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Pulpitis
Pulpitis
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Pulpitis

  1. 1. Pulpitis “ The pulp lives for the dentin and the dentin lives by the grace of the pulp. Few marriages in nature are marked by a greater affinity.” Alfred L. Ogilvie
  2. 2. PULP DENTIN COMPLEX The dental pulp is a soft tissue of mesenchymal orgin located in the center of a tooth. Specialized cells called odontoblasts are arranged peripherally in direct contact with the dental matrix. This close relationship between ododntoblasts and dentin – pulp dentin complex.
  3. 3. Odontoblast the multifunctional cell
  4. 4. Pulp is a microcirculatory system containing arterioles and venules
  5. 5. Pulp is unique Surrounded by rigid walls Susceptible to changes in pressure Minimal collateral blood supply Composed of simple connective tissue Lacks prioprioception Highly sensitive
  6. 6. Immune response in pulp Dendritic cells and macrophages bind to antigen T and B cells respond to antigens Immune response occurs Pulp tissue is presented with new antigen Innate response initiated Followed by specific response Bacteria enter Limited blood supply of pulp Low compliance chamber of pulp
  7. 7. Immune defense Primarily two mechanisms account for this effect: (i) The peripherally directed flow of dentinal fluid (ii) The absorbance of bacteria and bacterial macromolecules to the inner walls of the tubules Thereby, dentin is able to temper exposures of noxious elements to the pulp, allowing it to adapt and organize an effective immune defense response.
  8. 8. Non specific immune response Acids and enzymes of bacteria dissolve enamel and dentin Permeability increases Toxins diffuse in to dentinal tubules Macrophages and neutrophils are activated Odontoblasts are first cells to be contacted by toxic bacterial broth
  9. 9. Haemodynamic changes of pulp in caries Blood flow increased in few experiments Interstitial fluid pressure increases by the movement of fluid from the capillaries to the interstitial space
  10. 10. Neural changes in pulpitis Sympathetic activity inhibits odontoclasts Afferent fibers release neuropeptides- substance P, calcitonin gene related peptide Vasodilatation and capillary permeability increases with these neuropeptides In injured pulps – Nerve growth factor increases Sprouting of sensory nerve fibers occurs within next day of injury
  11. 11. Neuropeptides are transported via axonal blood flow to nerve terminals in the pulp
  12. 12. Etiology of pulpitis  Dental caries  Traumatic exposure  Thermal changes  Fracture of crown  Chemical irritation  Cracked tooth syndrome
  13. 13. Abott etal 2007
  14. 14. Diseases of pulp( grossman)  Pulpitis  Acute serious  Acute suppurative  Chronic ulcerative  Chronic hypertrophic  Pulp degeneration  Calcific  Fibrous  Atrophic  fatty  Necrosis or gangrene of pulp
  15. 15. Pulpitis- response to injury  The severity of the caries determines the fate of the pulp. (Smith, 2002) Mild injury such as slowly progressing caries in the dentin, mild abrasion and erosion, fracture of the enamel and dentin, chemical irritation. (D. Tziafas, 2004)  Up regulation of biosynthetic activity of primary odontoblasts to form tertiary dentin
  16. 16.  Extent Of Injury To Pulp Severe dentinal injury with no exposure of pulp Cases with Rapidly progressive caries During Cavity preparation Cytotoxic injury in pulpal cells during restoration. Dead tracts form
  17. 17. Severe injury A. Odontoblasts under injury site are destroyed (forming dead tracts). B. Inflammatory-healing cascade occurs. C. Proliferation of pulpal cells into the dentin surrounding the pulp. D. Fibroblast cells laid down as fibrodentin on dentin-pulp border. E. If cariogenic environment is removed, new generation odontoblast-like cells (dentin forming cells) differentiate from pulp to form tubular tertiary dentin.
  18. 18. Symptoms of pulpitis Acute pulpitis Chronic pulpitis  Noticeable pain  Worsened by lying down  Acute sensitivity to hot and cold Seen commonly in adolscents and children  Less noticeable pain  Found in adults
  19. 19. REVERSIBLE PULPITIS  The pain is of very short duration and does not linger after the stimulus has been removed.  The tooth is not tender to percussion.  The pain may be difficult to localize.  The tooth may give an exaggerated response  to vitality tests.  The radiographs present with a normal appearance, and there is no apparent widening of the periodontal ligaments.
  20. 20. IRREVERSIBLE PULPITIS  There is often a history of spontaneous bouts of pain which may last from a few seconds up to several hours.  When hot or cold fluids are applied, the pain elicited will be prolonged. In the later stages, heat will be more significant; cold may relieve the pain.  Pain may radiate initially, but once the peri- odontal ligament has become involved, the patient will be able to locate the tooth.  The tooth becomes tender to percussion once inflammation has spread to the periodontal ligament.  A widened periodontal ligament may be seen on the radiographs in the later stages.
  21. 21. DIFFERENCES Reversible pulpitis Irreversible pulpitis  Mild- moderate inflammation  No lingering pain  Sharp pain especially to cold  No spontaneous pain  Reverses upon removal of etiology  A delta fiber stimulation  Persistent inflammatory condition- noxious stimulus  Rapid onset of pain  Pain is spontaneous  Exacerbated on bending or lying down  Referred pain  Boring, throbbing, severe in later stages

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