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