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Pathology of pulp and its sequels

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Pulp & Periapical Diseases
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Pathology of pulp and its sequels

  1. 1. PATHOLOGY OF PULP AND ITS SEQUELS Definition, classification and consequences
  2. 2. Inflammation of pulp (pulpitis) Definition, causes, clinical findings and classification
  3. 3. What is pulp? What is pulpits? How does pulpitis takes place (mechanism)? Definition and classification01 Major causes and risk factors Clinical features02 What are signs and symptoms? complications03 How many divisions need to be under consideration to obtain a good classification for pulpal inflammation? Management04
  4. 4. Bright Smile With Regular Dental Checkup PULP What is pulp? Pulp is inner portion of tooth after enamel and dentin which has been described as both a highly resistant organ and as an organ with little resistance or recuperating ability. It is a delicate connective tissue liberally interspersed with tiny blood vessels, lymphatics, myelinated and unmyelinated nerves, and undifferentiated connective tissues cells.
  5. 5. Tooth structure Periapical tissue Dentin Pulp Enamel
  6. 6. WHAT IS PULPITIS? Pulpitis or inflammation of the pulp in human teeth occurs most commonly secondary to dental caries that has penetrated the enamel and dentin, and is usually associated with pain. Because of the intimate relationship between dentin and pulp, together they have been termed the dentinopulp complex, which emphasizes the fact that an insult to dentin can also insult pulp. The inflammatory response by pulp includes the development of edema and the influx of lymphocytes, plasma cells, and macrophages. Due to pulp being completely encased in its rigid dentinal chamber, the inflammatory response increases the pressure in the pulp chamber/horn that can cause a collapse of the venous microcirculation. This can result in areas of pulpar hypoxia and anoxia that may lead to localized or generalized pulp necrosis and death. If the pulp survives, it allows tertiary dentin formation to seal off the area of insulted (e.g., exposed) pulp, and this hopefully results in complete resolution of the pulpitis.
  7. 7. Classification
  8. 8. Causes and risk factors Mechanical (attrition, abrasion, trauma …) Thermal (uninsulated restorations, polishing…) Chemical (erosions due to dental materials’ acids and base properties) Bacterial (anachoresis, streptococci, staphylococci) Heat Chemical Mechanical Bacterial Life-style Life-style (tobacco, high sugar diet, chronic bruxism, poor oral hygiene habit…)
  9. 9. Reversible pulpitis: It is a mild to moderate inflammatory condition of the pulp caused by noxious stimuli in which the pulp is capable of returning to un-inflammed state following removal of the stimuli. Irreversible pulpitis: It is a persistent inflammatory condition of the pulp, which may be symptomatic or asymptomatic and is caused by a noxious stimulus. It is by bacterial involvement of the pulp through caries, although many clinical factors, chemical, thermal or mechanical injury may also be the cause. Reversible vs irreversible Clinical differences The pain of irreversible pulpitis is more severe and lasts longer. In reversible pulpitis, the cause of pain is generally traceable to a stimulus such as cold water or air whereas in irreversible pulpitis, the pain may come without any apparent stimulus.
  10. 10. DEFINITION MECHANISM CLINICAL FEATURES • It is a productive pulpal inflammation developed from granulation tissue, covered by epithelium, resulting long-term with low-grade pulpal infectious exposure. • In order to a polyp be developed, a large open cavity (pulpitis operta), a young resistant pulp and a chronic low-grade stimulus are necessary. • Mostly involved teeth are deciduous molars and first permanent molars of children and youngs due to large root openings and well blood supply. It appears as a fleshy, reddish pulpal mass, filling most of the pulpal chamber and sometimes even more that interferes comfortable closure. It is asymptomatic, more resistant that pulp tissue but less resistant than gingiva. Due to pressure during chewing bolus, pain may be felt and bleeding may happen (because of large venous mesh Chronic pulp hyperplasia (pulp polyp)
  11. 11. What is PULP DEGENERATION Present in elder people as a result of persistent irritants in teeth since youngsters. In early stages, there are no symptoms and no clinical findings. As degeneration progresses, the tooth may become discolored and the pulp within does not respond to stimuli. Calcific degeneration—A part of pulp tissue is replaced by calcific material that is pulp stones and denticles are formed. The calcific material has a laminated structure like the skin of an onion and lies unattached within the body of pulp. In another type of calcification, the calcified material is attached to the wall of the pulp cavity and is an integral part of it which is called as diffuse calcification. Atrophic degeneration—It is observed in older people. The pulp tissue is less sensitive than normal. Fibrous degeneration—It is characterized by replacement of the cellular element by fibrous connective tissue. On removal from the root canal, the pulp has the characteristic appearance of a leathery fiber.
  12. 12. PULP CALCIFICATION Various forms of pulp calcifications are found within the pulp which may be located in the pulp chamber or in the root canals. It can occur in any sex and in any teeth in the dental arch. They can be seen in forms of pulp stones, pulp denticles and pulp diffuse calcification. CLINICAL FANIFESTATION There is no clear-cut etiology. There is no relation between pulpal inflammation and irritation, as that arising from caries or trauma, since pulp calcification can be found in unerupted teeth. Extremely high percentage of pulp stones yield pure growth of streptococci on culture but often the affected teeth are normal. ETIOLOGY
  13. 13. SEQUELS OF PULPITIS If none of the irritating products of pulp necrosis reach the periapical tissue, then no periapical pathos is induced. Carious tooth (reversible state) Pulpitis (irreversible state) Pulp necrosis (no treatment applied) Periodontal diseases (infections spread through root canal into periodontal tissues) STEP 1 STEP 2 STEP 3 STEP 4 STEP 5
  14. 14. An abscess is a localized collection of pus, surrounded by an area of inflamed tissue in which hyperemia and infiltration of leucocytes is marked. Periapical abscess is a localized collection of pus in the alveolar bone, at the root apex of a tooth, following death of the pulp. PERIAPICAL ABCESS
  15. 15. It develops in the periapical region of the tooth as sequelae to necrosis of pulp. Pain is severe and of throbbing type. Periapical abscess may confine to osseous structures and during the early period of abscess formation, may cause excruciating pain without observable swelling. The patient may appear pale, irritable and weak from pain, loss of sleep as well as from absorption of septic products. He may have slight fever (99 to 100°F). Patients experience sensitivity or pressure in the affected area. Ice relives the pain and heat intensifies it aspiration yield yellowish pus. The tooth becomes more painful, appears elongated and mobile.
  16. 16. Establish drainage immediately, if possible — may be done by opening the pulp chamber and passing file through the canal into the periapical region. Antibiotics like Penicillin 500 mg, qid, for 5 days and analgesics should be given. In 24 to 48 hours, it can be determined if the tooth can be treated endodontically or extraction is necessary. MANAGEMENT
  17. 17. DRY SOCKET Dry socket (alveolar osteitis) is a painful dental condition that sometimes happens after you have a permanent adult tooth extracted. Dry socket is when the blood clot at the site of the tooth extraction fails to develop, or it dislodges or dissolves before the wound has healed. Exposure of the underlying bone and nerves results in intense pain, not only in the socket but also along the nerves radiating to the side of your face. The socket becomes inflamed and may fill with food debris, adding to the pain. If you develop dry socket, the pain usually begins one to three days after your tooth is removed. Dry socket is the most common complication following tooth extractions, such as the removal of third molars (wisdom teeth).
  18. 18. Clinical features & causes Signs and symptoms  Severe pain within a few days after a tooth extraction  Partial or total loss of the blood clot at the tooth extraction site, which you may notice as an empty- looking (dry) socket  Visible bone in the socket  Pain that radiates from the socket to your ear, eye, temple or neck on the same side of your face as the extraction  Bad breath or a foul odor coming from your mouth  Unpleasant taste in your mouth Causes and risk factors  Bacterial contamination of the socket  Trauma at the surgical site from a difficult extraction, as with an impacted wisdom tooth  Smoking and tobacco use.  Oral contraceptives.  Improper at-home care.  Having dry socket in the past.  Tooth or gum infection.
  19. 19. It is composed of dense fibrous tissue and is situated at the periapex of pulpless tooth, in which usually Confined in the periapical area, which leads to accumulation of chronic inflammatory cells. Young fibroblasts, endothelial cells and capillaries proliferate, which lead to granuloma formation. After endodontic treatment, the granuloma resolves, but in some cases, granulation tissue gets slowly organized with the production of more and more collagen fibers, which in turn leads to scar formation. PERIAPICAL SCAR
  20. 20. Clinical features of apical scar It occurs usually after endodontic treatment and in patients treated by periapical curettage or root resection. It is more common in anterior region of maxilla. Tooth is nonvital and the patient is asymptomatic. Periapical scar (fibrous scar)
  21. 21. MANAGEMENT Removal of polyp Polypectomy Prevention Cleansing root canals and disinfecting Placing intracanal medicament RCT (root canal therapy) Removing pulp partially (coronal) or completely Pulpotomy and Pulpectomy
  22. 22. EVERYTHING IS CHANGED WITH PREVENTION
  23. 23. By: Dr.Ali Karimyar 9722070
  24. 24. THANK YOU

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