Pulpitis OD


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Oral Diagnosis I
Third Year

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Pulpitis OD

  1. 1. Groap 2
  2. 2. Outline • Definition. • Causes. • Types. • Pulpitis - Histopathology. • References.
  3. 3. Definition • Pulpitis refers to the inflammation of the dental pulp within the tooth. • The pulp contains: – the blood vessels. – the nerves. – connective tissue inside a tooth, provides nutrients.
  4. 4. Causes Inflammation of the dental pulp, usually due to:  Bacterial infection in dental caries.  Tooth fracture.  Chemical irritants.  Thermal factors.  Traumatic exposure. Any condition that cause exposure of the tooth pulp.
  5. 5. Types Once the pulp has become inflamed the tooth can be diagnostically divided into two categories: 1. Reversible pulpitis. 2. Irreversible pulpitis. A. Pulp Necrosis. B. Acute Pulpitis. C. Chronic inflammation
  6. 6. Reversible Pulpitis (pulp hyperemia). • A common condition affecting a tooth accompanied by short-lived pain following application of heat or cold; the pulp usually recovers. • It does not have to be treated as it will heal on its own over time.
  7. 7. Irreversible Pulpitis: Pulp Necrosis • A general term referring to a dead pulp (one that does not respond to standard pulp tests); pulp death may have been preceded by acute or chronic inflammation.
  8. 8. Irreversible Pulpitis: Acute Pulpitis • A common condition affecting a tooth accompanied by severe, relentless pain; the acute inflammation associated with it invariably causes pulp death requiring pulp extirpation or extraction.
  9. 9. Irreversible Pulpitis: Chronic Pulpitis • A common condition affecting a tooth accompanied by dull, bearable pain; the chronic inflammation associated with it usually causes pulp death requiring pulp extirpation or tooth extraction.
  10. 10. Symptoms and Signs Acute pulpitis is usually associated with:  severe tooth pain. The tooth becomes sensitive to hot or cold foots and pressure, such as might occur with chewing. Acute reversible: sensitive to cold. Acute irreversible: sensitive to hot & cold. Swelling.
  11. 11. Pulpitis - Histopathology Poor correlation between microscopic changes & clinical symptoms. Inflammatory process may be modified by several factors : 1 : Nature, severity and duration of insult. 2 : Efficiency of host defenses. 3 : Efficiency of pulpo-dentinal complex defenses. 4 : Special anatomy of pulp: surrounded by hard tissue and cannot tolerate edema.
  12. 12. Pulpitis - Histopathology • Immune reactions in inflamed tissue may contribute to tissue damage. • Rate of progression of pulpitis is variable, but end result of untreated pulpitis is total necrosis except in the case of pulp polyp formation.
  13. 13. Closed pulpitis: whether acute or chronic, may progress to necrosis due to limited ability of pulp to withstand inflammatory edema since it is surrounded by hard tissues.
  14. 14. Closed pulpitis (general feature) : • First type Acute closed pulpitis : - Initiation of hyperaemia. - Infiltration by inflammatory cells & destruction of adjacent odonoblast. - Formation of a little abscess. - Pulp is obliterated by dilated BV & acute inflammatory cells. • Second type Chronic closed pulpitis : - main feature are a predominantly mononuclear cells. - More vigorous connective tissue reaction. - Small necrosis area + pus formation (granulation tissue) - little abscess may form.
  15. 15. Open pulpitis or chronic hyperplastic pulpitis (pulp polyp): • Pulp is survive but large carious cavities. • Young molar teeth with wide apices and good blood supply. • Usually devoid of sensation on gentle probing. • Polyp consists of chronically inflamed hyperplastic granulation tissue protruding from pulp cavity.
  16. 16. Open pulpitis or chronic hyperplastic pulpitis (pulp polyp): • May become epithelialized by spontaneous grafting of desquamated oral epithelial cells from saliva. • Histologically, odontoblasts survive & the pulp is replaced by granulation tissue.
  17. 17. Treatment  1-Drilling and filling for reversible pulpitis  2-Root canal and crown for irreversible pulpitis  3-or extraction Causes of endodontic treatment failure:  Presence of infected and necrotic pulp tissue in root canal. (main cause)  Over or incompletely filled teeth  Excessive hemorrhage  Chemical irritants (Hypersensitivity to the materials used)
  18. 18. References • Burket's Oral Medicine: Diagnosis and Treatment. • www.medicinenet.com • www.ada.org • Regazi , Oral Pathology. • Mosby, Dental drug reference.