A concise information on diseases of pulp

1. DISEASES OF
DENTAL PULP
DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS
SHUBHAM PARMAR
INTERN

2. CAUSES OF
PULP DISEASE
 PHYSICAL CAUSES
A) Mechanical
1)Trauma – Accidental
Iatrogenic during dental procedures
2) Pathologic wear – Attrition
Abrasion
Bruxism
Abfraction
3) Crack through body of tooth ( cracked tooth
syndrome)
4) Barometric changes (Barodontalgia)

3. CAUSES OF
PULP DISEASE
 B) Thermal
1) Heat from cavity preparation, at either low
or high speed
2) Exothermic heat from the setting of cement
3) Conduction of heat and cold through
deep fillings without a protective base
4) Frictional heat caused by polishing a
restoration
 C) Electrical (galvanic current from dissimilar
metallic fillings)

4. CAUSES OF
PULP DISEASE
 CHEMICAL CAUSES
A) Phosphoric acid, acrylic monomer, etc.
B) Erosion (acids)
 BACTERIAL CAUSES
A) Toxins associated with caries
B) Direct invasion of pulp from caries or trauma
C) Microbial colonization in the pulp by
bloodborne microorganisms (Anachoresis)

6. CLASSIFICATION OF THE DISEASES
OF THE PULP
 INFLAMMATORY DISEASES OF THE DENTAL PULP
1) Reversible pulpitis
2) Irreversible pulpitis
a) Symptomatic irreversible pulpitis (previously known as acute
irreversible pulpitis)
b) Asymptomatic irreversible pulpitis (previously known as chronic
irreversible pulpitis)
c) Chronic hyperplastic pulpitis
d) Internal resorption

7.  PULP DEGENERATION
1) Calcific degeneration (radiographic diagnosis)
2) Atrophic degeneration (histopathologic diagnosis)
3) Fibrous degeneration
 PULP NECROSIS

8. SEQUELAE OF PULPAL DISEASES

9. Reversible Pulpitis
 Definition - Reversible pulpitis is a mild-to-moderate inflammatory
condition of the pulp caused by noxious stimuli in which the pulp is
capable of returning to the uninflamed state following removal of the
stimuli
 Cause - any agent that is capable of injuring the pulp (Trauma, Thermal
shock, excessive dehydration of a cavity, Chemical stimulus, as from sweet
or sour foodstuffs or from irritation of a filling; or bacteria, as from caries

10.  SYMPTOMS – Characterized by short, sharp pain lasting for a
moment
Pain is specific to a stimulus
Pain is instantly relieved on removal of the
stimulus
More often brought on by cold than hot food
or beverages and by cold air
Does not occur spontaneously
Does not continue when the stimulus has
been removed
Cause of the pain is generally traceable to a
stimulus, such as cold water
 DIAGNOSIS –Diagnosis is by a study of the patient’s
symptoms and by clinical tests
Application of cold is an excellent method of
locating and diagnosing the involved tooth

11.  Treatment – prevention is the best treatment for reversible
pulpitis
Periodic care
Early insertion of filling if a cavity has developed
Removal of noxious stimuli

12. Irreversible Pulpitis
 Definition - Irreversible pulpitis is a persistent inflammatory condition of the
pulp, symptomatic or asymptomatic in nature with the pulp
becoming incapable of healing
 Types - Asymptomatic irreversible pulpitis
Symptomatic irreversible pulpitis
 Cause - Bacterial involvement of the pulp through caries
Reversible pulpitis may deteriorate into irreversible pulpitis

13.  Symptoms – Sharp, piercing, or shooting type of pain
May be intermittent or continuous
In the early stages pain may be caused by
sudden temperature changes
Pain due to packing food into a cavity or
suction exerted by the tongue or cheek
Prolonged painful response to heat relieved by
cold
Pain occurs spontaneously
Pain often continues even after stimulus has
been removed
Postural pain may also be seen (nocturnal
pain)
In later stages pain is boring, gnawing, or
Throbbing type

14.  Diagnosis – Deep cavity extending to the pulp
Grayish, scum-like layer over the exposed pulp
Odour of decomposition
Radiograph may also show exposure of the
pulp
Thermal test may elicit pain that persists after
removal of the thermal stimulus
 Treatment – Root Canal Treatment
Pulpectomy
Pulpotomy
Extraction of tooth
if tooth is not
restorable

16. Chronic Hyperplastic Pulpitis (Pulp Polyp)
 Definition - Chronic hyperplastic pulpitis or pulp polyp is a productive
pulpal inflammation due to an extensive carious exposure of a
young pulp
 Characterized by the development of granulation tissue
 Cause - Slow, progressive carious exposure of the pulp
Young resistant pulp
Low grade stimulus
 Symptom- Symptomless, except during mastication

17.  Diagnosis – Seen in children and young adults
Reddish fleshy pulpal mass fills the pulp
chamber
Polyp tissue is less sensitive than normal pulp
and more sensitive than gingival tissue
Bleeds easily if cut
 Treatment – Elimination of polyp tissue followed by pulp
extirpation
Bleeding should be controlled with pressure

18. Internal Resorption
 Definition - Internal resorption is an idiopathic slow or fast progressive
resorptive process occurring in the dentin of the pulp chamber
or in the root canals of the teeth
 Cause – Patients have a history of trauma
 Symptoms – Asymptomatic if occurs in root
Manifest as a reddish area called PINK SPOT in the crown
 Treatment – Root Canal treatment using thermoplasticized gutta percha

20. Pulp Degeneration
 Calcific Degeneration - Pulp tissue is replaced by calcific material pulp
stones or denticles
Calcification are generally present in the pulp
chamber
Calcified material has a laminated structure like the skin of
an onion
Lies unattached within the body of the pulp
Pulp stones are present in more than 60% of adult teeth

21.  Diagnosis – Clinically asymptomatic
Crown may exhibit discoloration
Obliteration of the pulp space is evident
radiographically
 Treatment
o Asymptomatic Tooth - Aesthetic management of the
discoloured tooth with a full-coverage restoration or
laminate restoration
o Symptomatic Tooth - Endodontic therapy using a
microsurgical retrograde approach
Endodontic therapy is not recommended unless the
tooth is symptomatic

22. Pulp Degeneration
 Atrophic Degeneration – Seen in pulps of
older people
Observed histopathologically
Fewer stellate cells are present and
intercellular fluid is increased
Pulp tissue is less sensitive than normal
No clinical diagnosis exists
 Fibrous Degeneration - Characterized
by replacement of the cellular elements by
fibrous connective tissue
Pulp has the characteristic appearance of a
leathery fibre

23. Necrosis of Pulp
 Necrosis is death of the pulp
 May be partial or total
 Seen as a sequalae of inflammation or trauma
 Types - Coagulation necrosis - soluble portion of tissue is converted into a
solid material
Liquefaction necrosis – proteolytic enzymes convert the tissue into
a softened mass, a liquid, or amorphous debris

24.  Symptoms – Asymptomatic
Discoloration of the tooth
 Diagnosis – Radiographs show thickening of the
periodontal ligament
History of severe pain lasting from a few
minutes to a few hours and sudden cessation of
pain
Tooth does not respond to cold, electric pulp
test, or the test cavity
 Treatment – Root Canal Treatment

25. References
 Grossman’s Endodontic Practice 13e
 Cohen’s Pathways of Pulp 11e
 Google Images