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Pulpal diseases

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Diseases of pulp
Diseases of pulp
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Pulpal diseases

  1. 1. Prepared by : Addisu Dabi (Intern) Abraham Abebe (Intern) Temesgen Haregot (Intern)
  2. 2. Outline Introduction Causes of pulpal diseases Pathways of bacterial invasion of pulp Classification of pulpal diseases .Reversible pulpitis .Irreversible pulpitis .Pulp polyp .Internal resorption(pulp/root) .Pulp degeneration .Pulp necrosis
  3. 3. Introduction • Dental pulp consists of vascular connective tissue contained within the rigid dentin walls. • It is the principal source of pain within the mouth and also a major site of attention in endodontics and restorative treatment.
  4. 4. PATHWAYS OF BACTERIAL INVASION OF PULP A) Direct invasion by way of the dentin such as • Caries • Fracture of crown or root • Exposure during cavity preparation • Attrition, abrasion ,erosion • Crack in crown B) Invasion through open blood vessels or lymphatics –periodontal diseases, an accessory canal in furcation area, gingival infection. C) Invasion through blood such as during infectious diseases or transient bacteremia.
  5. 5. Grossman’s clinical classification of pulpal diseases 1. Pulpitis  a. Reversible – Symptomatic (Acute) – Asymptomatic (Chronic)  b. Irreversible pulpitis i. Acute a. Abnormally responsive to cold b. Abnormally responsive to heat ii. Chronic a. Asymptomatic with pulp exposure  b. Hyperplastic pulpitis  c. Internal resorption  2. Pulp degeneration a. Calcific (Radiographic diagnosis) b. Other (Histopathological diagnosis)  3. Necrosis
  6. 6. REVERSIBLE PULPITIS Definition: Reversible pulpitis is a mild to moderate inflammatory condition of pulp caused by noxious stimuli in which the pulp is capable of returning to un inflamed state following removal of stimulus.
  7. 7. Cause: Trauma Disturbed Occlusal relationship Thermal shock Overheating during polishing a filling Excessive dehydration of a cavity Symptoms: Sharp pain lasting for a moment which is mainly caused by cold beverages than hot foods.
  8. 8. Diagnosis: By the study of patients symptoms and by clinical tests, pain is sharp, lasts for few seconds and disappears when stimulus is removed. Differential diagnosis: Irreversible pulpitis. Treatment: Periodic care to prevent development of caries, early insertion of filling, desensitization of necks of teeth, use of cavity varnish or base.
  9. 9. IRREVERSIBLE PULPITIS Definition: Irreversible pulpitis is a persistent inflammatory condition of pulp, symptomatic or asymptomatic caused by a noxious stimulus. Cause: Caries Chemical ,thermal or mechanical irritation
  10. 10. Symptoms: • A paroxysm of pain is caused by sudden temperature change, pressure from packing foods into a cavity . • Pain continues on removal of cause has been removed. • Pain comes spontaneously without apparent cause. • Pain is of sharp piercing type. • It may be continuous or intermittent. • Change of position may increase intra pulpal pressure which may exacerbate the pain.
  11. 11. Differential diagnosis: Reversible pulpitis Asymptomatic irreversible pulpitis. Treatment: Complete removal of pulp or pulpectomy and the placement of an intra canal medicament.
  12. 12. CHRONIC HYPERPLASTIC PULPITIS/PULP POLYP Definition: Chronic hyperplastic pulpitis or pulp polyp is a productive pulpal inflammation due to an extensive carious exposure of a pulp.
  13. 13. Cause: • Slow ,progressive carious exposure of the pulp is the cause. Symptoms: • This condition is symptomless, except during mastication when pressure of food bolus may cause discomfort.
  14. 14. Diagnosis:  Fleshy reddish pulpal mass fills most of pulp chamber or extends beyond the confines of tooth This is characteristic feature of pulp polyp which is seen mostly in teeth of children and young adults . Radiographs show a large open cavity with direct access to pulp.  More current than normal is required to elicit response by means of electric pulp tester.
  15. 15. Differential diagnosis: Proliferating gingival tissue. Treatment: Elimination of polypoid tissue followed by extirpation of pulp.
  16. 16. INTERNAL RESORPTION Definition: Internal resorption is an idiopathic slow or fast progressive resorptive process occurring in the dentin of the pulp chamber or root canals of the teeth. Cause: Cause is not known. Often history of trauma present.
  17. 17. Symptoms: Internal resorption in root is asymptomatic. In crown it is seen as pink spot. Diagnosis: Internal resorptions are usually diagnosed during routine radiographic examination. Radiographically there will be a change in the wall of root canal or pulp chamber with a round or ovoid radiolucent area
  18. 18. Differential diagnosis: External root resorption. Treatment: Extirpation of pulp. Routine endodontic treatment. Obturation with plasticized guttapercha technique.
  19. 19. PULP DEGENERATION • It seen mostly in older people. Symptoms: • Early stages of pulpal degenerations are clinically asymptomatic. • In later stages tooth becomes discolored and pulp will not respond to stimulation. • Continuous degeneration of the tissue results in necrosis.
  20. 20. Cause: • Persistent and mild irritation in the younger people. • The various pulpal degenerations are: Calcific degeneration Atrophic/resorptive degeneration Fibrous degeneration
  21. 21. Calcific degeneration: In calcific degeneration part of pulp tissue is replaced by calcific material, that is pulp stones or denticles are formed. Atrophic/resorptive degeneration: In atrophic degeneration fewer stellate cells are present in pulp and intercellular fluid is increased. Fibrous degeneration: In this type of degeneration pulp is characterized by replacement of cellular elements fibrous connective tissue
  22. 22. Pulp stone Atrophic changes of pulp with age ….Continuous degeneration of the tissue results in necrosis…..
  23. 23. NECROSIS OF PULP Definition: Necrosis is death of the pulp. • It may be partial or total, depending on whether part of or entire pulp is involved. Cause: Caused by any noxious insult injurious to the pulp.
  24. 24. Necrosis is of 2 types - Coagulative necrosis:  sudden interruption of blood vessels  Protoplasm of all cells becomes fixed and opaque.  Cell mass is recognizable histologically, intracellular details lost. Liquefactive necrosis  Degradation of tissue  The entire cell outline is lost  The liquefied area is surrounded by dense zone of PMNL (dead or drying), chronic inflammatory cells.
  25. 25. Symptoms: Discoloration of teeth-Greyish or brownish discoloration. No painful symptoms. Partial necrosis responds to thermal changes. Diagnosis: • Radiograph shows thickening of periodontal ligament. • Necrosed pulp does not respond to thermal test Treatment: • Endodontic treatment
  26. 26. THANK U ! HAVE A NICE DAY ANY QUESTION?

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