6. Classification of pulp disease
• Base on Severity of inflammation
– Reversible pulpitis
– Irreversible pulpitis
• Acute
• Chronic
– Asymptomatic with pulp exposure
– Hyperplastic
– Internal resorption
– Pulp degeneration
• Calcification
– Pulp necrosis
• Coagulation necrosis
• Liquefaction necrosis
7. Classification of pulp disease
• According to involvement
– Focal or Subtotal or Partial pulpitis
– Total or Generalized pulpitis
• According to severity
– Acute
– Chronic
• According to presence or absence of direct
communication between dental pulp and oral
environment
– Pulpitis Aperts (Open pulpitis)
– Pulpitis Clausa (Closed pulpitis)
8. Classification of pulp disease
• American Association of Endodontists
– Normal pulp
– Reversible pulpitis
– Symptomatic irreversible pulpitis
– Asymptomatic irreversible pulpitis
– Pulp necrosis
– Previously treated
– Previously initiated therapy
ENDODONTICS: Colleagues for Excellence Published for the Dental
Professional Community by the American Association of Endodontists
11. Reversible pulpitis
• Mild to moderate pain
• Responds to cold and sweet
stimuli
• Pain does not occur without
stimuli
• Pain subsides within second
after removed stimuli
• No significant radiographic
change in periapical region
• Removed irritant such as
dental caries before pulp
damaged
14. Irreversible pulpitis
• Persistent inflammatory
condition of pulp
• Symptomatic or
Asymptomatic
• Early stage : Pain when
sudden temperature
change and continues
when cause was removed
• Late stage : Pain increase
intensity and due to
patient awake at night
• RCT or Extraction
15. Symptomatic
irreversible pulpitis
Asymptomatic
irreversible pulpitis
Extensive
restoration
Tooth fracture exposed
pulp
Has clinical symptoms No clinical symptoms
Deep caries may be exposed
pulp or exposed pulp
Subjective finding
Sensitive to thermal
change
Persistent response
to Hot & cold stimuli
Severe lancinating
or throbbing pain if
intrapulpal abscess
formation
Increase
sensitivity to pulp
vitality test
Not tender to
percussion unless
inflammation
spread to
periapical region
Objective finding
Mild intermittent pain
Response to thermal stimuli
Reduced response to pulp
vitality test
19. Chronic hyperplastic pulpitis
• Also called “Pulp polyp”
• Over growth of pulp
tissue outside the
boundary of pulp
chamber
• Most common in
deciduous molar and 1st
permanent molar
• Asymptomatic
irreversible pulpitis
22. Reversible pulpitis Irreversible pulpitis
• Mild to moderate pain
• Brief duration
• Response to cold stimuli
• Once stimulus is removed, pain
is usually subsides
• Tooth responds to electric pulp
tester at lower currents
• Teeth usually show deep caries,
metallic restoration with
defective margins
• Reversible pulpitis if allowed to
progress can led to irreversible
pulpitis
• Sharp, severe, radiating pain of
long duration & varying intensity
• Pain continues even after the
stimulus is removed
• Pain may exacerbate with
bending over or lying down
• It may progress to more severe
pain that is gnawing or
throbbing
• Increased by stimulus, like heat
and may relieved by cold
• If inflammation/Infection
extended to periapical tissue
can cause periapical disease
24. Pulp necrosis
• Partial or Total death of
dental pulp from long
term interruption of
blood supply to the
pulp
• Untreated irreversible
pulpitis such as caries
exposed pulp or trauma
to tooth
• Tooth discoloration
25. Pulp necrosis
• Not response to pulp
vitality test
• Pain on percussion if
PDL around apical
region was inflamed
• Radiographic change
can be found
• RCT and final
restoration by fixed
prosthodontics or
Extraction
28. Previously treated tooth:
• Clinical diagnosis
•Tooth has been endodontically treated
• Canals are obturated with various filling materials
• Tooth typically does not respond to thermal or electric
pulp testing
29. Previously Initiated Therapy
• Clinical diagnostic
• Tooth has been previously treated by partial endodontic
therapy such as pulpotomy or pulpectomy
• Degree of response to pulp testing depending on the level
of therapy, the tooth may or may not respond
• History taking is the most important for diagnosis
30. Reference
• ENDODONTICS: Colleagues for Excellence
Published for the Dental Professional Community
by the American Association of Endodontists
• Neville BW, Damm DD, Allen CM, and Bouquot
JE., Oral and Maxillofacial Pathology, 3rd edition.
Saunders: Philadelphia, 2009
• Sapp JP et al. (2004) Contemporary oral and
maxillofacial pathology, 2nd edition
• R.A Cawson, Cawson’s Essentials of Oral
Pathology and Oral Medicine,8th Edition, Page 60
Reversible Pulpitis is based upon subjective and objective findings indicating that the inflammation should resolve and the
pulp return to normal following appropriate management of the etiology. Discomfort is experienced when a stimulus such
as cold or sweet is applied and goes away within a couple of seconds following the removal of the stimulus. Typical etiologies
may include exposed dentin (dentinal sensitivity), caries or deep restorations. There are no significant radiographic changes
in the periapical region of the suspect tooth and the pain experienced is not spontaneous. Following the management of
the etiology (e.g. caries removal plus restoration; covering the exposed dentin), the tooth requires further evaluation to
determine whether the “reversible pulpitis” has returned to a normal status. Although dentinal sensitivity per se is not an
inflammatory process, all of the symptoms of this entity mimic those of a reversible pulpitis
Dental pulp exhibiting hyperemia and edema. The adjacent dentin was cut recently during placement of dental restoration
Symptomatic Irreversible Pulpitis is based on subjective and objective findings that the vital inflamed pulp is incapable of healing and that root canal treatment is indicated. Characteristics may include sharp pain upon thermal stimulus, lingering pain (often 30 seconds or longer after stimulus removal), spontaneity (unprovoked pain) and referred pain. Sometimes the pain may be accentuated by postural changes such as lying down or bending over and over-the-counter analgesics are typically ineffective. Common etiologies may include deep caries, extensive restorations, or fractures exposing the pulpal tissues. Teeth with symptomatic irreversible pulpitis may be difficult to diagnose because the inflammation has not yet reached the periapical tissues, thus resulting in no pain or discomfort to percussion. In such cases, dental history and thermal testing are the primary tools for assessing pulpal status.
Asymptomatic Irreversible Pulpitis is a clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing and that root canal treatment is indicated. These cases have no clinical symptoms and usually respond normally to thermal testing but may have had trauma or deep caries that would likely result in exposure following removal.
Dental pulp exhibiting an area of fibrosis and chronic inflammation peripheral to zone of abscess formation
Chronic inflammation that produces hyperplastic granulation tissue that extrudes from chamber
Pulp Necrosis is a clinical diagnostic category indicating death of the dental pulp, necessitating root canal treatment.
The pulp is non-responsive to pulp testing and is asymptomatic. Pulp necrosis by itself does not cause apical periodontitis
(pain to percussion or radiographic evidence of osseous breakdown) unless the canal is infected. Some teeth may be nonresponsive
to pulp testing because of calcification, recent history of trauma, or simply the tooth is just not responding. As
stated previously, this is why all testing must be of a comparative nature (e.g. patient may not respond to thermal testing on
any teeth)
Previously Treated is a clinical diagnostic category indicating that the tooth has been endodontically treated and the
canals are obturated with various filling materials other than intracanal medicaments. The tooth typically does not respond
to thermal or electric pulp testing.
Previously Initiated Therapy is a clinical diagnostic category indicating that the tooth has been previously treated by
partial endodontic therapy such as pulpotomy or pulpectomy. Depending on the level of therapy, the tooth may or may not
respond to pulp testing modalities.