Oral Diagnosis I Third Year

1. Groap 2

2. Outline
• Definition.
• Causes.
• Types.
• Pulpitis - Histopathology.
• References.

3. Definition
• Pulpitis refers to the
inflammation of the dental
pulp within the tooth.
• The pulp contains:
– the blood vessels.
– the nerves.
– connective tissue inside a
tooth, provides nutrients.

4. Causes
Inflammation of the dental pulp, usually due
to:
 Bacterial infection in dental caries.
 Tooth fracture.
 Chemical irritants.
 Thermal factors.
 Traumatic exposure.
Any condition that cause exposure of the
tooth pulp.

5. Types
Once the pulp has become inflamed the tooth
can be diagnostically divided into two
categories:
1. Reversible pulpitis.
2. Irreversible pulpitis.
A. Pulp Necrosis.
B. Acute Pulpitis.
C. Chronic inflammation

6. Reversible Pulpitis (pulp hyperemia).
• A common condition affecting a tooth
accompanied by short-lived pain following
application of heat or cold; the pulp usually
recovers.
• It does not have to be treated as it will heal on
its own over time.

7. Irreversible Pulpitis: Pulp Necrosis
• A general term referring to
a dead pulp (one that does
not respond to standard
pulp tests); pulp death may
have been preceded by
acute or chronic
inflammation.

8. Irreversible Pulpitis: Acute Pulpitis
• A common condition affecting a tooth
accompanied by severe, relentless pain; the
acute inflammation associated with it
invariably causes pulp death requiring pulp
extirpation or extraction.

9. Irreversible Pulpitis: Chronic Pulpitis
• A common condition affecting a tooth
accompanied by dull, bearable pain; the
chronic inflammation associated with it
usually causes pulp death requiring pulp
extirpation or tooth extraction.

10. Symptoms and Signs
Acute pulpitis is usually associated
with:
 severe tooth pain.
The tooth becomes sensitive to hot or
cold foots and pressure, such as might
occur with chewing.
Acute reversible: sensitive to cold.
Acute irreversible: sensitive to hot &
cold.
Swelling.

11. Pulpitis - Histopathology
Poor correlation between microscopic changes & clinical
symptoms.
Inflammatory process may be modified by several factors :
1 : Nature, severity and duration of insult.
2 : Efficiency of host defenses.
3 : Efficiency of pulpo-dentinal complex defenses.
4 : Special anatomy of pulp: surrounded by hard tissue and
cannot tolerate edema.

12. Pulpitis - Histopathology
• Immune reactions in inflamed tissue may
contribute to tissue damage.
• Rate of progression of pulpitis is variable, but
end result of untreated pulpitis is total
necrosis except in the case of pulp polyp
formation.

13. Closed pulpitis:
whether acute or chronic, may
progress to necrosis due to limited
ability of pulp to withstand
inflammatory edema since it is
surrounded by hard tissues.

14. Closed pulpitis (general feature) :
• First type Acute closed pulpitis :
- Initiation of hyperaemia.
- Infiltration by inflammatory cells & destruction of adjacent
odonoblast.
- Formation of a little abscess.
- Pulp is obliterated by dilated BV & acute inflammatory cells.
• Second type Chronic closed pulpitis :
- main feature are a predominantly mononuclear cells.
- More vigorous connective tissue reaction.
- Small necrosis area + pus formation (granulation tissue)
- little abscess may form.

15. Open pulpitis or chronic hyperplastic
pulpitis (pulp polyp):
• Pulp is survive but large carious cavities.
• Young molar teeth with wide apices and good
blood supply.
• Usually devoid of sensation on gentle probing.
• Polyp consists of chronically inflamed
hyperplastic granulation tissue protruding from
pulp cavity.

16. Open pulpitis or chronic hyperplastic
pulpitis (pulp polyp):
• May become epithelialized by spontaneous
grafting of desquamated oral epithelial cells
from saliva.
• Histologically, odontoblasts survive & the pulp
is replaced by granulation tissue.

17. Treatment
 1-Drilling and filling for reversible pulpitis
 2-Root canal and crown for irreversible pulpitis
 3-or extraction
Causes of endodontic treatment failure:
 Presence of infected and necrotic pulp tissue in root
canal. (main cause)
 Over or incompletely filled teeth
 Excessive hemorrhage
 Chemical irritants (Hypersensitivity to the materials
used)

19. References
• Burket's Oral Medicine:
Diagnosis and Treatment.
• www.medicinenet.com
• www.ada.org
• Regazi , Oral Pathology.
• Mosby, Dental drug reference.