Pulp and periapical pathosis

1
Pulp and periapical pathosis

• (Principles and Practice of Endodontics, Walton
  and Torabinejad)
• Powerpoint 2002 presentation
• www.konfog.sote.hu
• /Klinika bemutatása/munkatársaink/Vág
  János/pulpalpathosis_en

2
The aim of the diagnosis is to determine

• Necessity of medicaments (antibiotic prevention)?
• Which tooth should be treated?
• What treatment should be applied?
• Making a filling
• Root canal treatment
• Extraction of the tooth

3
Basic principle of the diagnosis

• Anamnesis - Health history (medical, dental) -
  1., 3.
• Fever
• Pain (subjective examination, tentative
  diagnosis)
• Oral investigation
• Inspection (fistula, swelling, open pulp
  chamber) - 2., 3.
• clinical tests
• vitality tests -
  2., 3.
• percussion
  - 2., 3.
• Mobility
  - 2., 3.
• X-ray
  - 2., 3.
• selective anesthesia - 2.

• Necessity of antibiotic prevention?
• Which tooth should be treated?
• What treatment should be applied?
• Making a filling
• Root canal treatment
• Extraction of the tooth

4
Vitality test

• cold test ethyl chloride

• electrical pulp test

• (test cavity)

5
Aetiology of the pulp and periapical pathosis

• Microbial dental caries
• Mechanical operative procedure (iatrogenic),
  trauma
• Chemical pulpal (acid etching, bond), periapical
  (irrigation)

6
The pathway of the pulp and periapical pathosis
set out from caries
7
Pulpal pathosis

• General symptoms of the inflammation
• rubor
• calor
• tumor (oedema)
• dolor
• functio laesa
• The special anatomical aspects of the pulp
  enclosed chamber

8
Classification of pulpal diseases(according to
symptoms and treatment)

• Reversible pulpitis
• Irreversible pulpitis
• Hyperplastic pulpitis
• Pulpal necrosis

9
Reversible pulpitis

• Anamnesis
• pain stimulated by cold and sweet, tooth can be
  fixed
• Clinical examination
• vitality test positive, short respond
• Treatment
• removing of the exciting agent
• making a filling (or pulp capping)

10
Irreversible pulpitis

• Anamnesis
• generally asymptomatic
• or mild or severe spontaneous pain
• difficult to localise
• Clinical examination
• vitality test long, sharp respond
• Treatment
• root canal treatment

11
Hyperplastic pulpitis- in young people,
chronically inflammed pulp

• Anamnesis
• asymptomatic
• Clinical examination
• vitality test positive
• open pulp chamber within polypous tissue
• Treatment
• root canal treatment

12
Pulpal necrosis

• Anamnesis
• asymptomatic
• Clinical examination
• vitality test negative
• Treatment
• root canal treatment

13
Does any radiological symptom link to simple
pulpal pathosis?
No, it doesnt

• Rare exceptions calcification and internal
  resorption

14
Periapical pathosis
15
Aetiology

• non-treated pulpal disease
• trauma (hyperocclusion)
• irrigants
• instrumentation

16
Symptoms of periapical pathosis generally

• Anamnesis
• acute pain, swelling
• chronic mild or no symptoms
• Clinical examination
• vitality test usually negative
• Radiological symptoms

17
Classification of periapical pathosis

• Acute apicalis periodontitis
• Chronic apical periodontitis
• Condensing osteitis
• Acute apical abscess (closed)
• Suppurative apical periodontitis (open)

18
Acute apical periodontitis

• Anamnesis
• symptoms of pulpitis or necrosis pain on bite
• Clinical examination
• pain on percussion
• X-ray
• thickening of periodontal ligament space
• Treatment
• root canal treatment, (adjustment of occlusion)

19
Chronic apical periodontitis

• Anamnesis
• asymptomatic or slight discomfort
• Clinical examintaion
• little or no pain on percussion
• X-ray
• interruption of lamina dura or apical
  radiolucency
• Treatment
• root canal treatment

20
Radiogram of healthy periodontium and chronic
apical periodontitis
21
Acute apical abscess (closed)

• Anamnesis
• severe discomfort, swelling, fever
• Clinical examination
• swelling, localisation?
• X-ray
• radiolucent lesion (localisation)
• Treatment
• root canal treatment, drainage, (antibiotics)

22
Suppurative apical periodontitis (open)

• Anamnesis
• asymptomatic (drain), swelling
• Clinical examination
• fistula, swelling
• X-ray
• radiolucent lesion (localisation with
  guttapercha)
• Treatment
• root canal treatment