Diseases of The Pulp
Pulpitis is the inflammation of the pulp tissue
Usually caused by caries penetrating the dentin
Most common manifestations are tooth ache
&increased sensitivity to hot & cold
Pulp inflamed > pressure build ups on pulp cavity >
pressure on nerves & surrounding tissues > pain
Causes of Pulpal Inflammation
(1) Mechanical Cause
iatrogenic damage for
(2) Thermal Cause
during cavity preparation
(3) Chemical Cause
arise from erosion
or inappropriate use
of acidic dental material
(4) Bacterial Cause
can damage pulp
through toxins secreted
by bacteria from caries
1) Based on Severity of Inflammation
-Symptomatic ( acute)
- Asymptomatic ( Chronic)
- abnormally responsive to cold
-abnormally responsible to hot
- Asymptomatic with
- Internal resorption
(3) Pulp Degeneration
(4) Pulp Necrosis
(2) According to Involvement
Acc. To involvement:
1. Focal / subtotal /partial pulpitis (inf. Is confined to a portion of pulp)
2. Total / generalized pulpitis ( most part of the pulp is involved)
Acc. To severity :
Acc. To presence or absence of direct communication b/w pulp & oral
1.Pulpitis asperta (open)
2.Pulpitis clousa (closed)
Stimuli of short duration
eg. Cutting dentin
mild to moderate inflammatory
condition of pulp
caused by noxious stimuli
pulp is capable of returning
to un-inflammed state
following removal of stimuli
agent capable of
injuring pulp like:-
• disturbed occlusal
• thermal shock
sharp pain lasting for
often brought on by cold
than hot food or beverages
and by cold air
does not continue
when the cause has been
tooth responds to electric
pulp testing at lower
Ranges from hyperemia to mild to moderate inflammation of the affected area.
Dilated blood vessels
Presence of immunologic response
early insertion of filling
if a cavity has developed
removal of noxious
Focal reversible pulpitis
also known as pulp hyperemia
excessive accumulation of
blood within pulp tissue
leads to vascular congestion
sensitive to thermal
particularly to cold
application of ice or cold
fluids to tooth result in pain
disappears upon removal
of thermal irritant or
restoration of normal
responds to electrical test
stimulant at lower level
indicates lower pain
threshold than that of
• deep carious lesion
• large metallic restoration
• restoration with defective
removal of irritants
before the pulp is
Carious lesion should be
excised & restored or
defective filling is replaced.
If primary cause is not
corrected, extensive pulpitis
may result in death of pulp.
Dilation of pulp blood vessels.
Edema fluid collection due to damage of vessel wall & allowing extravasations
of RBC or diapedesis of WBC.
Slowing of blood flow & hemoconcentration due to transudation can cause
Reparative or reactionary dentin in adjacent dentinal wall
extensive acute inflammation
frequent sequel of focal
Usually occurs in a tooth with a large
carious lesion /restoration
Commonly a defective restoration
around whivh there has been recurrent
tooth with large carious
where there has been
pulp exposure due to
faulty cavity preparation
severe pain is elicited by
pain persists even after
disappears or been
may be continuous
intensity may be increased
when patient lies down
application of heat may
may cause acute
exacerbation of pain
tooth reacts to electric
pulp vitality tester at a
lower level of current
than adjacent normal
Edema in pulp with vasodilation.
Infiltration of polymorphonuclear leukocytes along
vascular channels & migrate through endothelium
Destruction of odontoblasts at pulp dentin border.
Rise in pressure due to inflammatory exudate
local collapse of venous part of circulation
Tissue hypoxia & anoxia Destruction of pulp &
Abscess consists pus, leukocytes & bacteria.
Numerous abscess formation cause pulp liquefaction
& necrosis. (acute suppurative pulpitis)
TREATMENT & PROGNOSIS:
Drainage of exudates from pulp chamber.
Pulpotomy & placing calcium hydroxide over entrance of root
Root canal treatment.
Extraction of tooth.
may develop with or without episodes of acute pulpitis
More frequewntly occurs as chronic type from the onset.
Pain is not prominent, mild, dull ache which is intermittent.
Reaction to thermal changes is reduced because of degeneration of nerves.
Response to pulp vitality tester is reduced.
Wide open carious lesion & with exposure of pulp cause relatively little
Manipulation with small instruments often elicits bleeding but with little
Infiltration of mononuclear cells, lymphocytes & plasma cells, with vigorous
connective tissue reaction.
Capillaries are prominent; fibroblastic activity & collagen fibers in bundles.
When granulation tissue formation occurs in wide open exposed pulp surface
– ulcerative pulpitis. (with bacterial stains & micro org. in carious lesion)
If pulpal reaction vacillates between an acute & chronic phase causes pulp
abscess formation, which is surrounded by fibrous CT wall.
TREATMENT & PROGNOSIS:
Root canal therapy
Extraction of tooth.
Chronic Hyperplastic pulpitis
also called as pulp polyp or pulpitis aperta
Overgrowth of pulp tissue outside the boundary of pulp
chamber as protruding mass.
a form chronic pulpitis
Occurs either as a chroniv lesion
from onset or as a chronic stage of
a previously ACUTE PULPITIS
Children & young adults with high
degree of tissue resistance &
reactivity & responds to proliferative
Pulp - pinkish red globule of tissue
protruding from chamber & extend
Most commonly affected are
deciduous molar & Ist permanent
Pulp is relatively insensitive because
few nerves in hyperplastic tissue.
Lesion bleeds profusely upon provocation.
Due to excellent blood supply high tissue
resistance & reactivity in young persons leads to
unusual proliferative property of pulp.
Some cases, gingival tissue adjacent, may
proliferate into carious lesion & superficially
resemble hyperplastic pulpitisa
Hyperplastic tissue is basically
granulation tissue, consisting
delicate CT fibers & young blood
Inflammatory infiltrates –
lymphocytes, plasma cells &
Stratified squamous type epithelial
lining resembles oral mucosa with
well formed rete pegs.
TREATMENT & PROGNOSIS:
Extraction of tooth or RCT.
Grafted epithelial cells are believed
to be desquamated epith. Cells,
which carried by saliva.
Origin of these cells is unknown.
They are degenerated superficial
squames, which ’ve lost dividing
When pulp polyp is present for a
long time, persistent rubbing of
buccal mucosa may help in grafting
of epith. cells
death of pulp
may be partial or total
depending on whether part
or the entire pulp is
sequeala of inflammation
can also occur following
• pulp is destroyed before
an inflammatory reaction
(1) Coagulation Necrosis
• tissue is converted into
tissue mass consisting
chiefly of coagulated
(2) Liquefaction Necrosis
• results when proteolytic
enzymes convert the
tissue into softened mass
liquid or amorphous debris
no painful symptoms
discoloration of tooth
• 1st indication that the
• pulp is dead
history of pain lasting from
a few minutes to a few
hours followed by
complete + sudden
cessation of pain
preparation + obturation of
Parece que tem um bloqueador de anúncios ativo. Ao listar o SlideShare no seu bloqueador de anúncios, está a apoiar a nossa comunidade de criadores de conteúdo.
Atualizámos a nossa política de privacidade.
Atualizámos a nossa política de privacidade de modo a estarmos em conformidade com os regulamentos de privacidade em constante mutação a nível mundial e para lhe fornecer uma visão sobre as formas limitadas de utilização dos seus dados.
Pode ler os detalhes abaixo. Ao aceitar, está a concordar com a política de privacidade atualizada.