types of pain in teeth in pediatric patients. types of pulpitis and details

1. Diseases of the Pulp
Presented by
Dr Rahul Katyayan
For the- Faculty of
Pediatric dentistry.

2. CONTENTS
⚫ INTRODUCTION
⚫ PULPITIS
⚫ SEQUELAE
⚫ CAUSES
⚫ CLASSIFICATION
⚫ REVERSIBLE PULPITIS
⚫ FOCAL REVERSIBLE PULPITIS
⚫ IRREVERSIBLE PULPITIS
⚫ ACUTE PULPITIS
⚫ CHRONIC PULPITIS
⚫ NECROSIS
⚫ REFERENCES

3. ⮚ formative organ of tooth
⮚ builds primary dentin
during development of tooth
⮚ secondary dentin after
tooth eruption
⮚ reparative dentin in response
to stimulation as long as
odontoblast remain vital
Pulp

4. ⮚ most common cause of
dental pain
⮚ loss of teeth in younger
persons
⮚ usual cause is caries
penetrating the dentin
Pulpitis

5. Pulpitis
UNTREATED
Death of pulp
Spread of Infection through
apical foramina into periapical tissues
Causes Periapical Periodontitis

6. ⮚ (1)Physical Cause
a)Mechanical
b)Thermal
⮚ (2) Chemical Cause
⮚ (3) Bacterial Cause
Causes of Pulpal
Inflammation

7. ⮚ (a) Mechanical Cause
A. trauma
a) accident (contact sports)
b) iatrogenic damage due to dental procedure
(during cavity or crown preparation)
B. Pathologic wear ( atrrition, abrasion)
C. Cracked tooth syndrome
D. Barometric changes
Causes of Pulpal
Inflammation

8. ⮚ (b) Thermal Cause
✔ uninsulated metallic
restoration
✔ during cavity preparation
✔ polishing
Causes of Pulpal
Inflammation

9. ⮚ (2) Chemical Cause
✔ arise from erosion
✔ or inappropriate use
of acidic dental material
Causes of Pulpal
Inflammation

10. ⮚ (3) Bacterial Cause
✔ can damage pulp
through toxins secreted
by bacteria from caries
✔Microbial colonization in
the pulp by blood borne
microorganisms
(anachoresis).
Causes of Pulpal
Inflammation

11. ⮚ (1) Based on Severity of
Inflammation
⮚ (2) According to Involvement
Classification

12. ⮚ (1) Reversible Pulpitis
⮚ (2) Irreversible Pulpitis
⮚ (3) Pulp Degeneration
⮚ (4) Pulp Necrosis
(1) Based on Severity
of Inflammation

13. ⮚ (1) Reversible Pulpitis
✔ Symptomatic (acute)
✔ Aysptomatic (chronic)
⮚ (2) Irreversible Pulpitis
✔ Acute
• Abnormally responsive to cold
• Abnormally responsive to heat
(1) Based on Severity
of Inflammation

14. ⮚ (2) Irreversible Pulpitis
✔ Chronic
• Asymptomatic with
pulp exposure
• Hyperplastic
• Internal resorption
(1) Based on Severity
of Inflammation

15. ⮚ (3) Pulp Degeneration
✔ Calcific
⮚ (4) Pulp Necrosis
(1) Based on Severity
of Inflammation

16. ⮚ (1) According to extent of inflammation
⮚ (2) According to Severity
⮚ (3) According to presence or
absence of direct
communication
between dental pulp +
oral environment
(2) According to
Involvement

17. ⮚ (1) According to extent of inflammation
✔ Focal or Subtotal or
Partial Pulpitis
✔ Total or Generalized
Pulpitis
(2) According to
Involvement

18. ⮚ (2) According to Severity
✔ Acute
✔ Chronic
(2) According to
Involvement

19. ⮚ (3) According to presence or
absence of direct
communication
between dental pulp +
oral environment
✔ Pulpitis Aperts (open pulpitis)
✔ Pulpitis Clausa (closed pulpitis)
(2) According to
Involvement

20. ⮚ mild to moderate inflammatory
condition of pulp
✔ caused by noxious stimuli
✔ pulp is capable of returning
to un-inflammed state following removal of stimuli
Reversible Pulpitis

21. ⮚ Causes
✔ agent capable of
injuring pulp like:
• trauma
• disturbed occlusal
relationship
• thermal shock
Reversible Pulpitis

22. ⮚ Clinical Features
✔ sharp pain lasting for
a moment
✔ often brought on by cold
than hot food or beverages
and by cold air
Reversible Pulpitis

23. ⮚ Clinical Features
✔ does not continue
when the cause has been
removed
✔ tooth responds to electric
pulp testing at lower
current
Reversible Pulpitis

24. ⮚ Management
✔ prevention
✔ periodic care
✔ early insertion of filling
if a cavity has developed
✔ removal of noxious
stimuli
Reversible Pulpitis

25. ⮚earliest form
⮚ also known as pulp hyperemia
⮚ excessive accumulation of
blood within pulp tissue
⮚ leads to vascular congestion
Focal Reversible
Pulpitis

26. ⮚ Clinical Features
✔ sensitive to thermal
changes
✔ particularly to cold
✔ application of ice or cold
fluids to tooth result in pain
Focal Reversible
Pulpitis

27. ⮚ Clinical Features
✔ disappears upon removal
of thermal irritant or
restoration .
✔ responds to electrical test
stimulant at lower level
of current
Focal Reversible
Pulpitis

28. ⮚ Clinical Features
✔ indicates lower pain
threshold than that of
adjacent normal
teeth
Focal Reversible
Pulpitis

29. ⮚ Clinical Features
✔ teeth show:
• deep carious lesion
• large metallic restoration
• restoration with defective
margins
Focal Reversible
Pulpitis

30. ⮚ Management
✔ removal of irritants
before the pulp is
severely damaged
Focal Reversible
Pulpitis

31. ⮚ persistent inflammatory
condition of pulp
⮚ may be symptomatic or
asymptomatic
⮚ caused by noxious stimulus
Irreversible Pulpitis

32. ⮚ Causes
✔ bacteria involvement of
pulp through caries
✔ chemical
✔ thermal
✔ mechanical injury
Irreversible Pulpitis

33. ⮚ Clinical Features
Early Stage
✔ paroxysm of pain
caused by:
• sudden temperature
changes like cold,
sweet, acid foodstuffs
Irreversible Pulpitis

34. ⮚ Clinical Features
Early Stage
✔ pain often continues
when cause has been
removed
✔ may come and go
spontaneously
Irreversible Pulpitis

35. ⮚ Clinical Features
Early Stage
✔ pain
• sharp
• piercing
• shooting
• generally severe
Irreversible Pulpitis

36. ⮚ Clinical Features
Early Stage
✔ pain
• bending over exacerbates pain which
• lying down is due to change in
• change of position intrapulpal pressure
Irreversible Pulpitis

37. ⮚ Clinical Features
Late Stage
✔ pain
• more severe as if tooth is under
• throbbing constant pressure
Irreversible Pulpitis

38. ⮚ Clinical Features
Late Stage
✔ pain
• patient is often awake
at night due to pain
• increased by heat and
sometimes relieved by cold,
although continued application
of cold may intensify pain
Irreversible Pulpitis

39. ⮚ Management
✔ complete removal of pulp
or pulpectomy
✔ if the time is a factor, pulpotomy
should be done as an emergency
procedure
✔ Surgical removal should be considered if the tooth
is not restorable.
Irreversible Pulpitis

40. Clinical Difference
Reversible Pulpitis Irreversible Pulpitis
⮚ pain generally lasts for few
seconds
⮚ the pain produced by thermal
stimulus disappears as soon as
the stimulus is removed
Pain may last several
minutes or later
⮚ pain lingers even after
the stimulus is removed
⮚ pain may come without
any apparent stimulus

41. ⮚ extensive acute inflammation
of pulp
⮚ frequent sequel of focal
reversible pulpitis
Acute Pulpitis

42. ⮚ Causes
✔ tooth with large carious
lesion
✔ defective restoration
where there has been
recurrent caries
✔ pulp exposure due to
faulty cavity preparation
Acute Pulpitis

43. ⮚ Clinical Features
✔ severe pain is elicited by
thermal changes
✔ pain persists even after
thermal stimulus
disappears or been
removed
Acute Pulpitis

44. ⮚ Clinical Features
✔ may be continuous
✔ intensity may be increased
when patient lies down
✔ application of heat
may cause acute
exacerbation of pain
Acute Pulpitis

45. ⮚ Clinical Features
✔ tooth reacts to electric
pulp vitality tester at a
lower level of current
than adjacent normal
teeth
Acute Pulpitis

46. ⮚ Clinical Features
✔ pressure increases
because of lack of
escape of inflammatory
exudate
✔ rapid spread of inflammation
through pulp with pain
+ necrosis
Acute Pulpitis

47. ⮚ Management
✔ early stages of acute pulpitis pulpotomy
(removal of coronal pulp)
✔ placing material that
favors calcification such
as:
• calcium hydroxide
over entrance of
root canals
Acute Pulpitis

48. ⮚ Management
✔ root canal filling with
inert material like
gutta percha should be
done
Acute Pulpitis

49. ⮚ may develop with or
without episodes of
acute pulpitis
⮚ many pulps under large
carious cavities die painlessly
⮚ 1st indication is then
development of periapical
periodontitis, either with pain
or seen by chance in radiograph
Chronic Pulpitis

50. ⮚ Clinical Features
✔ dull aching type
✔ more often intermittent
than continuous
Chronic Pulpitis

51. ⮚ Management
✔ root canal therapy
✔ followed by crown
restoration
Chronic Pulpitis

52. ⮚ also called as pulp polyp
or pulpitis aperta
⮚ essentially an excessive
exuberant proliferation
of chronically inflammed
dental pulp tissue
Chronic Hyperplastic
Pulpitis

53. ⮚ pulpal inflammation due
to an extensive carious
exposure of a young pulp
⮚ development of granulation
tissue
⮚ covered at times by epithelium
⮚ resulting from long standing
low grade infection
Chronic Hyperplastic
Pulpitis

54. ⮚ Causes
✔ slow progressive
exposure of pulp
✔ bacterial infection
Chronic Hyperplastic
Pulpitis

55. ⮚ Clinical Features
✔ most commonly involved
are deciduous molars +
1st permanent molar
• excellent blood supply
• large root opening
Chronic Hyperplastic
Pulpitis

56. ⮚ Clinical Features
✔ asymptomatic
✔ seen only in teeth of children
+ young adults
Chronic Hyperplastic
Pulpitis

57. ⮚ Clinical Features
✔ polypoid tissue appears
• fleshy
• reddish pulpal mass filling
most of pulp chamber
or cavity
• or even extend beyond
confines of tooth
Chronic Hyperplastic
Pulpitis

58. ⮚ Clinical Features
✔ polypoid tissue appears
• sometimes, if mass is
large enough
• interferes with closure
of mouth
Chronic Hyperplastic
Pulpitis

59. ⮚ Clinical Features
✔ polypoid tissue appears
• may cause discomfort
during mastication
• due to pressure of food
bolus
Chronic Hyperplastic
Pulpitis

60. ⮚ Clinical Features
✔ polypoid tissue appears
• tissue easily bleeds
because of rich network
of blood vessels
• tooth may respond or
not at all to thermal test
Chronic Hyperplastic
Pulpitis

61. ⮚ Management
✔ elimination of polypoid tissue
✔ followed by extirpation of pulp
✔ hyperplastic tissue bleeeding
can be controlled by pressure
✔ pulpectomy or extraction of tooth can also
be done if the tooth is not restorable.
Chronic Hyperplastic
Pulpitis

62. ⮚ death of pulp
⮚ may be partial or total
depending on whether part
or the entire pulp is
involved
Necrosis

63. ⮚ Causes
✔ sequeala of inflammation
✔ can also occur following
trauma
• pulp is destroyed before
an inflammatory reaction
Necrosis

64. ⮚ Types
✔ (1) Coagulation Necrosis
✔ (2) Liquefaction Necrosis
Necrosis

65. ⮚ Types
✔ (1) Coagulation Necrosis
• soluble portion of
tissue is precipitated
or converted into a solid
material
Necrosis

66. ⮚ Types
✔ (1) Coagulation Necrosis
• tissue is converted into
tissue mass consisting
chiefly of coagulated
▪ proteins
▪ fats
▪ water
Necrosis

67. ⮚ Types
✔ (2) Liquefaction Necrosis
• results when proteolytic
enzymes convert the
tissue into softened mass
liquid or amorphous debris
Necrosis

68. ⮚ Clinical Features
✔ no painful symptoms
✔ discoloration of tooth
• 1st indication that the pulp
is dead
Necrosis

69. ⮚ Clinical Features
✔ history of pain lasting from
a few minutes to a few
hours followed by
complete + sudden
cessation of pain
Necrosis

70. ⮚ Management
✔ preparation + obturation of
root canals
Necrosis

71. References:
❖ Books
⮚ Grossman’s endodontic practice twelfth edition
⮚Textbook of oral pathology shafers
⮚Cawson, R.A: Cawson’s Essentials of Oral Pathology and
Oral Medicine, 8th Edition.(page 60)
⮚ Ghom, Ali & Mhaske, Shubhangi: Textbook of Oral
Pathology. (pages 420-425)

72. References:
⮚Adrian,J.C.,et al.:J. Am. Dent. Assoc.,83:113,
1971.
⮚Allard, U., et al.:Oral Surg.,48:454, 1979.
⮚Austin, L.T.:J. Am. Dent. Assoc.,17:1930, 1930.
⮚Baume, L.: SSO Schweiz. Monatsschr.
Zahnheilkd.,77:1082, 1965.

73. References:
⮚Baume, L.: Transactions of the Fourth
International Conference on Endodontics.
Philadelphia: University of Pennsylvania
press, 1968, p. 66 .
⚫Baume, L.J.: Monogr. Oral Sci.,8:1-
220, 1980.

74. THANK
YOU