Professional Documents
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Oral pathology
Diseases of the pulp
Classification of pulpitis:
In the past, pulpitis has been classified into many classifications
according to clinical : acute and chronic, open and closed, partial and
total, exudative and suppurative , reversible or irreversible .
Those are confused classifications because the inflammation of the
pulp is a continuous process and very difficult to classify it into so
many classifications.
RECENT CLASSIFICATION:
1. Focal reversible pulpitis.
2. Acute pulpitis.
3. Chronic pulpitis.
4. Chronic hyperplastic pulpitis.(pulp polyp).
Clinical features:
1. The pain is sharp and intense and respond to sudden change in
temperature.
2. Pain remain for 5-10 min. or even 20 min.
3. Sensitivity will disappear as soon as the stimulus is removed.
4. Easily localized to a particular tooth.
5. The tooth may show a deep carious lesion, large restoration or
restoration with defective margin.
Histological features:
1. Dilatation of the pulp vessels.
Irreversible
1.
2.
3.
4.
Elicited
Sharp
Less zone
Not affected by body
position
5. Easily localized
1.
2.
3.
4.
5.
Spontaneous
Dull
More zone
Affected by body position
Difficult to be localized
Clinical features:
1. Usually occur in a tooth with a large carious lesion or a restoration
with defective one or with secondary caries.
2. The involved tooth is sensitive to heat and cold.
3. The pain continues even when the stimulus is removed.
4. The degree of pain correspond with the extent of the infection, as
more of the pulp becomes inflamed, the pain becomes very severe.
5. Pain at night increases due to increased blood pressure.
6. Low pain threshold.
7. Difficulty in localizing the pain due to lack of properioceptive
fibers of the pulp.
Histological features:
Microscopic examination of a tooth with acute pulpitis reveals symptoms
of acute inflammation similar to those attending acute inflammation in
other parts of the body.
1. Vascular dilatation
2. Oedema in the C.T.
3. Migration of polymorphs, especially beneath the carious
area(lysosomal enzyme when they die)
4. Death of odontoblast.
5. Formation of a pulp abscess ( localized area of pus) which arises
from breakdown of leukocyte, bacteria as well as necrotic tissue.
6. Inflammation spread rapidly to involve the entire pulp lead to
liquefaction and necrosis this is termed as acute suppurative
pulpitis.
Clinical features:
1. Dull, intermitted pain is indicated.
2. Increased pain threshold due to degeneration of nerve fiber.
3. Last for 1-2 hours.
Clinical features:
1. Seen particularly in primary molars and sometimes also in newly
erupted permanent molars.
2. We see a polyp in the center of a deep lesion due to excessive
proliferating of chronically inflamed dental tissue.
3. Occur almost in children and young adult .(good blood supply,
large root opening and high tissue resistance).
4. Involve teeth with large, open carious lesions.
Histopathologic features:
1. The polyp is a mass of granulation tissue.
2. Inflammatory cell infiltration, chiefly lymphocyte and plasma cells
sometimes mixed with polymorphs.
3. Pulp polyp appears to be covered with stratified squamous
epithelium as a result of implantation of epithelial cells from the
oral mucous membrane.
Treatment: by R.C.T or extraction.
Clinical features:
1. There may be pain which means there is still some vital pulp tissue
left such as another canal.
2. Discoloration of the tooth, because the products of gangrene pass
into the dentinal tubule and show through the translucent enamel
giving the tooth a greenish-black color.
3. Foul odor when the inflamed pulp are open for R.C.T.
Pulp necrosis:
1. Pulpitis liquefactive type of N
Gangrenous N
2. Traumatic injury to the apical blood supply
Coagulative N
Due to ischemia
It may occur in the coronal part of the pulp in which case, the pink
tissue of the pulp show through the enamel (pink tooth) which
represents the granulation tissue showing through the remaining tooth
substance.
The treatment is R.C.T., if the resorption perforates the P.D ligament,
the tooth is treated by extraction.
External resorption:
External resorption of the tooth is more common the internal
resorption, it occurs naturally in the shedding of primary teeth.
External resorption refers to the loss of cementum and dentin of a
tooth from the external surface in toward the pulp.Radiographically
appears as irregular loss of root structure.
Known causes are:
1. P.A. inflammation
2. Reimplantation of teeth, the root is resorbed and replaced by bone
causing ankylosis, although sometime, the entire root or roots are
resorbed and the tooth is exfoliated.
3. Tumors and cysts, this is due to pressure on the root by the lesion.
4. Excessive forces during orthodontic movement.
5. Impacted teeth, teeth that are completely embedded in the bone may
undergo resorption of the crown; root or both, there may be resorption
of adjacent tooth without resorption of impacted tooth.
6. Idiopathic resorption.
Barotrauma :(aerodontalgia)
Caisson disease:
1. Mild form (pain in one or more large joints)
2. Severe cases (circulatory disturbance and may cause death).
Age changes in the pulp: The size of the pulp decreased
gradually with age due to the continued production of secondary
dentine, decreased elasticity, reduction in the cellularity and
increase in collagen fiber content has also been reported.
These changes may alter the response of the tissue to injury and it
impairs healing potential.
Also the prevalence of pulp stones and diffuses calcification shown
to be increased with age.
There is little correlation between the clinical feature and the type
or extent of the pulp inflammation, histologically ; this is because
an absence of symptom is not indicated that the pulp is normal as
pulp death following pulpitis may occur without any previous
history of pain .
The most difficult thing is the decision clinically whether the
pulpitis is reversible or irreversible which will determine the type
of management of the affected tooth.
This decision depends on many factors:
1. Age of patients
2. Size of the carious lesion
3. Presence or absence of symptoms
4. Pulp vitality tests
5. Radiographic evidence
6. Direct observation.