2. CAUSES OF
PULP DISEASE
PHYSICAL CAUSES
A) Mechanical
1)Trauma – Accidental
Iatrogenic during dental procedures
2) Pathologic wear – Attrition
Abrasion
Bruxism
Abfraction
3) Crack through body of tooth ( cracked tooth
syndrome)
4) Barometric changes (Barodontalgia)
3. CAUSES OF
PULP DISEASE
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 fillings without a protective base
4) Frictional heat caused by polishing a
restoration
C) Electrical (galvanic current from dissimilar
metallic fillings)
4. CAUSES OF
PULP DISEASE
CHEMICAL CAUSES
A) Phosphoric acid, acrylic monomer, etc.
B) Erosion (acids)
BACTERIAL CAUSES
A) Toxins associated with caries
B) Direct invasion of pulp from caries or trauma
C) Microbial colonization in the pulp by
bloodborne microorganisms (Anachoresis)
5.
6. CLASSIFICATION OF THE DISEASES
OF THE PULP
INFLAMMATORY DISEASES OF THE DENTAL PULP
1) Reversible pulpitis
2) Irreversible pulpitis
a) Symptomatic irreversible pulpitis (previously known as acute
irreversible pulpitis)
b) Asymptomatic irreversible pulpitis (previously known as chronic
irreversible pulpitis)
c) Chronic hyperplastic pulpitis
d) Internal resorption
9. Reversible Pulpitis
Definition - Reversible pulpitis is a mild-to-moderate inflammatory
condition of the pulp caused by noxious stimuli in which the pulp is
capable of returning to the uninflamed state following removal of the
stimuli
Cause - any agent that is capable of injuring the pulp (Trauma, Thermal
shock, excessive dehydration of a cavity, Chemical stimulus, as from sweet
or sour foodstuffs or from irritation of a filling; or bacteria, as from caries
10. SYMPTOMS – Characterized by short, sharp pain lasting for a
moment
Pain is specific to a stimulus
Pain is instantly relieved on removal of the
stimulus
More often brought on by cold than hot food
or beverages and by cold air
Does not occur spontaneously
Does not continue when the stimulus has
been removed
Cause of the pain is generally traceable to a
stimulus, such as cold water
DIAGNOSIS –Diagnosis is by a study of the patient’s
symptoms and by clinical tests
Application of cold is an excellent method of
locating and diagnosing the involved tooth
11. Treatment – prevention is the best treatment for reversible
pulpitis
Periodic care
Early insertion of filling if a cavity has developed
Removal of noxious stimuli
12. Irreversible Pulpitis
Definition - Irreversible pulpitis is a persistent inflammatory condition of the
pulp, symptomatic or asymptomatic in nature with the pulp
becoming incapable of healing
Types - Asymptomatic irreversible pulpitis
Symptomatic irreversible pulpitis
Cause - Bacterial involvement of the pulp through caries
Reversible pulpitis may deteriorate into irreversible pulpitis
13. Symptoms – Sharp, piercing, or shooting type of pain
May be intermittent or continuous
In the early stages pain may be caused by
sudden temperature changes
Pain due to packing food into a cavity or
suction exerted by the tongue or cheek
Prolonged painful response to heat relieved by
cold
Pain occurs spontaneously
Pain often continues even after stimulus has
been removed
Postural pain may also be seen (nocturnal
pain)
In later stages pain is boring, gnawing, or
Throbbing type
14. Diagnosis – Deep cavity extending to the pulp
Grayish, scum-like layer over the exposed pulp
Odour of decomposition
Radiograph may also show exposure of the
pulp
Thermal test may elicit pain that persists after
removal of the thermal stimulus
Treatment – Root Canal Treatment
Pulpectomy
Pulpotomy
Extraction of tooth
if tooth is not
restorable
15.
16. Chronic Hyperplastic Pulpitis (Pulp Polyp)
Definition - Chronic hyperplastic pulpitis or pulp polyp is a productive
pulpal inflammation due to an extensive carious exposure of a
young pulp
Characterized by the development of granulation tissue
Cause - Slow, progressive carious exposure of the pulp
Young resistant pulp
Low grade stimulus
Symptom- Symptomless, except during mastication
17. Diagnosis – Seen in children and young adults
Reddish fleshy pulpal mass fills the pulp
chamber
Polyp tissue is less sensitive than normal pulp
and more sensitive than gingival tissue
Bleeds easily if cut
Treatment – Elimination of polyp tissue followed by pulp
extirpation
Bleeding should be controlled with pressure
18. Internal Resorption
Definition - Internal resorption is an idiopathic slow or fast progressive
resorptive process occurring in the dentin of the pulp chamber
or in the root canals of the teeth
Cause – Patients have a history of trauma
Symptoms – Asymptomatic if occurs in root
Manifest as a reddish area called PINK SPOT in the crown
Treatment – Root Canal treatment using thermoplasticized gutta percha
19.
20. Pulp Degeneration
Calcific Degeneration - Pulp tissue is replaced by calcific material pulp
stones or denticles
Calcification are generally present in the pulp
chamber
Calcified material has a laminated structure like the skin of
an onion
Lies unattached within the body of the pulp
Pulp stones are present in more than 60% of adult teeth
21. Diagnosis – Clinically asymptomatic
Crown may exhibit discoloration
Obliteration of the pulp space is evident
radiographically
Treatment
o Asymptomatic Tooth - Aesthetic management of the
discoloured tooth with a full-coverage restoration or
laminate restoration
o Symptomatic Tooth - Endodontic therapy using a
microsurgical retrograde approach
Endodontic therapy is not recommended unless the
tooth is symptomatic
22. Pulp Degeneration
Atrophic Degeneration – Seen in pulps of
older people
Observed histopathologically
Fewer stellate cells are present and
intercellular fluid is increased
Pulp tissue is less sensitive than normal
No clinical diagnosis exists
Fibrous Degeneration - Characterized
by replacement of the cellular elements by
fibrous connective tissue
Pulp has the characteristic appearance of a
leathery fibre
23. Necrosis of Pulp
Necrosis is death of the pulp
May be partial or total
Seen as a sequalae of inflammation or trauma
Types - Coagulation necrosis - soluble portion of tissue is converted into a
solid material
Liquefaction necrosis – proteolytic enzymes convert the tissue into
a softened mass, a liquid, or amorphous debris
24. Symptoms – Asymptomatic
Discoloration of the tooth
Diagnosis – Radiographs show thickening of the
periodontal ligament
History of severe pain lasting from a few
minutes to a few hours and sudden cessation of
pain
Tooth does not respond to cold, electric pulp
test, or the test cavity
Treatment – Root Canal Treatment