain persists spontaneously

Pulp may not be healthy to savePulp may not be healthy to save

Test of pulp- dead or aliveTest of pulp- dead or aliveElectric pulp testerElectric pulp tester

It helps to recognize the pulp whether it’s It helps to recognize the pulp whether it’s alive or dead but not healthinessalive or dead but not healthiness

If person feels the electric charge If person feels the electric charge delivered to the tooth the pulp is alivedelivered to the tooth the pulp is alive

TreatmentTreatment If pulp viable just remove irritant n healed itselfIf pulp viable just remove irritant n healed itself Removal of caries n restoration by filling Removal of caries n restoration by filling If pulp deadIf pulp dead

RCTRCT Tooth extractionTooth extraction

antibiotic is given- penicillin in acute casesantibiotic is given- penicillin in acute cases

Root canal treatmentRoot canal treatment Root canal treatment is the process where the dentist Root canal treatment is the process where the dentist

removes the pulp( i.e. pulp extirpation) from an infected removes the pulp( i.e. pulp extirpation) from an infected tooth and replaces it with dental fillingtooth and replaces it with dental filling

Indications for RCTIndications for RCTDental caries :Dental caries :

an untreated cavityis a common cause of pulp infection.an untreated cavityis a common cause of pulp infection.

the reduced blood supply also limits the pulp’s ability to heal the reduced blood supply also limits the pulp’s ability to heal

itselfitselfPulpitisPulpitis

the pulp can become damaged from trauma or facturethe pulp can become damaged from trauma or factureAbscessAbscess

once the pulp become infected, the infection can spread to the once the pulp become infected, the infection can spread to the

bone around the tooth forming abscess bone around the tooth forming abscess

if the rct is not done,the tooth may have to be if the rct is not done,the tooth may have to be

extractedextractedRepeated dental procedures on toothRepeated dental procedures on tooth

ProcedureProcedureFirst an opening is made through the occlusal area of First an opening is made through the occlusal area of posterior teeth and lingual surface of anterior teethposterior teeth and lingual surface of anterior teethAfter the diseased pulp is removed, the pulp chamber After the diseased pulp is removed, the pulp chamber & root canal is enlarged & shaped in preparation for & root canal is enlarged & shaped in preparation for being filledbeing filledIf more than one visit is needed, a temporary filling is If more than one visit is needed, a temporary filling is placed in the opening of the toothplaced in the opening of the toothThe temporary filling is removed and the pulp The temporary filling is removed and the pulp chamber & root canal permanent restoration is donechamber & root canal permanent restoration is doneIn final step, a crown is usually placed over the tooth In final step, a crown is usually placed over the tooth to restore its natural shiny apperanceto restore its natural shiny apperance

all RCT procedures are done by isolating the tooth all RCT procedures are done by isolating the tooth with a rubber dam to provide saliva-free with a rubber dam to provide saliva-free environment.environment.

RCT may be done in single or multiple visits RCT may be done in single or multiple visits depending on complexity of the toothdepending on complexity of the tooth

X-rays are taken to determine the length of the X-rays are taken to determine the length of the root & to monitor the various aspects of root & to monitor the various aspects of treatmenttreatment

Root files are used to clean the Root files are used to clean the unhealthy pulpunhealthy pulp

Filling Filling Temporary filling material - Zinc oxide or zinc Temporary filling material - Zinc oxide or zinc

phosphate phosphate Permanent – Gutta PerchaPermanent – Gutta Percha

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