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Etiology of pulp diseases

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Diseases of the pulp
Diseases of the pulp
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Etiology of pulp diseases

  1. 1. Good afternoon
  2. 2. The dental pulp loose connective tissue occupying a cavity lying in center of dentin.
  3. 3. Morphology
  4. 4. FUNCTIONS OF DENTAL PULP • Nutrition : blood supply • Sensation : temp – vibration – chemicals • Formative : maintain of dentin • Protective : formation of tertiary dentin • Defensive : inflammatory response
  5. 5. Dentin Pulp corePredentin Odontoblasts layer Cell free zone Cell rich zone Histology
  6. 6. Undifferentiated cell Odontoblast Odontoblast like cellOdontaclast
  7. 7. The nerve of pulp consist of : • Afferent nerves : conduct impulses to be received as a pain • Sympathetic fibers : regulation of micro circulation in pulp
  8. 8. Sensory fibers Large myelinated A-fibers A-alpha Touch pressure A-beta vibration A-gamma Mechano- receptor A-delta Pain temp Intermediate efferent B-fibers Small unmyelinated C-fibers Pain temp
  9. 9. C fibersA-delta fibers UnmylinatedMylinatedMylenation 2 m/s20 m/sConduction velocity DeepSuperficialLocation of terminals Throbbing dull But less bearable Sharp - fast But bearable Pain character High by tissue damageLow by hydrodynamicStimulation threshold
  10. 10. Dentin sensitivity
  11. 11. Normal pulp Free of spontaneous pain Moderate response to stimulus Response disappear when removal
  12. 12. Diagnosis Objective Subjective • Visual and tactile • Thermal testes • Electrical testes • Recent • pain
  13. 13. Wein classification 1891 Bacterial Traumatic Iatrogenic Idiopathic
  14. 14. 1. Bacterial A- coronal ingress • Caries: the most common cause of ingress of bacteria to pulp • Fractured crown • Anomalous tract: as dens invaginatus , dens evaginatus and radicular lingual groove
  15. 15. B- radicular ingress • Caries: less common than coronal caries • Retrogenic infection: periodontal pocket • Hematogenic infection: anachoresis
  16. 16. 2. Traumatic A- acute • Coronal fracture • Radicular fracture • Luxation • Avulsion
  17. 17. B- chronic • Attrition: physiological wear • Abrasion: mechanical loss of tooth structure • Erosion: chemical loss of tooth structure
  18. 18. 3. Iatrogenic • Cavity preparation Heat Depth Desiccation Vibration Acid etching
  19. 19. • Restoration Fractured restoration Leaky restoration Acid containing restorations
  20. 20. • Periodontal curettage • Periradicular curettage • Rhinoplasty • Osteotomy
  21. 21. • local anesthesia • Orthodontic movement • Intubation for general anesthesia
  22. 22. 4. Idiopathic • Aging • Internal resorption • Hereditary hypophosphatemia
  23. 23. Classification Acc. to type Bacterial Physical Mechanical Chemical
  24. 24. Physical  Thermal : . Large metallic restorations without base . . cavity preparation . . setting of some cements e.g. Acrylic resin .
  25. 25.  Pressure  Speed  Depth of cutting  presence or absence of insulating base
  26. 26.  Electrical : presence of two dissimilar metals ( galvanism ) .  Radiation : -Direct effect -Indirect effect
  27. 27. Mechanical  Trauma  cracked tooth syndrome  Abrasion  Lack of temporary coverage after crown- bridge preparation
  28. 28.  operative procedures : operative procedures must taken during cavity preparation, ‫ــ‬ cavity depth ‫ــ‬ pulp exposure ‫ــ‬ pin insertion
  29. 29.  Orthodontic movements : orthodontic movement , can lead to devitalization of the pulp and pulpal hemorrhage .
  30. 30.  Deep periodontal curettage Deep periodontal curettage, leads to damaging the pulpal vessels, so it should be done after R.C.T
  31. 31. Chemical  Dental materials  Antibacterial agents
  32. 32.  Dental materials * monomer in composite restorations . * Amalgam, has cytotoxic effect . *cements, some has potential irritation to pulp e.g. Free phosphoric acid in phosphate cements . * Etching agents , if placed over 15 seconds in dentin can cause chronic inflammation of the pulp .
  33. 33.  Antibacterial agents * Antibacterial agents as silver nitrate, phenol and eugenol which was used to sterilize the cavity preparation have shown cytotoxic effects and causes inflammatory changes
  34. 34. Barodontalgia / Aerodontalgia symptom rather than a pathological pain caused by a change in barometric pressure
  35. 35. Gomaa Eslam Khaled By Abanoub Andrew Samir Abdallah

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