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Disorder of-the-dental-pulp

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Disorder of-the-dental-pulp

  1. 1. Disorder of the dental pulp
  2. 2.  Inflammation is the most important disease process affecting the dental pulp
  3. 3. pulpitis  Clincal features: a clinical diagnosis of acute pulpitis is usually made when the patient complains of a severe throbbing pain at times lacinating in type precipitated by hot or cold stimuli or on lying down and which often keeps the patient awake , the pain generally lasts for about 10-15 mins but may be more or less continuous.
  4. 4.  In contrast a clinical diagnosis of chronic pulpitis is associated with spontaneous attacks of dull aching pain which can last for an hour or more.
  5. 5. Pathway of Pulpitis
  6. 6. Etiology  Dental caries is the most common cause of pulpitis.  By other MO’s reaching the pulp via other routes.  Traumatic injury.
  7. 7. Microbial  Bacteria generally reach the pulp as a result of dental caries.  Inflammation of the pulp starts before the leading organisms reach the pulp.  Pulpitis is seen histologically when the leading organisms in the dentine are within abuot 1mm of the pulp in permanent or twice this distance in deciduous teeth.
  8. 8. Chemical and thermal injury Chemical and thermal injury to the pulp may occur during restorative procedures.  Irritant substances may be directly applied to an exposed pulp or may diffuse through dentine after insertion of a restorative material.
  9. 9. Pulp polyp  Chronic hyperplastic pulpitis.  In deciduous or recently erupted permanent teeth with wide open carious cavities and a good apical blood supply, pulpitis may be associated with a hyperplastic response characterized by the production of exuberant granulation tissue. The polyp may become epithelialized by the spontaneous grafting of oral epithelial cells present in the saliva.
  10. 10.  Clinically ,an ulcerated pulp polyp present as a dark red yellow flecked (because of the fibrous exudates) fleshy mass protruding from the pulp chamber , which bleed readily on probing, in contrast , an epithelialized polyp is firmer , pinkish white in color and does not bleed readily  they both usually devoid of sensation on gentle probing.
  11. 11. The effect of cavity preparation and restorative material  The speed, heat , pressure and coolants may all irritate the pulp tissue.  The main threat to the pulp is from frictional heat generated during the cutting process.
  12. 12.  Histological changes in pulp reaction to restorative techniques and materials are aspiration or displacement of odontoblast or their nuclei into the dentinal tubules and a reduction in the number of odontoblasts.
  13. 13. Healing of pulp  Animal experiments gave shown that it is possible for pulpitis to heal if the irritant agent are removed from the dentine.
  14. 14.  In some where the pulp is exposed during cavity preparation , and following pulpotomy ,it is possible to maintain pulp vitality by pulp-capping . Ideally capping agent should be no irritant Should stimulate the formation of a calcific barrier , and have and antibacterial action as most pulp exposures are contaminated by saliva.
  15. 15. Pulp calcification  Pulp stones are calcified bodies with an organic matrix and occur most frequently in the coronal pulp.  True/false pulp stone.  True pulp stones contain tubules and may have an outer layer of predentine and adjacent odontoblasts.
  16. 16.  False pulp stones are composed of concentric layers of calcified material with no tubular structure.  According to their location in pulp , stones may be described as free , adherent of interstitial when they have become surrounded by reactionary or secondary dentine.  Pulp stones increase in size and number with age and after tooth operative procedure.

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