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Pulpitis
Pulpitis
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Pulpitis

  1. 1. PULP INFLAMMATION By / Ahmed Elgamal
  2. 2. DEFINITION  Dental pulp is the soft CT of the tooth that supports and surrounded by dentin
  3. 3. DENTAL PULP ZONES The odontoblastic zone Consists of :  Cell body  Odontoblastic process which extend into predentin matrix The cell free zone Contain :  Blood capillaries  very small nerve fibers Function ?!! The cell rich zone Contain :  Blood vessels & nerves The central zone Contains :  Cells embedded in collagen matrix  Blood vessels  Lymphatics  Nerves Ahmed Elgamal
  4. 4. FUNCTION OF DENTAL PULP Induction Pulp induce dentine formation which induce enamel formation Dentin formation Nutrition Supplies nutrients essential for dentin via DT Defense  Form tertiary dentin in response to trauma  Immunologic inflammatory reaction Sensation Pulp is innervated by both sensory and autonomic nerve fibers
  5. 5. Causes of pulpitis mechanical traumatic iatrogenic attrition abrasion thermal Metallic R Cavity prep chemical erosion Acidic materials bacterial Open cavity Periapical inf
  6. 6. CLASSIFICATION pulpitis involvement involvement partial total severity acute chronic Communication between pulp & oral environment Open pulpitis Closed pulpitis severity reversible irreversible Pulp degeneration Pulp necrosis
  7. 7. REVERSIBLE PULPITIS Early mild transient pulpitis Called pulp hyperemia stimuli - Dilatation of pulpal BV - Collection of edematous fluid - increase pressure inside pulp pain
  8. 8. REVERSIBLE PULPITIS Clinical features  Sensitive to thermal change ( COLD )  Sharp pain lasting for a moment  Disappears after removal of stimuli  No history of spontaneous pain  No sensitivity to percussion  teeth show : ( deep caries & large metallic R & restoration with defective margins )
  9. 9. MANAGEMENT Diagnosis should be confirmed by a cold test Remove the cause before the pulp is severely damaged If the lesion is untreated , the duration of pain upon stimulation can become IRREVERSIBLE PULPITIS
  10. 10. IRREVERSIBLE PULPITIS Why an inflamed pulp might be symptomatic or asymptomatic ?
  11. 11.  Persistent inflammatory condition of pulp  Caused by ( chemical , thermal , mechanical , bacterial )  Pressure increases because of lack of escape of inflammatory exudate ACUTE PULPITIS
  12. 12. ACUTE PULPITIS Early stage Pain with cold and relived by heat Continuous & spontaneous sever pain even after removing stimulus Pain with lying down due to change in intrapulpal pressure Late stage More sever and throbbing pain even the tooth under constant pressure Pt. awake at night due to pain pain with heat and may relived by cold Clinical features  Pain may be referred EX : lower molars referring pain to the ear
  13. 13. Why Pt. has pain with cold in case of reversible and early stage of irreversible pulpitis ?! but in case of late stage has pain with hot ?! Pt. has pain with sweets ?! Referred pain with acute pulpitis and not with reversible pulpitis ?!
  14. 14. CLASSIFICATION OF CHRONIC PULPITIS Chronic closed pulpitis Chronic open ulcerative pulpitis Chronic open hyperplastic pulpitis Chronic open pulpitis
  15. 15.  There are fibroblastic activity  Newly formed capillaries  Deposition of collagen fibers ( as a local protective barrier to wall the infection )  Pulp abscess may present with granulation tissue Chronic pulpitis
  16. 16. CHRONIC OPEN ULCERATIVE PULPITIS  Entire or the greater part of pulp shows chronic inflammatory changes  The pulp is exposed to outside ( no dentine roof )  Edema escapes through the exposure  Minimum dull pain that become worse by thermal changes
  17. 17. CHRONIC HYPERPLASTIC PULPITIS  Also called pulp polyp  Essentially an excessive exuberant proliferation of chronically inflamed dental pulp tissue  Development of granulation tissue  Covered at time by epithelium  The tooth is VITAL
  18. 18. CAUSES  Long standing low grade infection  extensive carious exposure of a young pulp  Bacterial infection
  19. 19. CLINICAL FEATURES  Most commonly involved are primary molars & 1st permanent molar >> due to  Excellent blood supply  Large root opening  Asymptomatic except of feeling of pressure during mastication  in children and young adults  Tooth may or may not respond to thermal test
  20. 20.  Polypoid tissue appears Fleshy Reddish pulpal mass filling most of pulpal chamber May interferes with mouth closure Easily bleeds ( rich blood vessels )
  21. 21. The cause of pain in case of necrotic pulp ?!

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