Pulp Disease

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• Pulp Disease

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Pulpitis

• Inflammation of the pulp from any cause.

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Unique Features of Pulpitis

• Rigid dentin walls confines inflammation
• Inflammation leads to increased intrapulpal
  pressure and secondary compression of venous
  return
• Strangulation of the arterial inflow can lead to
  necrosis of the pulp

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Types of Noxious Stimuli that Cause Pulpitis

• Mechanical damage. Accidents, iatrogenic injury,
  attrition, abrasion and barometric injury
• Thermal injury. Transmitted through metallic
  restorations, cavity preparation, polishing
  exothermic reactions of dental materials
• Chemical irritation. Erosion or use of acidic
  dental materials
• Bacterial effects. Toxins associated with
  extension of caries or via anachoresis

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Classification of Pulpitis

• Acute or chronic
• Subtotal or total
• Infected or sterile
• Reversible or irreversible

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Clinical Characteristics of Reversible Pulpitis

• Sudden, mild-to-moderate pain on exposure to
  extremes in temperature usually most dramatic to
  cold stimuli.
• Sweet or sour foods or beverages also may cause
  pain.
• Pain does not occur without stimulus and subsides
  rapidly when removed.
• Tooth responds at lower threshold to electrical
  stimulation mobility and sensitivity to
  percussion absent.

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Clinical Characteristics of Irreversible Pulpitis

• Sharp, severe pain upon thermal stimulation that
  continues after stimulus removed.
• Cold is especially uncomfortable although heat,
  sweet or acids can elicit pain. Later heat
  intensifies and cold relieves pain.
• Pain can be spontaneous, continuous and
  exacerbated when lying down.
• Early response at low then later at higher
  threshold to electrical stimulation or not at
  all.
• Pain localized early then more diffuse.
• Pain becomes throbbing and keeps the patient
  awake at night.

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Histopathology of Pulpitis
Irreversible chronic pulpitis with necrosis of
pulp
abscess
?
Irreversible chronic pulpitis with necrosis of
pulp
Acute reversible pulpitis (hyperemia)
Closed irreversible chronic pulpitis with
abscess in pulp horn
Acute pulpitis
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Histopathology of Pulpitis
Acute pulpitis with degeneration of odontoblasts
Chronic pulpitis with degeneration of
odontoblasts
Acute pulpitis due to pulp exposure with abscess
formation
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Chronic Hyperplastic PulpitisPulp Polyp

• Uncommon form of pulpitis in which an
  inflammatory hyperplasia (granulation tissue)
  extrudes to fill a large cavity in the crown
• Usually seen in children or young adults
• Deciduous or permanent mandibular molar most
  likely to be involved
• Apex of affected permanent tooth often
  incompletely formed

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Chronic Hyperplastic Pulpitis (Pulp Polyp)
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Secondary DentinPhysiologic Secondary Dentin

• Dentin formed after the completion of the tooth
  regular, organized tubular structure
• Slow, gradual normal (physiologic) process that
  increases after age 35-40 and leads to smaller
  pulp chambers and root canals
• Proceeds from crown down through root canals
  pulpal floor of posterior teeth and east on
  lateral walls
• More advanced in males associated with
  arthritis, gout, renal stones, gallstones,
  atherosclerosis, hypertension
• Age estimation, reduced sensitivity, caries
  resistance and protection of pulp from trauma

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Secondary Dentin

• Formation of secondary dentin in response to
  advancing caries

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Localized Secondary DentinSecondary Reparative
Dentin Irregular or Tertiary Dentin

• Laid down in areas of focal injury or insult
• Haphazardly organized irregular or disorganized
  tubules
• Significant traumatic injury can lead to
  accelerated early pulp obliteration termed
  calcific metamorphosis (yellow crown)
• Can occur in response to
• Attrition
• Fracture
• Erosion
• Abrasion
• Caries
• Periodontal disease
• Mechanical injury from dental procedures
• Irritation from dental materials

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Pulpal Calcifications

• Three types
• Denticles Epithelial remnants thought to induce
  odontoblastic differentiation (epitheliomesenchyma
  l interaction)
• Pulp stones Nidus of pulp tissue seeds the
  formation of a concentric stone
• Diffuse linear calcifications Fine, fibrillar,
  irregular calcifications that parallel pulp
  vasculature increases with age

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Pulp Calcifications
?
Diffuse linear calcifications
Calcific metamorphosis
Pulp stone
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Significance of Pulpal Calcifications

• Estimated to occur in from 8-90
• Only 20 can be seen radiographically (denticles
  pulp stones can be seen but not diffuse linear
  calcifications)
• Typically of little clinical significance may be
  a consideration in RCT
• Can be associated with
• Dentin dysplasia II
• Pulp dysplasia
• Tumoral calcinosis
• Calcinosis universalis
• Ehler-Danlos syndromes