Etiology Of Pulp And Periapical Diseases PDF

By Dr. Dana Saeed Lecturer of Endodontics Galala University  The pulp is a unique connective tissue. It is a low compliance tissue, encased in rigid enamel and dentin structure; with a restricted capacity for pulp tissue expansion; limiting its ability to tolerate edema leading to irr...

By Dr. Dana Saeed Lecturer of Endodontics Galala University  The pulp is a unique connective tissue. It is a low compliance tissue, encased in rigid enamel and dentin structure; with a restricted capacity for pulp tissue expansion; limiting its ability to tolerate edema leading to irreversible damage due to stagnation and self-strangulation of pulpal circulation. Lack of collateral circulation; cannot tolerate edema (edema → vessels collapse → hypoxia → tissue necrosis). Potential for reparative dentine formation. Bacterial invasion from a carious lesion is the most frequent initial cause of pulp inflammation. Bacterial Causes Traumatic Causes Iatrogenic Causes Chemical Causes Idiopathic Causes  Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes 1. Bacteria and their byproducts are the most common cause for endodontic disease. 2. They enter through certain pathways. 3. The response of pulp depends on: No. Of microorganisms X Virulence Host resistance  Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes A) Coronal B) Radicular Ingress Ingress Caries Caries Fractures Periodontal Pocket Anomalous tract Hematogenic infection  Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes 1) Caries: Bacteria in D.T. below lesion Inflamed not infected  Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes 1) Caries: THREE BASIC REACTIONS PROTECT PULP AGAINST CARIES: 1. Decrease permeability of dentin. 2. Formation of tertiary or sclerotic dentin. 3. Inflammatory and immune reactions.  Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes 1- Caries: The rate of caries attack to dentin and pulpal response depend on: 1. Degree of dentin calcification. 2. Dentin thickness 3. Acuteness or chronicity of caries.  Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes 1) The degree of calcification of the remaining dentin: (Dentin permeability): the rapidity and degree of flow of noxious stimuli toward the pulp are directly related to the absence or presence of a dense dentin barrier. Thus, the most permeable would-be: 1. Dead tract dentin (empty tubules) 2. Primary dentin 3. 2nd dentin 4. 3ry dentin 5. Sclerotic dentin (the least permeable).  Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes 2. Dentin thickness: Pathosis increased when the lesion reached within 0.5 mm of the pulp as the number and diameter of the dentinal tubules increased near the pulp.  Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes 3. Acuteness or chronicity of caries: Type of caries stimulates the production of an effective reactional dentin barrier: Acute Overcomes the pulp calcific defense capability Chronic Allows time for reactional and sclerotic dentin to develop.  Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes 2) Fractures (complete & incomplete): Complete fracture extending into pulp chamber: Trauma  Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes Incomplete fracture of the crown: Crack: incomplete fracture of tooth with vital pulp. Incomplete fracture of the crown Crack 1. Allows bacterial entrance into the pulp 2. Pulp infections depend on the extend of the fracture Complete extending into Only through Enamel pulp chamber Dentin hypersensitivity Pulp is hypersensitive to and irreversible pulpitis cold and mastication  Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes 2) Incomplete fracture of the crown Diagnosis of crack is done through: Light not transmitted 1) Transillumination 2) Bite test  Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes 2) Incomplete fracture of the crown 3) Dye test Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes Non fracture trauma  Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes 3- Anomalous tract: Ø Anomalous tooth development of both the crown and the root, accounts for pulp death, usually by bacterial invasion. Ø In each case dens evaginatus, dens invaginatus, andr radicular lingual grooves bacterial infection is the cause of pulp inflammation or tooth loss.  Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes 3- Anomalous tract: a) Radicular lingual groove (palatogingival groove) :  Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes 3- Anomalous tract: a) Radicular lingual groove : Clinical appearance of palatogingival groove. Palatal periodontal pocket extends to the apex.  Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes 3- Anomalous tract: b) Dens invaginatus  Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes 3- Anomalous tract: c) Dens evaginatus (Talon cusp)  Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes Coronal Ingress Radicular Ingress Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes Radicular Ingress 1) Caries: Root caries is less frequent occurrence than coronal caries. is a common sequel to gingival recession Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes Radicular Ingress 2) Periodontal Pocket: Deepening of the gingival sulcus due to periodontal diseases (periodontal pockets) is suggested to increase atrophy and dystrophic calcifications in the dental pulp.  Periodontal Pocket May lead to pulp involvement Extending to lateral accessory canals. Bacterial Traumatic Iatrogenic Chemical Idiopathic Causes Causes Causes Causes Causes Radicular Ingress 3) Hematogenic Infection: The anachoretic attraction of bacteria to a lesion readily applies to injured pulp tissue. Anachoresis of bacteria from a systemic transient bacteremia explains the unusual number of infected pulp canals, following impact injury without fracture.