Definition of pulpitis, Factors causing injury to the pulp, aerodontalgia, classification of pulpitis, clinical features of various types of pulpitis, histopathology and its treatment are inlisted in this presentation.

2. Presented by :- Ayam Chhatkuli
Roll No:- 103

3.  Dental pulp is a delicate
connective tissue
liberally interspersed
with tiny blood vessels,
lymphatics, nerves, and
undifferentiated
connective tissue cells
 It reacts to bacterial
infection or to other
stimuli by an
inflammatory response
known as pulpitis

4.  Pulpitis are primarily a result of dental caries in
which bacteria or their products invade the dentin
and pulp tissue
 Brannstrom and linda among others, have reported
that changes in the pulp may occur even with very
early dental caries represented by demineralization
limited to the enamel alone
 Bacteria circulating in the blood stream tend to
settle out or accumulate at sites of pulpal
inflammation, such as that which might follow
some chemical or mechanical injury to the pulp
and is known as “Anachoretic Pulpitis.”

5.  Anachoresis is a phenomenon by which
blood borne bacteria, dyes, pigment, metallic
substances, foreign proteins and other
materials are attracted to the site of
inflammation.
 In cracked tooth syndrome, the cracks are
often minute and invisible clinically and they
allow the bacteria to enter into the pulp.
 Pulpitis may also arise as a result of chemical
irritation of the pulp caused by erosion or use
of acidic restorative materials.
 This may occur not only in an exposed pulp to
which some irritating medicament is applied
but also in intact pulps beneath deep or
moderately deep cavities into which some
irritating filling material is inserted.

6.  Severe thermal change in a tooth may also
produce pulpitis
 Heat produced by over-rapid tooth preparation or
without sufficient collant may also cause pulpal
irritation.
 When two dissimilar metallic restorations are
pressent, the saliva acts as an electrolyte and
there will be formation of a galvanic current. This
may be transmitted to the pulp through metallic
restoration and may this initiate pulpitis

7.  Pain experienced in a recently
restored tooth during low
atmospheric pressure
 Pain is experienced either during
ascent or descent
 Chronic pulpitis which appears
asymptomatic in normal condition
may also manifest as pain at high
altitude because of low pressure
 It is generally seen in altitude
over 5000 feet but most likely to
be observed in 10,000 feet and
above.

8. Rouch classified barodontalgia according to the
chief complaint:
Class I:- In acute pulpitis, sharp pain occurs for
a moment on ascent
Class II:- In chronic pulpitis, dull throbbing pain
occurs on ascent
Class III:- In necrotic pulp, dull throbbing pain
occurs on descent but it is asymptomatic on
ascent
Class IV:- In periapical cyst or abscess, severe
and persistent pain occurs with both ascent
and descent.

9. A. Physical factors
 Acute injury
 Accidental blow to the teeth
 Heating due to grinding
 Cavity preparation without water spray
 Vigorous polishing with rotary instruments
 Root planning in periodontal therapy
 Large metallic restoration with inadequate
insulation

10.  Chronic injury
Attrition due to abrasive foods or brixism
Abrasion due to abnormal tooth brushing
B. Chemical factors
Medicament or materials applied to dentin
surface may cause damage to the pulp by
diffusion through the dentinal tubules

11. C. Microbial Factors
 Dental caries with bacterial invasion of dentin
and pulp
 Bacterial invasion into the pulp from a
fractures tooth, where the dental pulp is
exposed to the oral environment
 “Anachoretic infection” off the pulp occurs,
when bacteria present in the circulation
bloodstream tend to accumulate in the pulp
and cause infection.

12. Classification of pulpitis
Acute Pulpitis Chronic Pulpitis

13. Inflammatory process is confined to a
portion of the pulp, usually a portion of the
coronal pulp such as a pulp horn, the
condition has been called Partial or Focal
pulpitis.
If most of the pulp is diseased, the term
total or generalized pulpitis has been used.

14. Based upon the presence or absence of a
direct communication between the dental
pulp and the oral environment
 Open Pulpitis(pulpitis aperta)
Pulpitis in which the pulp obviously
communicate with the oral cavity
 Closed Pulpitis( pulpitis clausa)
Pulpitis in which the pulp doesn’t
communicates with the oral cavity

15. Classification of the Pulpal disease
 Inflammatory disease
 Focal reversible pulpitis
 Acute pulpitis
 Chronic pulpitis
 Chronic hyperplastic pulpitis
 Other miscellaneous condition of the pulp
 Aerodontalgia
 Necrosis
 Reticular atrophy
 Calcifications
 Pulpal metaplasia

16.  Focal reversible pulpitis or pulp hyperemia is a
mild, transient, localized inflammatory reaction in
the pulp.
Etiology of Focal reversible pulpitis
 Slowly progressing chronic carious lesion
 Stimuli of short duration e.g cutting dentin while
cavity preparation
 Metallic restoration without proper thermal
insulation
 Chemical irritation to the pulp
 Excessive pressure by orthodontic appliances

17.  The tooth with focal reversible pulpitis is sensitive to thermal
changes, especially to cold.
 Pain often results while drinking cold fluids or when ice or cold
air is applied to the tooth.
 Pain often is of very short duration and it disappears as soon
as the thermal irritant is withdrawned.
 Pain also results when the tooth is exposed to extremely high
temperatures
 Young people develop focal reversible pulpitis more often than
the older individuals because of the more reparative capacity
of the pulp tissue among the former group

18.  Pulpal stimuli, which cause reversible pulpitis in
young people often causes irreversible pulpitis to
the older individuals because of the less pulpal
tissue viability.
 The affected tooth responds to stimulation by
electric pulp tooth tester at a lower level of current
when compared with an adjacent normal tooth.
 The involved tooth often has large carious lesions
or restoration with improper insulation.

19.  Acute inflammatory reaction in the pulp
limited to the odontoblastic or
subodontoblastic regions, adjacent to the
irritated dentinal tubules.
 Dilatation of pulpal blood vessels with
increased vascular permeability.
 Edema in the pulp with infiltration by the
polymorphonuclear leukocyte in the area.
 Few odontoblast cells could be damaged in
the localized area of injury

20.  Odontoblast cell nuclei may be displaced into
the dentinal tubules due to either increased
local tissue pressure or due to abnormal
dentinal fluid movements during injury
 Thrombosis of pulpal blood vessels may
occur in some cases
 Repair takes place by redifferentiation of
odontoblast cells, which are damaged and
sometimes with deposition of reparative
dentin.

21.  Patient symptoms and clinical tests:-
 Pain :- It is sharp but of brief duration,
ceasing when irritant is removed. It is usually
by cold, sweet, and sour stimuli.
 Visual examination and history:- May reveals
caries, traumatic occlusion and undetected
fractures.
 Radiograph:-
o Show normal PDL and lamina dura in otherwords
normal periapical tissue
o Depth of caries or restoration may be evident

22.  Percussion test:- Shows negative response;
i.e tooth is normal to percussion and
palpation without any mobility
 Vitality test:- Pulp responds, readily to cold
stimuli. Electric pulp tester requires less
current to cause pain.
Treatment
 Best treatment of reversible pulpitis is
prevention.
 No endodontic treatment is needed for this
condition.

23.  Acute pulpitis ia an irreversible condition
characterized by acute, intense inflammatory
reaction in the pulpal tissue.
Etiology of acute pulpitis
 Caries progressing beyond the dentinal barriers
and reaching the pulp
 Pulp exposure due to faulty cavity preparation
 Blow to tooth with subsequent damage cavity
preparation without water spray
 Cracked tooth syndrome
 Tooth or tooth coming in the line of fracture when
the jaw is traumatized
 Anachoretic infection to the pulp

24.  The tooth is extremely sensitive to hot and cold stimuli, however the
pain in acute pulpitis can start spontaneously in the absence of any
stimuli
 A short and severe “lancinating” type of pain is often elicted from the
affected tooth.
 Application of hot or cold stimuli cause an increase in the intensity of
pain and such type of pain persist for a longer duration even after the
stimuli are removed.
 As the dental pulp is located within the solid confinement of dentinal
walls, intrapulpal pressure builds-up quickly and so is the pain, since
there is lack of escape route of inflammatory exudates during pulpal
inflammation
 In the initial stage of acute irreversible pulpitis the pain can be
localized or rather the patient can identify the offending tooth,
however in the more severe later stages the pain becomes regional
and the patient is unable to identify the offending tooth.

25.  The intensity of pain increases during sleep because
there is an increase in the local blood pressure in head
and neck region in supine position
 Acute pulpitis is often associated with micro abscess
formation in the pulp along with liquefaction
degeneration
 When drainage is established, small amount of pus
exudes from the opening, which has a noxious odor.
 The affected tooth responds to a lower level of current,
if electric pulp tester is used.
 Pain subsides when the drainage is established or
when the pulp undergoes complete necrosis.

26. Patient with acute pulpitis are often
apprehensive and moderately ill.
When intrapulpal pressure becomes very
high during acute inflammation, it can
cause collapse of the apical blood vessels.
This phenomenon is known as “ pulp-
strangulation.”

27.  Severe edema in the pulp with
vasodilation.
 Moderate to dense infiltration of
polymorphonuclear
 Focal or complete destruction of the
odontoblast cells at the pulp dentin
border
 Many micro-abscess formation,
characterized by areas of
liquefaction degeneration in the pulp
being surrounded by dense band of
neutrophils and micro organisms
 In sever cases, there may be
complete liquefaction and necrosis
of the pulp with total destruction of
the odontoblastic cell layer. This
phenomenon is known as acute
suppurative pulpitis.

28.  Death of the pulp may also be accompanied
by issue dehydration. This condition is known
as “dry gangrene of the pulp”.
Treatment
 Drainage of exudate or pus from the pulp
chamber
 Direct pulp capping
 Root canal treatment
 Extraction of tooth

29. It is a condition characterized by a low
grade, often persistent inflammatory
reaction in the pulpal tissue with little or no
constitutional symptoms.
Etiology
It is same to as of acute pulpitis but the
irritants are of low virulence.

30.  Sign and symptoms are much milder in
comparision to the aute pulpitis
 Tooth with chronic pulpitis may be asymptomatic
for quiet some time
 In other cases there may ne an intermittent dull
and throbbing pain in the tooth
 The tooth is less sensitive to hot and cold stimuli
 The tooth usually responds to a higher level of
current when electric pulp test is used
 Even if the pulp is exposed to the oral environment
through a large open cavity in the tooth, still a very
little pain is felt

31.  The chronic inflammatory response in the pulp is
characterized by cellular infiltration by lymphocytes,
plasma cells and macrophages e.t.c.
 The chronic nature of the inflammation may continue
for a long time with occasional periods of acute
exacerbations
 Blood capillaries are prominent and few microrganisms
are also found in the pulpal tissue
 Prolonged chronic inflammation may encourage
fibroblastic activity in the pulp with formation of
collagen bundles
 Chronic inflammation in the pulp in some cases may
result in integral resorption of the tooth

32. Treatment
Root canal treatment
Extraction of teeth

33. It is an unusal type of hyperplastic
granulation tissue response in the pulp
which is characterized by an overgrowth of
the tissue outside the boundary of the pulp
chambers as a protruding mass

34.  Pulp polyp clinically appears as a
small,pinkish red, lobulated mass which
protrudes from the pulp chamber and often
fills up the carious cavity
 The teeth in which pulp polyp commonly
develops are often the deciduous molars and
first permanent molars
 The condition is obviously seen in either
children or young adults
 Affected tooth always has a large open
carious cavity, which is present for a long
duration

35. The lesion bleeds profusely upon
provocation
If traumatized, the pulp polyp becomes
ulcerated and appears as a dark red,
fleshy mass with fibrinous exudate on the
surface
The involved teeth is usually painless but it
may be sensitive to thermal stimuli

36.  The hyperplastic pulpal tissue lesion presents the
features of a granulation tissue mass, consisting of
numerous proliferating fibroblasts and young blood
capillaries
 There may be edema and hyperemia of the pulpal
tissue
 Inflammatory cells infiltation chiefly by the
lymphocytes, plasma cells and sometimes
polymorphonuclear neutrophils in the tissue are
common
 Reparative secondary dentin may be formed
adjacent to the dentinal wall of the affected tooth

37.  Stratified sqamous type epithelial lining is often
observed on the surface of the pulp polyp, which
resembles oral epithelium.
 The epithelial cells on the surface of the polyp are
believed to be the desqamated epithelial cells,
which came either from the buccal mucosa,
gingiva or from the salivary gland ducts
 These cells are carried via saliva and are
transplanted on to the surface of the pulp polyps
 The epithelized surface of the pulp polyps may
sometimes show even well formed rete peg
formation

38. Treatment
Root canal treatment
Tooth extraction