Pulpitis Lecture Notes PDF

# Pulp ## Definition: Pulpitis: - Any inflammation of the pulp. - It is the most common cause for dental pain. ## Etiology of Pulpitis (Pulp Irritants) 1. Microbial (bacterial) 2. Mechanical 3. Chemical 4. Thermal 5. Electrical 6. Aerodontalgia (Barodontalgia) 7. Odonto-iatrogenic (dentist induc...

# Pulp ## Definition: Pulpitis: - Any inflammation of the pulp. - It is the most common cause for dental pain. ## Etiology of Pulpitis (Pulp Irritants) 1. Microbial (bacterial) 2. Mechanical 3. Chemical 4. Thermal 5. Electrical 6. Aerodontalgia (Barodontalgia) 7. Odonto-iatrogenic (dentist induced pulpitis) ### Microbial (bacterial) irritation Bacteria can reach the pulp through: 1. **Crown**: - Dental caries - Attrition or Abrasion - Fracture due to trauma 2. **Periodontal ligaments**: - Deep Periodontal pocket involving the periapical area - Deep Periodontal pocket communicating with Accessory root canals 3. **Haematogenous (blood born) infection**: - Anachoresis: a phenomenon in which circulating bacteria in the blood tend to localize in inflamed pulp (due to lack of oxygen) ### Mechanical irritation - Traumatic pulp exposure - Excessive tooth reduction - Rapid separation of teeth during orthodontic treatment ### Thermal irritation - Excessive heat generation by: - Bur or stone without coolant during cavity preparation - Setting of cement (exothermic reaction) - Polishing of restoration or teeth - Prolonged contact of thermal pulp testers, (hot or cold) - Deep metallic fillings without an efficient protective base ### Chemical Irritation - Odontoiatrogenic: by using irritant substances like alcohol, chloroform, zinc phosphate cement. - Acidic products of bacteria inces - Excessive gingival recession: the roots become exposed to the chemical agents found in some foods. ### Electrical irritation - When using two different metallic restorations (gold vs. amalgam) ### Aerodontalgia (Barodontalgia) - The pain in tooth caused by a change in atmospheric pressure. - Common with deep-sea divers and pilots flying at high altitudes. ## Dental Pulp is a delicate "loose" connective tissue which consists of: 1. Blood vessels 2. Nerves 3. Lymphatics 4. Undifferentiated C. cells ## The unique features of the pulp: 1. The pulp is enclosed by hard unyielding walls of dentin -> no swelling during inflammation. 2. Narrow apical foramen during inflammation an increased amount of blood enters, but less amount of venous drainage -> pulp congestion -> pulp necrosis. 3. Lack of collateral circulation if the primary blood supply is cut -> pulp necrosis. 4. The pulp responds very definitely to sudden temperature changes 5. Pain is the only sign of inflammation (no redness, hotness, swelling, or loss of functions). 6. Pain is difficult to be localized because the nerve supply of the pulp is free nerve endings ## Classifications of pulp disease: 1. **According to Type of inflammation** - **Acute pulpitis**: - High virulence of microorganism - Low host defense - Sharp severe pain - Short duration - **Chronic pulpitis**: - Low virulence of microorganism - High host defense - Dull pain - Long duration 2. **According to Extent of pulp involvement**: - **Focal or partial pulpitis**: - Confined to portion of pulp. - **Total or generalized pulpitis**: - Most of the pulp is involved. 3. **According to Presence of direct communication between pulp & oral cavity**: - **Open pulpitis**: pulp is communicated with the oral cavity - **Closed pulpitis**: pulp is not communicated with the oral cavity 4. **According to severity of inflammation**: - **Reversible pulpitis** - **Irreversible pulpitis** ## Focal Reversible Pulpitis (Pulp Hyperemia) - It is a mild transient pulpal inflammation. - The earliest form of pulpitis in which pulp is capable of full recovery (returning to un-inflammed state) if the irritating factor is removed. - Occur due to bacterial acid permeating along the dentinal tubules before bacterial invasion of the pulp. - **Causes**: - Deep carious lesions. - Large metallic restorations without adequate base. ## Clinical Features: - **Pain**: - Mild-to-moderate pain of short duration occurs when the tooth is exposed to thermal changes especially cold. - The pain disappear within seconds after the stimulus is removed. - No pain on percussion. - **Electric pulp testing**: - The tooth responds to electric pulp testing at lower levels of current than the control tooth. - **Percussion**: - No pain in Percussion. ## Histopathological features: 1. Vasodilatation and hyperemia (engorgement of blood vessels). 2. Edema of the pulp tissues. 3. Intact odontoblastic layer 4. Secondary dentin in adjacent dentinal wall ## Treatment: - By removal of the cause.