Diseases of the pulp & periapical tissues /cosmetic dentistry courses

Diseases of the pulp & periapical
tissues
INDIAN DENTAL ACADEMY
Leader in continuing Dental
Education
www.indiandentalacademy.com

OBJECTIVES
 At the end of the lecture student should know the
– pathophysiology of the pulp disorders
– etiological factors for the pulp diseases
– classification of pulpal diseases

Introduction
 Pulp is the formative organ of the
tooth.
 It is a connective tissue system,
composed of cells, ground
substance and fibers.
 Irritation to pulp causes pulpal
injuries.
 Irritants may be living or
nonliving. www.indiandentalacademy.com

 The living irritants are usually bacterial,
 Nonliving irritants may be mechanical,
thermal, chemical .

• The initial response of dental pulp to injury is similar to
other connective tissue but
• The nature & course of the response is different
Because
• Anatomic features

Pathophysiology
Injury
Inflammation
Hyperemia (vasodilatation)
Edema

Pathophysiology
Pulp in a confined area ( within rigid calcified dentinal
walls)
Pulpal inflammation
Vasodilatation
Increased pulpal pressure
Vessel damage
Necrosis

Pulpitis :- An inflammation of the pulpal tissue that may be
acute or chronic, with or without symptoms, and reversible or
irreversible

Etiologies of
pulp pathologies
Physical BiologicalChemical
Mechanical Thermal Electrical

I. Physical
A) Mechanical
1.Trauma
a. Accidental ( contact sports)
b. Iatrogenic dental procedures
(wedging of teeth, cavity or crown preparation etc.)
2. Pathologic wear ( attrition, abrasion etc.)
3. Crack through body of tooth (Crack tooth syndrome)
4. Barometric changes ( Barodontalgia )

B. Thermal
1. Heat from cavity preparation, at either low or high
speed
2. Exothermic heat from the setting of cement
3. Conduction of heat and cold through deep filling
without a protective base
4. Frictional heat caused by polishing a restoration

C. Electrical ( galvanic current from dissimilar metallic
filling) II. Chemical
A. Phosphoric Acid, acrylic monomer, etc
B. Erosion ( acid )
III. Biological
A. Toxins associated with caries
B. Direct invasion of pulp from caries or trauma
C. Microbial colonization in the pulp by blood borne
microorganisms (anachoresis)

Crack tooth syndrome( Crack through body of tooth)
• Crack may develop in enamel from thermal tensile
stresses, because transient heat is conducted much more
readily in enamel than in dentin.
• When teeth are subjected to sudden temperature change,
the enamel reaches the new temperature much more
rapidly than the dentin.

• With lower temperatures, the enamel is restrained from
contracting by the dentin, resulting in enamel cracks.

• C/O of pain, ranging from mild to excruciating at the
initiation or released of the biting force.
• Crack through body of the tooth may be better visualized
by using a dye or by trasilluminating the tooth with a
fibro-optic light.

Classification

• Open Pulpitis: This term has been used to describe
those cases of pulpitis in which the pulp
communicates with the oral cavity.
• Closed Pulpitis : Those cases of pulpitis in which no
such communication exists.

• Chronic Hyperplastic pulpitis : This is a unique
form of pulpitis wherein the inflamed pulp, instead of
perishing by continued suppuration, reacts by
excessive and exuberant proliferation.

• Ulcerative pulpitis : There is sometimes an attempt
by the pulp to ward off the infection through
deposition of collagen around the inflamed area. The
tissue reaction may resemble the formation of
granulation tissue. When this occurs on the surface of
the pulp tissue in a wide-open exposure, the term
ulcerative pulpitis is applied.

Depending upon the extent of
involvement of pulp
Pulpitis
Acute Chronic
Partial /focalPartial /focal Total/Generalised Total/Generalised

Etiology
• Dentinal & pulpal irritation due to deep restorations,
usually metallic & without adequate insulation
• Restorations with defective margins
FOCAL REVERSIBLE PULPITIS

Clinical features
• Early mild transient pulpitis
• Localised
• Sensitive to thermal changes, particularly cold
• Response to electric pulp tester: at low level of current
( lower pain threshold /greater sensitivity)

Pain Symptoms in Reversible
Pulpitis
• Elicited
• Sharp
• Less than 20 min duration
• Disappears upon removal of irritant
• Unaffected by body position
• Easily localized

Histopathology
Capillary bed engorgement

Increased number of cells in the location of the cell-free zone.
The reaction is localized to the affected tubules. The
odontoblastic layer may be partially disrupted because many of
the odontoblasts have been displaced ( aspirated ) into the
tubules.

Prognosis
The capability for resolution depends on
• The strength and duration of the irritant
• The extent of the pulp tissue affected
• The prior health status of the pulp itself.

Summary
– pathophysiology of the pulp disorders
– etiological factors for the pulp diseases
– classification of pulpal diseases

Diseases of the pulp & periapical tissues /cosmetic dentistry courses

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Diseases of the pulp & periapical tissues /cosmetic dentistry courses