Pulp diseases Dr. Győrfi Adrienne
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Pulp diseases
Dr. Győrfi Adrienne
Irritative factors
1. Microbial irritants: Streptococci,
Lactobacilli,
Actinomyces viscosus
2. Mechanical irritants: inadequate cooling during
cavity or crown preparation,
trauma or orthodontic
movement, deep scaling
and curettage
3. Chemical irritants: alcohol, chloroform,
hydrogen peroxide,
acid etching
Inflammatory mediators
histamine, prostaglandin, szerotonin,
substance P (P-anyag), kalcitonin-gén-
related peptide (CGRP), neurokinin A,
bradykinin, kallidin, nitrogénmonoxid
Classicifacion of pulpal diseases
1. Reversible pulpitis
2. Irreversible pulpitis
3. Hyperplastic pulpitis (Pulp polyp)
4. Pulpal necrosis
5. Pulp calcification
6. Internal resorption
1. Reversible pulpitis
Etiology: cervical erosion, occlusal
attrition, caries, operative procedures
Symptoms: asymptomatic or mild
symptoms
Vitality test: transient pain in response to cold, hot or
electrical stimuli
Radiograph: -
Treatment: removal of the irritative factors, pulp
capping
2. Irreversible pulpitis
Etiology: sequela to reversible pulpitis,
operative procedures, trauma
Symptoms: spontaneous pain
Vitality test: prolonged pain in response to cold,
hot or electrical stimuli
Radiograph: -
Treatment: root canal therapy
3. Hyperplastic pulpitis
(Pulp polyp)
Etiology: in childhood chronically inflammed young pulp is in occlusal surfaces of caries crowns,
a form of irreversible pulpitis
Symptoms: asymptomatic or symptoms of
irreversible pulpitis, in many cases are found during clinical examination as a raddish
cauli-flower-like tissue
Vitality test: similar to normal teeth
Radiograph: -
Hystology: granulomatous tissue
Treatment: pulpotomy or root canal therapy
Pulp polyp
3. Hyperplastic pulpitis
(Pulp polyp)
Etiology: in childhood, same as for irreversible pulpitis
Symptoms: asymptomatic or symptoms of
irreversible pulpitis, a raddish
cauli-flower-like tissue
Vitality test: similar to normal teeth
Radiograph: -
Hystology: granulomatous tissue
Treatment: pulpotomy or root canal therapy
4. Pulpal necrosis
Etyology: sequela to irreversible pulpitis,
traumatic injury
Symptoms: asymptomatic or pain in response
to heat and percussion,
discolouration
Vitality test: the patient doesn’t feel the cold
Radiograph: -
Treatment: root canal therapy
5. Pulp calcification
Etiology: permanent irritative factors: dental caries
Symptoms: yellowish discolouration of the crown
Vitality test: decreased reaction to stimuli
Radiograph: obliteration of pulp chamber and root
canal: pulp stone or calcific metamorphosis
Treatment: -
Pulp stone
Calcific
metamorphosis
5. Pulp calcification
Etiology: dental caries
Symptoms: yellowish discoloration of the crown
Vitality test: decreased reaction to stimuli
Radiograph: obliteration of pulp chamber and root
canal: pulp stone or calcific metamorphosis
Treatment: -
6. Internal resorption
Etiology: inflammation in the pulp
Symptoms: asymptomatic, pink spot in the crown
Vitality test: similar to normal teeth
Radiograph: radiolucent lesion with irregular
enlargement of the root canal
compartment
Treatment: root canal therapy
Internal resorption
6. Internal resorption
Etiology: inflammation in the pulp
Symptoms: asymptomatic, pink spots in the crown
Vitality test: similar to normal teeth
Radiograph: radiolucent lesion with irregular
enlargement of the root canal
compartment
Treatment: root canal therapy
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