Professional Documents
Culture Documents
12
prolonged cavity preparation or excessive dehydration of a cavity is usually the physical causes.
Chemical stimuli are sweet or sour foodstuffs, irritation from a filling, caries.36
Sharp pain that lasts for a moment more often by cold beverages is a characteristic
feature. The clinical difference between reversible and irreversible pulpitis is that the severity is
greater and duration of the pain is longer in irreversible pulpitis. Asymptomatic reversible
pulpitis can result from incipient caries and is resolved on removal of the caries and proper
restoration of the tooth.36
13
measures.16
Irreversible Pulpitis:
It is a persistent inflammatory condition of the pulp, symptomatic or asymptomatic
caused by noxious stimuli. The initial reaction is a very sharp pain to hot or cold stimuli which
linger for minutes to hours after the stimulus is removed. Spontaneous throbbing pain may wake
the patient at night and may become worse when lying down, is a feature of irreversible pulpitis.
The patient may completely avoid eating on the side of the mouth due to the severity of the
pain.79
Patients with irreversible pulpitis often need strong analgesics to relieve pain and may
have difficulty locating the precise tooth that is the source of the pain. They may even confuse
the maxillary and mandibular arches (but not the left and right sides of the mouth) because of the
extensive branching of dental nerve axons and perhaps fewer proprioceptive fibres in the pulp.
Information provided by the patients and the results of pulp sensibility tests are helpful in pain
14
15
16
Hyperplasia
17
18
19
change or activation of dentinoclasts within the inflamed pulp tissue that is in contact with the
coronal pulp which is necrotic and infected. This condition is usually asymptomatic and often
only recognized during a routine radiographic examination. If symptoms are present, they are
usually indicative of an infected canal or pain when perforation of the crown occurs and the
metaplastic tissue is exposed to oral fluid and bacteria. Initially, part of the pulp (i.e., the apical
portion) is alive and still contains nerve fibres so a response to pulp sensibility testing is possible.
However, as the lesion progresses, the entire pulp become necrotic and infected, and overtime
the canal will become pulpless and infected, hence there will be no response to pulp sensibility
testing.16
Radiographically, internal inflammatory resorption will have an oval shaped increase in
the size of part of the root canal system. Periapical changes may be noted after the canal has
become infected and apical periodontitis develops. Internal replacement resorption is an
uncommon condition that occurs when the pulp undergoes metaplastic changes and the dentine is
resorbed and replaced by bone like hard tissue. Radiographically, internal replacement resorption
will have an irregular enlargement of the pulp space that is filled with bone like hard tissue.
Periapical changes do not usually occur with internal resorption.2
Accurate diagnosis of pulpal diseases is the key to all endodontic treatments. The
clinician should have an understanding of the various causative factors of pulpal diseases, collect
information about the presentation and history of symptoms and conduct many practical tests
before formulating the final diagnosis.36
WHO (1985)
Weine (1989)
Ingle (1965)
Walton &
Torabinejad (2002)
Healthy pulp
Initial (hyperaemia)
( reversible Pulpitis)
Hypersensitive Dentin
Hyperemia
Hyper reactive
pulpalgia
Acute suppurative
(pulpal abscess)
Chronic
Chronic ulcerative
Chronic hyperplastic
( pulp polyp )
Other unspecified
pulpitis
Pulpitis unspecified
Pulpitis
20
Hypersensitivity
Painful pulpitis
Acute pulpalgia
(acute pulpitis )
Chronic pulpalgia
(chronic pulpitis)
Hyperaemia
Acute pulpalgia
Incipient
Moderate
Advanced
Hyperplastic pulposis
Pulp necrosis
Pulp necrosis
Pulp necrosis
Liquefaction sicca
Pulpal calcification
Internal (intracanal
resorption )
Chronic pulpalgia
Pulp Degenerations
Pulp Degeneration
Pulp Degeneration
Denticles
Pulp calcification
Pulp stones
Atrophy
Dystrophic calcification
Atrophic pulposis
Calcific pulposis
Internal Resorption
Internal Resorption
Secondary or irregular
dentin
Comparative terminology and classification of pulp diseases used by various authors/organizations 2
21
Tronstad (1991)
Grossman (1978)
Healthy pulp
Pulpitis
Pulpitis
Pulpitis
Hyperaemia Pulpitides
Reversible
Irreversible
Asymptomatic irreversible
Pulpitis
Hyperplastic pulpitis
Internal resorption
Canal Calcification
Symptomatic
Irreversible pulpitis
Asymptomatic pulpitis
Symptomatic pulpitis
Acute pulpitis
Chronic ulcerative pulpitis
Chronic ulcerative pulpitis
Pulp necrosis
Necrosis
Necrotic pulp
Necrosis
(1984)
Partial
Complete
Pulp Degeneration
Pulp Degeneration
Atrophic pulp
Dystrophic mineralization
Calcific
Fibrotic
Atrophic
Internal Resorption
22
Amercian association of
endodontists
Glossary (2003)
Harty (1990)
Castellucci (2004)
Stock (2004)
Normal Pulp
Healthy pulp
Normal Pulp
Pulpitis
Pulpitis
Pulpitis
Concussed Pulp
Reversible pulpitis
Irreversible pulpitis
Reversible pulpitis
Irreversible pulpitis
Hyperemia
Pulpitis Irreversible
Reversible pulpitis
Irreversible pulpitis
Pulp necrosis
Necrosis
Necrosis
Pulp necrosis
( Internal resorption )