Pulpopathies: Formes cliniques et diagnostics

Pulpopathies: Clinical Forms

• Pulpopathies are clinical forms of diseases affecting the dental pulp.

• Hyperemia pulpaire Weine (Category II Baume): Second Advanced Stage

  • This is the potentially reversible initial stage of a pulp response, marking the start of an inflammatory cycle.
  • Characterized by temporary vasodilation, increased blood flow, and slowed circulation. Then, intra-pulp pressure increases.
  • Inflammation may be confined to a pulp horn or involve the entire pulp.
  • Prolonged vasodilation leads to capillary damage, leukocyte and plasma leakage, and elevated pulp pressure.
  • Edema and red blood cell extravasation put pressure on odontoblasts and nerve endings, causing pain.
  • Pain is not usually spontaneous, but rather provoked and lasts for a short time after stimulus.

• Diagnostic Considerations

  • Examination should assess for cavities, previous restorations, fractures, and occlusal trauma.
  • Patients may report on previous treatments and describe the nature of their pain.
  • Common findings include quick responses to cold and minimal electrical stimulation thresholds.
  • Percussion tests are usually non-reactive, but may yield a response in cases of prolonged vasodilation (prior cavity preparation).
  • Radiographs show cavity depth and proximity to the pulp chamber.

• Evolution

  • Conditions resolve after the causal factor is removed.
  • Persistent stimuli lead to partial or total acute pulpitis.

• Acute Symptomatic Pulpitis (Weine) (Category II and III Baume)

  • Inflammatory response within pulp connective tissue due to irritation, with prominent exudative forces.
  • Symptoms result from severe intra-pulp pressure.

• Pain Characteristics

  • Pain varies in duration (seconds to hours) and frequency (occasional to frequent, sometimes cyclic).
  • Pain is often sudden in onset and cessation.
  • It is often described as sharp, throbbing, or intermittent in nature.
  • Pain can be described as radiating or referred.
  • Location of pain sometimes correlates with stimulation site; sometimes not.

• Diagnostic Evaluation

  • Detailed patient history regarding pain onset, character, and contributing factors (e.g., trauma).
  • Assessment of response to thermal and electrical stimulation.
  • Evaluation of percussion sensitivity.
  • Radiographic evaluation to assess for cavity depth and proximity to pulp.

• Purulent Pulpitis (Category III Baume)

  • Characterized by the formation of pus pockets and the presence of bacteria and their toxins, which cause fluid buildup and increased leukocyte infiltration.
  • Severe pain.

• Chronic Pulpitis

  • Described as an inflammatory response within pulp tissues with proliferative forces predominating.
  • Often asymptomatic.
  • Can be observed in closed (enclosed) or open (exposed) forms.

• Chronic Closed Pulpitis

  • Characterized by cell and tissue changes.

• Chronic Open Pulpitis

  • Characterized by ulcer formation in the exposed pulp.
  • Can lead to the formation of a pulpal polyp.

• Pulp Necrosis

  • A condition where pulp tissue dies.
  • Can be asymptomatic or associated with pain.

• Internal Root Resorption

  • Characterized by the occurrence of a granulation tissue that contains odontoclasts; this process can lead to cavity formation.

• Pulp Atrophy

  • A reduction in the number and size of pulp cells.
  • Can be observed at the odontoblast layer.

• Degenerative Pulp Conditions

  • Various types of degeneration of pulp tissue (e.g., fibrous, fatty, hyaline, amyloid, cystic).