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Diseases of pulp

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Diseases of pulp

  1. 1. DISEASES OF PULP Prepared by :- Shagun Kumar (BDS, 2015-19) Guided by :- Dr. Sachin Mittal Dr. Shubhankar Dasgupta Dr. Zeba Rao
  2. 2. CONTENTS •Introduction •Etiology •Classification •Bibliography
  3. 3. INTRODUCTION The pulp or pulp chamber is the soft area within the centre of the tooth and contains nerve, blood vessels, and connective tissue. Dental pulp is the formative organ of the tooth and responds to hot and cold stimulus, that are perceived as pain. The pulp’s sensory role is important, but it has other roles as well. The pulp functions to form dentin, among other things. It supplies nutrients and moisture the surrounding areas of the tooth. The pulp also helps protect the tooth. Pulpitis refers to the inflammation of pulp. It is mainly caused by an opportunistic infection of the pulp space with commensal oral microorganisms. 06-04-2022
  5. 5. ETIOLOGY OF PULPAL DISEASES According to Grossman, 1. Physical Mechanical Trauma : - Accidental (E.g. - Contact sports) - Iatrogenic dental procedure. Pathological wear Cracked tooth syndrome Barometric changes
  6. 6. • Mechanical Trauma May be caused by a violent blow to the tooth during sports, accidents, fights etc. • Pathologic wear of teeth leading to pulp exposure due to attrition and abrasion, or compulsive bruxism.
  7. 7. Cracked tooth syndrome • Incomplete fracture through body of the tooth, including cracked enamel that can be appreciated with the help of dye or by trans illumination. • Diagnosed by reproducing the pain by asking patient to bite on rubber wheel. Mild to excruciating pain can be experienced on biting.
  8. 8. • Barodontalgia or Aerodontalgia is observed in altitudes above 50,000 ft. Usually occurs in patients with chronic pulpitis but not on ground level. • During ascend, trapped gases expand and move into the dentinal tubules. Movement of contents from the pulp chamber to the apex causes pain.
  9. 9. • Thermal Heat from cavity preparation and Exothermic reactions from setting of cements. ( 20° and 30° rise in temperature at 1mm and 0.5mm from the pulp chamber, respectively.) Frictional heat from polishing a restoration.
  10. 10. 2. Electrical Galvanic current due to interaction dissimilar metals 3. Chemical Erosion Dental materials, acrylic Monomer. 4. Bacterial Direct microbial invasion into the pulp. Microbial colonization by blood- borne microorganisms(anachoresis). Increased capillary permeability.
  11. 11. PULPAL PATHOSIS 1. Deep invasion by microbes and their byproducts into the dentin. 2. The pulp is affected by byproducts first, before actual bacterial invasion. (Via exposed dentinal tubules) 3. Local cellular invasion. 4. When bacterial invasion occurs, Polymorphonuclear neutrophils are infiltrated in the pulp. (first line defense) 5. This is followed by liquefaction necrosis of exposed site. 6. Eventually, necrosis spreads through the pulp and if not treated, periapical 06-04-2022
  13. 13. WHO CLASSIFICATION • K04.0 : Pulpitis/pulpal hyperaemia/pulpal abscess/pulp polyp, acute/ chronic hyperplastic/ ulcerative pulpitis • K04.1 : Necrosed pulp/pulp gangrene • K04.2 : Pulp degeneration, denticles/ pulp calcification • K04.3 : Abnormal hard tissue formation in pulp secondary or irregular dentin.
  14. 14. DISEASES OF THE PULP Accordingto Grossman:- • PULPITIS 1. Reversible Pulpitis (Symptomatic, Asymptotic) 2. Irreversible Pulpitis [ Acute—(a) Abnormally responsive to cold, (b) Abnormally responsive to heat. Chronic —–(a) Asymptotic with pulp exposure (b) Hyper-plastic pulpitis (c) Internal resorption. ] • PULP DEGENERATION 1. Calcific (Pulp stones or Denticles) 2. Atrophic 3. Fibrous • NECROSIS OF PULP
  15. 15. A. PULPITIS
  16. 16. DEFINITION : • Reversible Pulpitis denotes a level of pulpal inflammation in which the tissue is capable of returning to the normal state if the noxious stimuli are removed. Also referred to as “PULP HYPERAEMIA”. • Irreversible pulpitis is a persistent Inflammatory condition of the pulp, symptomatic or asymptomatic caused by a noxious stimulus. • It may be acute or chronic. REVERSIBLE PULPITIS IRREVERSIBLE PULPITIS
  17. 17. REVERSIBLE PULPITIS • Trauma, disturbed occlusal relationship. • Thermal shock • Excessive dehydration of cavity. • Irritation of exposed dentin. • Chemical stimulus. • Divided into 1. ACUTE – Occurs as a sequelae of reversible Pulpitis. Presents as an acute condition. An acute exacerbation of chronic pulpitis. 2. CHRONIC – Inflammation due to long term low grade injury. Large cavity, Asymptomatic with pulp exposure. IRREVERSIBLE PULPITIS ETIOLOGY Irreversible pulpitis
  18. 18. SIGNS AND SYMPTOMS lead
  19. 19. • Prevention • Periodic care • Carious lesion should be excised and restored or defective filling is replaced. • Removal of noxious stimuli. • If primary cause is not corrected, extensive pulpitis may result in the death of pulp. Chronic : 1. Extraction of tooth 2. And RCT TREATMENT REVERSIBLE PULPITIS IRREVERSIBLE PULPITIS Acute : 1. Drainage of exudates from pulp chamber. 2. Pulpotomy & placing calcium hydroxide over the entrance of the root canal. 3. Root canal treatment. 4. Extraction of tooth.
  20. 20. • Cap. Amoxicillin 500mg + clavulanic acid 125mg administered TDS for 5 days (Maximum dose : 40 mg/kg/day or 2-3 g/25hr) • Tab. Diclofenac sod. 50mg + Paracetamol 500mg administered BD x 3 days • Tab. Pantoprazol 40mg OD x 3 days
  21. 21. CHRONIC HYPERPLASTIC PULPITIS • Also known as pulp polyp or pulpitis aperta Overgrowth of pulp tissue outside the boundary of pulp chamber as protruding mass. A form chronic pulpitis. Occurs either as a chronic lesion from onset or as chronic stage of a previously ACUTE PULPITIS. 06-04-2022
  22. 22. CLINICAL FEATURES : Children and young adults with high degree of tissue resistance and reactivity and responds to proliferative lesions. Pulp – pinkish red globule of tissue protruding from chamber and extend beyond caries. Most commonly affected are deciduous molars and 1st permanent molars. Lesion bleeds profusely on provocation.
  23. 23. Pulp polyp
  24. 24. TREATMENT 1)Elimination of polypoid tissue followed by extirpation of pulp, provided the tooth can be restored. 2)After the removal of the hyperplastic pulp mass with a curette or spoon excavator, bleeding is controlled with pressure. 3)The pulp tissue of chamber is completely removed and a temporary dressing is sealed in contact with radicular pulp tissue.
  25. 25. INTERNAL RESORPTION • Idiopathic slow or fast progressive resorptive process occurring in the dentin of pulp chamber or root canals of teeth. • When there is insult leading to inflammation (trauma, bacteria, tooth whitening, orthodontic movement, periodontal treatment) in the root canal/s or beside the external surface of the root, cytokines are produced, and osteoclasts are activated and resorb the root surface • Such patients often have a history of trauma. SYMPTOMS : 1. The root of the tooth is asymptomatic. 2. In crown, it is manifested as a reddish area called as “Pink tooth of mummery” 3. The reddish area represents the granulation tissue showing through the resorbed area of crown.
  26. 26. TREATMENT A. Extirpation of pulp stops internal resorption.
  27. 27. B. PULP DEGENERATION oPulp degeneration is usually present in teeth of old people. oIt may also result in persistent, mild irritation in teeth of young patients.
  28. 28. TYPES OF PULPAL DEGENERATION 1.Calcific degeneration :- • In this, part of pulp is replaced by calcific material i.e., pulp stone or denticle. • It may occur in the root canal or pulp chamber. 1. : 2. Atrophic/Resorptive degeneration : • In atrophic degeneration fewer stellate cells are present in pulp and intercellular fluid is increased. 1. 2. 3. Fibrous degeneration : • In this type of degeneration, pulp is characterised by replacement of cellular elements fibrous connective tissue.
  29. 29. C. NECROSIS OF PULP  It is the death of pulp  It may be partial or total, depending on whether part, or the entire pulp is involved.
  30. 30. Types : Coagulation Caseation Liquefaction Death of pulp tissue may be with or without bacterial invasion. When the necrosis is due to ischemia with superimposed bacterial infection, it is referred to as pulp gangrene. When the necrosis is non-bacterial in origin, it is called pulp mummification.
  31. 31. Causes : It can be due to any noxious insult injurious to the pulp, such as bacteria, trauma and chemical irritation. Dental caries Trauma Treatment Pulpitis Infection
  32. 32. Pulp necrosis may or may not arise with symptoms. Signs and symptoms of pulpal necrosis include; . Pain Crown discolourat ion Abscess an d/or fistula Internal root resorption Increased tooth mobility There are additional signs of pulp necrosis which may be detected during radiographic assessment:-; Untreated caries Extensive/ deep restoration Previous pulp capping However, in some cases there may be no radiographic signs. For example, pulp necrosis caused by dental trauma which may only manifest/present itself with time, resulting in clinical changes.
  33. 33. . Pulp necrosis following trauma Unrestored anterior teeth may require endodontic treatment because of pulp necrosis caused by traumatic injury
  34. 34. Discoloration of tooth, tooth is greyish or brownish in colour. Pulp is dead. Management : Root canal treatment. Prognosis : Favourable.
  35. 35. BIBLIOGRAPHY • Grossman’s endodontic practice 12th edition • Review article by Dan- Krister Rechenberg, Jonah C. Galacia, and Ove A. Peters. • Burket’s Oral medicine