Pulpitis Overview and Types

Pulpitis

• Pulpitis is the most common cause of dental pain and tooth loss
• Microbial invasion is the most common cause of pulpitis via a carious lesion penetrating the dentin or a tooth fracture.
• Other causes include acute injury, chronic injury, thermal irritation, and chemical irritation.
• Untreated pulpitis can cause pulp death, spread of infection through the apical foramina, and periapical tissue inflammation.

Focal Reversible Pulpitis (pulp hyperemia)

• A mild, localized inflammatory reaction in the pulp.
• Tooth sensitivity to thermal changes, especially to cold.
• Short-lived pain that subsides when the thermal irritant is removed.
• More common in younger individuals due to the pulp's higher reparative capacity.
• The affected tooth responds to lower levels of current when tested with an electric pulp tester compared to an adjacent tooth.
• Often associated with a large carious lesion or poorly insulated restoration.
• Histopathology shows limited inflammation around the irritated dentinal tubules.

Acute Pulpitis

• Irreversible condition with intense inflammation in the pulp tissue.
• Can be an extension of focal reversible pulpitis, an exacerbation of chronic pulpitis, or acute from the beginning.
• Extreme tooth sensitivity to hot and cold stimuli with prolonged, sharp pain.
• Responds to lower levels of current when tested with an electric pulp tester
• Pain can be spontaneous, especially at night due to increased local blood pressure in the head and neck region.
• Tooth is not tender to percussion except when inflammation spreads to the periapical region.
• Histopathology shows severe edema, neutrophil infiltration, focal or complete odontoblast destruction, and potential abscess formation.

Chronic Pulpitis

• Persistent low-grade inflammatory reaction in the pulp tissue.
• Milder symptoms than acute pulpitis, with less sensitivity to thermal stimuli.
• Intermittent dull, throbbing pain or no pain.
• Responds to higher levels of current when tested with an electric pulp tester, indicating nerve fiber degeneration.
• Histopathology shows lymphocyte, plasma cell, and macrophage infiltration with collagen bundle formation.
• Small areas of pulpal necrosis and pus formation
• Prolonged survival of chronically inflamed pulps, allowing for symptom persistence with periods of acute exacerbations.
• Pulp death can be the final outcome.

Chronic Hyperplastic Pulpitis (Pulp Polyp)

• Proliferating granulation tissue through a cavity opening causing a pink-red protrusion.
• Most common in deciduous molars and first permanent molars in children and young adults.
• Lesions may bleed easily upon provocation.
• Large open carious cavity and pain may be absent or sensitive to thermal stimuli.
• Histopathology shows granulation tissue with lymphocytes, plasma cells, fibroblasts, young vessels, and neutrophils.
• Epithelium is often from the buccal mucosa, carried by saliva and transplanted onto polyp surface.

Pulp Necrosis

• Caused by untreated pulpitis (acute or chronic) or injury, leading to blockage of apical blood vessels and complete pulp tissue death.

This quiz covers the basics of pulpitis, including its causes, effects, and specific types such as focal reversible pulpitis. Test your understanding of microbial invasion, symptoms, and the importance of timely dental intervention. Explore the pathological aspects and clinical responses related to pulp health.