The pulp or pulp chamber is the soft area
within the centre of the tooth and contains
nerve, blood vessels, and connective
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.
ETIOLOGY OF PULPAL DISEASES
According to Grossman,
Mechanical Trauma : - Accidental (E.g. - Contact
- Iatrogenic dental procedure.
Cracked tooth syndrome
• 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
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.
• 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.
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.
Galvanic current due to interaction
Dental materials, acrylic Monomer.
Direct microbial invasion into the
Microbial colonization by blood-
Increased capillary permeability.
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
5. This is followed by liquefaction necrosis
of exposed site.
6. Eventually, necrosis spreads through
the pulp and if not treated, periapical
• 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
• Irreversible pulpitis is a persistent
Inflammatory condition of the pulp,
symptomatic or asymptomatic caused by a
• It may be acute or chronic.
REVERSIBLE PULPITIS IRREVERSIBLE PULPITIS
• Trauma, disturbed occlusal
• Thermal shock
• Excessive dehydration of
• 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
2. CHRONIC – Inflammation
due to long term low grade
injury. Large cavity,
Asymptomatic with pulp
• 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
1. Extraction of
2. And RCT
REVERSIBLE PULPITIS IRREVERSIBLE PULPITIS
1. Drainage of exudates
from pulp chamber.
2. Pulpotomy & placing
calcium hydroxide over
the entrance of the root
3. Root canal treatment.
4. Extraction of tooth.
• 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
• Also known as pulp polyp or
Overgrowth of pulp tissue outside
the boundary of pulp chamber as
A form chronic pulpitis.
Occurs either as a chronic lesion
from onset or as chronic stage of a
previously ACUTE PULPITIS.
CLINICAL FEATURES :
Children and young adults with
high degree of tissue resistance and
reactivity and responds to
Pulp – pinkish red globule of tissue
protruding from chamber and
extend beyond caries.
Most commonly affected are
deciduous molars and 1st
Lesion bleeds profusely on
1)Elimination of polypoid tissue followed by
extirpation of pulp, provided the tooth can be
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.
• Idiopathic slow or fast progressive resorptive process
occurring in the dentin of pulp chamber or root canals
• 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.
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.
A. Extirpation of pulp stops
B. PULP DEGENERATION
oPulp degeneration is usually present in teeth of old
oIt may also result in persistent, mild irritation in teeth of
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
• In atrophic degeneration fewer stellate
cells are present in pulp and intercellular
fluid is increased.
3. Fibrous degeneration :
• In this type of degeneration, pulp is characterised by replacement of
cellular elements fibrous connective tissue.
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.
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.
Causes : It can be due to any noxious insult
injurious to the pulp, such as bacteria, trauma
and chemical irritation.
Pulp necrosis may or may not arise with symptoms.
Signs and symptoms of pulpal necrosis include;
There are additional signs of pulp necrosis which may be
detected during radiographic assessment:-;
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.
. Pulp necrosis
Unrestored anterior teeth may
require endodontic treatment
because of pulp
necrosis caused by traumatic
Discoloration of tooth, tooth is greyish or brownish in
Pulp is dead.
Management : Root canal treatment.
Prognosis : Favourable.
• Grossman’s endodontic practice 12th edition
• Review article by Dan- Krister Rechenberg,
Jonah C. Galacia, and Ove A. Peters.
• Burket’s Oral medicine
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