Pulp Diseases (Lecture) PDF

Pulp Diseases Dr. Mohamed Arafa Lecturer of Oral and Maxillofacial Pathology Sequela of Dental caries  Pulp The dental pulp is a delicate connective tissue consisting of: -Tiny blood vessels. -Lymphatics. -Myelinated nerve, and unmyelinated nerves. -Undifferentiated connective...

Pulp Diseases Dr. Mohamed Arafa Lecturer of Oral and Maxillofacial Pathology Sequela of Dental caries  Pulp The dental pulp is a delicate connective tissue consisting of: -Tiny blood vessels. -Lymphatics. -Myelinated nerve, and unmyelinated nerves. -Undifferentiated connective tissue cells.  Unique features of the pulp Dental pulp has some unique features which include: 1. Encased by unyielding walls of dentin. 2. Narrow apical foramen from which nerves, arteries and veins enter. 3. Lack of collateral circulation. 4. The pulp responds very definitely to sudden temperature changes. 5. Pain is the only sign. 6. The nerve supply of the pulp is free nerve ending only.  Pulp Diseases Pulpitis Pulp necrosis Pulp degeneration Reversible Irreversible Calcification Pulp hyperemia Acute Chronic Closed Opened Closed Opened Hyperplastic Ulcerative  Pulpitis Definition: It is the inflammation of the dental pulp regardless of the presence or absence of infectious agent. It is the most common reason for dental pain. Pulp irritants: 1. Microbial (bacterial). 2. Mechanical. 3. Thermal. 4. Chemical. 5. Electrical. 6. Aerodontalgia. 1. Microbial (bacterial)  Bacterial irritation 1. Dental caries. 2. Trauma or “Dentist-induced” pulpitis. 3. Periodontal disease. 4. Anachoresis.  Bacterial irritation The principal pathways by which bacteria may gain entrance into the pulp: 1. Dental caries. 2. Trauma or “Dentist-induced” pulpitis. 3. Periodontal disease. 4. Anachoresis.  Bacterial irritation The principal pathways by which bacteria may gain entrance into the pulp: 1. Dental caries. 2. Trauma or “Dentist-induced” pulpitis. 3. Periodontal disease. 4. Anachoresis. 2. Mechanical irritant 1. Accidental due to trauma. 2. Odontoiatrogenic. Odontoiatrogenic a. Traumatic restorative procedures. b. Rapid separation of teeth. c. Traumatic occlusion.  3. Thermal irritation Teeth respond to sudden temperature changes. The range of response extends from 20°C to 45°C. Too hot or too cold stimuli may produce pulpitis. 1) Excessive heat during tooth preparation. 2) Exothermic dental materials. 3) Large metallic fillings without an efficient lining. 4) Frictional heat caused by polishing a restoration. 5) Prolonged contact of thermal pulp tester.  4. Chemical irritation 1. Drying the cavities by alcohol. 2. Improper mixing of cement. 3. Gingival recession. 4. Acidic products of bacteria in caries.  5. Electrical irritation Galvanic shock 6. Aerodontalgia (Barodontalgia) It is a pain in tooth caused by a change in barometric pressure.  Classification Pulpitis can be classified according to: 1. Type of inflammation. 2. Extent of pulp involvement. 3. Presence of direct communication between pulp with oral cavity. 4. Severity of inflammation.  Communication Type of Extent of pulp between pulp inflammation involvement with oral cavity Acute Partial Opened Chronic Total Closed  Inflammation Chronicity quiescence Acute Chronic Acute exacerbation High virulence Low virulence Low host defense High host defense Short period Long period Sharp pain Dull pain  Pulp Diseases Pulpitis Pulp necrosis Pulp degeneration Reversible Irreversible Calcification Pulp hyperemia Acute Chronic Closed Opened Closed Opened Hyperplastic Ulcerative  Focal reversible pulpitis Pulp hyperemia. It is a mild transient pulpal inflammation. ✓ Occur due to bacterial acid permeating along the dentinal tubules before bacterial invasion of the pulp. ✓ Cause: Deep carious lesion, large metallic restoration without a base or restorations with defective margins.  Focal reversible pulpitis Clinical features Nature of pain: Mild to moderate - intermittent - short duration. Thermal stimuli: most to cold stimuli. Percussion: No pain. Electric pulp test: tooth responds at lower level of current. Pulp hyperemia Histopathology 1. Vasodilatation of blood vessels. 2. Edema. 3. Intact odontoblastic layer. 4. Reparative secondary dentin.  Pulp hyperemia Treatment: Removal of the irritant Carious tooth → filling Defective restoration → replacement  Pulp Diseases Pulpitis Pulp necrosis Pulp degeneration Reversible Irreversible Calcification Pulp hyperemia Acute Chronic Closed Opened Closed Opened Hyperplastic Ulcerative  Acute Pulpitis Occur as a result of: Progression of Pulp hyperemia. Acute exacerbation of Chronic pulpitis. Pulp hyperemia Acute Pulpitis Chronic Pulpitis  Acute Pulpitis Clinical features Nature of pain: **Early: Sharp, Severe. **Late: Throbbing, Lancinating, Continuous. Thermal stimuli: **Early: Thermal stimulation especially Cold. **Late: Spontaneous. Pain relief: **Late: heat increase the pain but cold produce relief.  Acute Pulpitis Clinical features Percussion: No pain. Electric pulp test: **Early: responds at lower levels of current. **Late: responds at higher levels of current.  Histopathology 1. Vascular dilatation. 2. Oedema. 3. Destruction of odontoblastic layer. 4. Infiltration of polymorphonuclear leucocytes (PMNLs). 5. Pus formation. Treatment  Pulp Diseases Pulpitis Pulp necrosis Pulp degeneration Reversible Irreversible Calcification Pulp hyperemia Acute Chronic Closed Opened Closed Opened Hyperplastic Ulcerative  Chronic pulpitis It is an inflammatory reaction of pulp that results from long-term, low-grade injury and high tissue resistance which stimulates the formation of granulation tissue as an attempt for healing. Can occur as a sequel of acute pulpitis, pulp capped following traumatic exposure or anachoretic pulpitis.  Chronic closed pulpitis The long-term, low-grade irritation will stimulate: a. Odontoblasts to form reparative dentin. b. Dentinal sclerosis. c. Ingress of chronic inflammatory cells and formation of granulation tissue. Chronic closed Pulpitis Clinical features Pain: Dull, aching. Stimuli: Heat and Cold but less than the acute. Percussion: Not sensitive. Electric pulp tester: Respond at a higher level than normal. Chronic closed Pulpitis Histopathology 1. Reparative dentin. 2. Granulation tissue. a. fibroblasts. b. Newly formed collagen fibrils. c. Newly formed blood vessels. 3. Chronic inflammatory cells. Treatment  Pulp Diseases Pulpitis Pulp necrosis Pulp degeneration Reversible Irreversible Calcification Pulp hyperemia Acute Chronic Closed Opened Closed Opened Hyperplastic Ulcerative  Chronic open hyperplastic pulpitis Pulp Polyp. Essential features: ▪ Child and young age. ▪ Large carious cavity and wide pulp exposure. ▪ Wide apical foramen. ▪ Deciduous molars and first permanent molars.  Pulp polyp Clinical features Pink - Reddish mass protruding from the large opened pulp chamber. Painless. May or may not bleed. Percussion: not sensitive.  Pulp & Gingival Polyp Pulp Polyp Gingival Polyp  Histopathology A mass of granulation tissue infiltrated with chronic inflammatory cells. It may be covered by stratified squamous epithelium.  Treatment Cauterization of the polyp, then Root canal therapy.  Pulp Diseases Pulpitis Pulp necrosis Pulp degeneration Reversible Irreversible Calcification Pulp hyperemia Acute Chronic Closed Opened Closed Opened Hyperplastic Ulcerative  Chronic open ulcerative pulpitis It is a chronic inflammation in a carious tooth with exposed pulp. Appears as ulcerated lesion in a large carious cavity. Painless. Electric pulp tester: Respond at higher level of current. Replaced pulp tissue by granulation tissue.  Pulp Diseases Pulpitis Pulp necrosis Pulp degeneration Reversible Irreversible Calcification Pulp hyperemia Acute Chronic Closed Opened Closed Opened Hyperplastic Ulcerative Pulp necrosis Death of the pulp. Cessation of all symptoms. Discoloration of tooth. Cracks & fracture. Pulp necrosis The pulp tissues break up into debris, becoming structureless. ❖ Pulp gangrene. Treatment: RCT Include an iconic picture from the era.