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Pulpitis

  1. 1. NAME:RIFAT ALAM ROLL:19 GROUP:B Pulpitis 1.Define pulpitis.(Ru-Aug12) PULPITIS: An inflammation of the pulpal tissue that may be acute or chronic, with or without symptoms, and reversible or irreversible. (Ref. Contemporary oral and maxillofacial pathology) or Pulpitis medical symtoms in which dental pulp becomes inflamed . (lecture ) 2.Enumerate the causes of pulpitis.(Ru-Aug12,Feb-10) Causes of pulpitis:- BACTERIAL Caries Cracks in crown Periodontal pockets Malformed teeth TRAUMATIC Crown fractures Root fractures Partial avulsion Bruxism Abrasion IATROGENIC Heat generation Depth of preparation Dehydration of tubules Pulp exposure Volatile/toxic disinfectants Filling materials Thermul iniury. Severethermal stimuli can be transmitted through large uninsulated metallic restorations or may occur from such dental procedures as cavity preparation, polishing and exothermic chemical reactions of dental materials. Chemical irritation. Chemical-related damage can arise from erosion or from the inappropriate use of acidic dental materials. (Ref.Contemporary oral and maxillofacial pathology) (Oral and maxillofacial pathology,Naville) 3.Write down the sequele of pulpitis. (Ru-Feb-10,12) Sequele of pulpitis pulpitis---untreated---death of pulp---spread of infection through apical foramina into periapical tissue---periapical periodontitis. ( Ref.Cawson's essentials of oral pathology and oral medicine) Infectious sequelae of pulpitis include apical periodontitis, periapical abscess, cellulitis, and osteomyelitis of
  2. 2. the jaw. Spread from maxillary teeth may cause purulent sinusitis, meningitis, brain abscess, orbital cellulitis, and cavernous sinus thrombosis. Spread from mandibular teeth may cause Ludwig angina, parapharyngeal abscess, mediastinitis, pericarditis, empyema, and jugular thrombophlebitis. 4.Classification of pulpitis. a)Based on severity of inflammation:- 1.Reversible Pulpitis 2. Irreversible Pulpitis 3.Pulp Degeneration 4.Pulp Necrosis . b)According to involvement :- 1.Focal or Subtotal or Partial Pulpitis 2.Total or Generalized Pulpitis. c)According to severity :- 1.Acute Pulpitis 2.Chronic Pulpitis . d)According to presence or absence of direct communication between pulp and oral environment : 1.Pulpitis Aperts (open pulpitis) 2.Pulpitis Clausa ( closed pulpitis). Nice to know:- Mechanism of pulpitis : Pulpitis is the name given to any inflammation of the pulp regardless of the presence of an infectious agent. Because the pulp is contained within a solid unyielding chamber with an limited blood supply through the apical foramen and no collateral support, the inflammatory process that is so beneficial in the healing process in other parts of the body often becomes a mechanism of destruction in this confined location. Inflammation is by nature an expansile process consisting of dilation of blood vessels, leakage of fluids from blood vessels into the surrounding connective tissue, and migration of cells into the immediate area.The active dilation of the arterioles leads to increased pulpal pressure and secondary compression of the venous return, which can lead to strangulation of the arterial inflow. The increased pulpal pressures,combined with the accumulation of mediators, can lead to vessel damage, pulpal inflammation. and tissue necrosis. Severe localized pulpal damage can spread progressively to involve the more apical portion of the pulp. 5.Diagnosis of pulpitis (Du-Feb 12,13) (Ru-Aug 10) a) Pain: Comparison of Pain Symptoms in Reversible and Irreversible Pulpitis REVERSIBLE IRREVERSIBLE Elicited Spontaneous Sharp Dull <20 minutes’ duration >20 minutes’ duration Unaffected by body position Affected by body position Easily localized Often difficult to localize. Comparison of pain symptoms in acute and chronic pulpitis ACUTE CHRONIC severe,sharp,stabbing in character . dull in character if present. stabbing pain due to thermal changes reaction to thermal changes also reduces start spontaneously,when patient is pain is absent and have any relation with the position of pt. trying to get sleep. Pain is absent in total necrosis. spontaneous pain, or diffuse nature of pain resembling trigeminal neuralgia.
  3. 3. b) Radiographic findings:- Reversible pulpitis:- Normal. Irreversible pulpitis:- Depth and extent of caries lesion may be evident, normal PDL but slight widening may be seen in advanced stages. Acute pulpitis:- Tooth with large cariuos lesion. Chronic pulpitis:- chronic apical periodontitis in long standing cases.Condensing osteitis, low grade long standing irritation stimulates periapical bone deposition. Pulp necrosis:- Large cavity or filling or normal appearance unless there is concomitant apical peridontitis or condensing ostitis. Pulp degeneration:- c) Vitality Test:- Reversible pulpitis:- Tooth responds to electric pulp testing at lower current. Pain brought on by cold than hot food or beverages and by cold air. Irreversible pulpitis:- Heat intensifies the response and cold tend to relieve the pain and electric test requires less current to cause pain but more current is required when the tissue becomes more necrotic. Acute pulpitis:-Tooth reacts to electric pulp vitality tester at a lower level of current than adjacent normal teeth.pain persists even after thermal stimulus disappears or been removed. Chronic pulpitis:-Usually not responding to thermal test unless extreme cold is used. more current is required in electric pulp testing . Pulp necrosis:- Single rooted= not responding multi rooted=mixed response in liquefaction necrosis , electric test is positive when current is conducted through moisture present in a root canal. d) Visual examination:- Pulp necrosis:- show discoloration of tooth. Chronic hyperplastic pulpitis:- fleshy reddish pulpal mass filling most of pulp chamber or cavity or even beyond confines of tooth. 6. Treatment or Management of pulpitis. Reversible pulpitis: a) prevention b)periodic care c)remove the irritant d) dental filling apply. Irreversible pulpitis: a)pulpectomy b)placement of intracanal medicament c) to act as disinfectant or obtundent like cresatin,eugenol,formoeresol. Acute pulpitis:- a)removal of coronal pulp b)placing materials that favors calcification such as calcium hydroxide over entrance of root canals. c)root canal filling with inert material like gutta percha should be done. Chronic pulpitis:- a)root canal treatment b)extraction Chronic hyperplastic pulpitis:- a) elimination of polypoid tissue b)followed by extirpation of pulp c) extraction Pulp necrosis:- a) root canal treatment b) extraction FIGURES RELATED TO THIS TOPIC:-
  4. 4. Acute pulpitis. Tooth exhibiting a focal area of intrapulpal hemorrhage and acute pulpitis resulting from overheating during crown preparation Chronic pulpitis.
  5. 5. Chronic pulpitis Pulpal necrosis. Darkened central incisor caused by penetration of the tissue remnants of nonvital pulp into the dentin tubules. The small nodule on the gingiva above the tooth (parulis) is the surface opening of a drainage tract from a periapical abscess.
  6. 6. Hyperplastic pulpitis. A, Clinical appearance of pulp polyp in a grossly carious right mandibular first molar Microscopic appearance of grossly carious tooth and fibrotic pulp polyp with a stratified squamous epithelium on the surface. ALL THE INFORMATION ARE COLLECTED FROM LECTURE AND TEXTBOOKS AND ALSO FROM NET.
  7. 7. Hyperplastic pulpitis. A, Clinical appearance of pulp polyp in a grossly carious right mandibular first molar Microscopic appearance of grossly carious tooth and fibrotic pulp polyp with a stratified squamous epithelium on the surface. ALL THE INFORMATION ARE COLLECTED FROM LECTURE AND TEXTBOOKS AND ALSO FROM NET.

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