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Abnormalities of the pulp
 

Abnormalities of the pulp

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    Abnormalities of the pulp Abnormalities of the pulp Presentation Transcript

    • ABNORMALITI ES OF THE PULP Prepared by: Dr. Rea Corpuz
    • Pulp Calcification may be located  pulp chamber OR  root canals
    • Pulp Calcification Cause  no clear-cut etiology  no relation between inflammation + irritation • since pulp calcification can be found in unerupted teeth
    • Sundell Schematic Presentation Local Metabolic Hyalinization Vascular TraumaDysfunction of injured cell Damage ThrombosisGrowth Mineralization Fibrosis Vessel Wall Damage Pulp Stones
    • Classification Three types :  (1) Denticles  (2) Pulp stones  (3) Diffuse linear calcifications
    • (1) Denticles believed to form as a result of epitheliomesenchymal interaction within developing pulp form during period of root development occur in root canal + pulp chamber adjacent to furcation areas of multirooted teeth
    • (2) Pulp Stones believed to develop around central nidus of pulp tissue examples:  collagen fibril  ground substance formed within coronal portions of pulp
    • (2) Pulp Stones may arise as part of age- related or local pathologic changes most develops after tooth formation is completed usually free or attached some instances, may be embedded
    • (3) Diffuse Linear Calcifications doesn’t demonstrate lamellar organization of pulp stones exhibit areas of:  fine  fibrillar  irregular calcification may be present in pulp chamber or canals frequency increases with age
    • (3) Diffuse Linear Calcifications Clinical Significance:  very little clinical significance  except insofar as they may obstruct endodontic treatment
    • (3) Diffuse Linear Calcifications Clinical Significance:  discovered on radiograph only as radioopacity  may cause pain from mild pulpal neuralgia to severe excruciating pain resembling tic douloureux • as denticle may impinge on nerve of pulp
    • (3) Diffuse Linear Calcifications Clinical Significance:  difficulty may be encountered in extirpating pulp during root canal therapy
    • (3) Diffuse Linear Calcifications Treatment & Prognosis  No treatment is required
    • Resorption of the Teeth deciduous teeth are progressively loosened  result of progressive resorption of roots  physiological process arising from pressure of underlying successors resorption of permanent is always pathological
    • Resorption of the Teeth Pathology  pressure is probably main factor  resorption is mainly carried out by osteoclast  humoral mediators, such as prostgalndins • may contribute to resorption
    • Idiopathic Resorption (1) Internal Resorption (2) External Resorption
    • Idiopathic Resorption Internal Resorption  pink spot  curious + uncommon condition  dentin is resorbed from within the pulp
    • Idiopathic Resorption (1) Internal Resorption  tends to be localized  well-defined rounded area of rediolucency in crown  can affect any part of teeth  NO signs until pulp is opened + allows access to infection
    • Idiopathic Resorption (1) Internal Resorption  may be detected by chance in routine radiograph
    • Idiopathic Resorption (1) Internal Resorption
    • Idiopathic Resorption (1) Internal Resorption
    • Idiopathic Resorption (2) External Resorption  may be localized or generalized  unkown cause  mild degree of inflammation is often suspected
    • Idiopathic Resorption (2) External Resorption
    • Idiopathic Resorption (2) External Resorption Heithersay Classification
    • Idiopathic Resorption (2) External Resorption  usually a limited area of root is attacked from external surface near amelocemental junction • resorption goes on until pulp is reached
    • Idiopathic Resorption (2) External Resorption  often preferentially destroys root before penetrating the pulp
    • Idiopathic Resorption (2) External Resorption  accessible defects may be amenable to restoration with mineral trioxide or other materials  long term success in infrequent; unpredictable
    • Idiopathic Resorption (2) External Resorption  Pathology • vascular granulation tissue replaces part or periodontal ligament or pulp • osteoclasts border the affected dentin or enamel
    • Idiopathic Resorption (2) External Resorption  Treatment • usually untreatable • if a pink spot in an incisor tooth is noticed at an early stage  endodontic treatment should be carried out before
    • Idiopathic Resorption (2) External Resorption  Treatment • resorption of teeth may result from pressure exerted by impacted teeth  indication for removal of unerupted teeth
    • DISEASES OFPERIAPICALTISSU ES Prepared by: Dr. Rea Corpuz
    • Diseases of Periapical Tissues (1) Periapical Abscess (2) Periapical Granuloma (3) Radicular Cyst (4) Phoenix Abscess (5) Condensing Osteitis
    • (1) Periapical Abscess also known as Dento-alveolar Abscess; Alveolar Abscess acute or chronic supporative process of dental periapical region usually arises as a result of infection
    • (1) Periapical Abscess abcess ay develop directly as an acute apical periodontitis following an acute pulpitis but more commonly it originates in an area of chronic infection
    • (1) Periapical Abscess Clinical Feature  presents features of acute inflammation of apical peridontium  tooth is extremely painful  slightly extruded from its socket
    • (1) Periapical Abscess Clinical Feature  chronic periapical abscess generally presents no clinical features  mild, circumscribed area of suppuration that shows little tendency to spread from local area
    • (1) Periapical Abscess Radiographic Feature  except for SLIGHT thickening of periodontal membrane  no roentgenographic evidence of its presence  chronic abscess, developing in a periapical granuloma • radioluscent area at apex
    • (1) Periapical Abscess
    • (1) Periapical Abscess Histopathologic Features  area of suppuration is composed chiefly of central area of disintegrating polymorphonuclear leukocytes  dilation of blood vessels in periodontal ligament
    • (1) Periapical Abscess Histopathologic Features  tissue surrounding area of suppuration contains serous exudate
    • (1) Periapical Abscess Treatment & Prognosis  drainage must be established • open pulp chamber • extract the tooth
    • (1) Periapical Abscess Treatment & Prognosis  under some circumstances tooth may be retained • root canal therapy
    • (1) Periapical Abscess Treatment & Prognosis  left untreated, spread of infection • osteomyelitis • cellulitis • bacterimia • formation of fistulous tract opening on skin or oral mucosa
    • (2) Periapical Granuloma also known as Apical Periodontitis one of the most common sequeala of pulpitis localized mass of chronic granulation tissue  response to infection
    • (2) Periapical Granuloma Clinical Features  1st evidence; spread beyond confines of tooth pulp  may be noticeable sensitivity of involved tooth to percussion  mild pain when biting or chewing on solid food
    • (2) Periapical Granuloma Clinical Features  some cases tooth feels elongated in its socket  sensitivity is due to • hyperemia • edema • inflammation of apical periodontal ligament
    • (2) Periapical Granuloma Radiographic Features  earliest evidence, thickening of ligament at root apex  proliferation of granulation tissue  concomitant resorption of bone continue
    • (2) Periapical Granuloma Radiographic Features  appear as a radiolucent area of variable size seemingly attached to root apex  some cases, well circumscribed lesion • definitely demarcated from surrounding bone
    • (2) Periapical Granuloma Histologic Features  arises as chronic process from onset  does not pass through an acute phase
    • (2) Periapical Granuloma Histologic Features  begins as: • hyperemia • edema of periodontal ligament with infiltration of chronic inflammatory cells  chiefly lymphocytes  plasma cells
    • (2) Periapical Granuloma Histologic Features  inflammation + locally increased vascularity of tissue • induce resorption of supporting bone adjacent to this area
    • (2) Periapical Granuloma Histologic Features  as bone is resorbed • proliferation of fibroblast + endothelial cells • formation of more tiny vascular channels • numerous delicate connective tissue fibrils
    • (2) Periapical Granuloma Treatment & Prognosis  extraction of involved teeth  under certain conditions, root canal therapy with or without subsequent apicoectomy
    • (2) Periapical Granuloma Treatment & Prognosis
    • (2) Periapical Granuloma Treatment & Prognosis  left untreated, may undergo transformation into an apical periodontal cyst • proliferation of epithelial rests in the area
    • (3) Radicular Cyst also known as Apical Periodontal Cyst; Periapical Cyst; Root End Cyst common not inevitable sequela of periapical granuloma originating as a result of:  bacterial infection  necrosis of dental pulp  following carious involvement of tooth
    • (3) Radicular Cyst Pathogenesis  initial reaction leading to cyst formation • proliferation of epithelial rest in the periapical area involved by granuloma • epithelial proliferation follows an irregular pattern of growth
    • (3) Radicular Cyst Clinical Features  asymptomatic  present no clinical evidence of their presence  seldom painful or even sensitive to percussion
    • (3) Radicular Cyst Clinical Features  represents chronic inflammatory process • develops only over a long period of time
    • (3) Radicular Cyst Radiographic Features  identical with periapaical granuloma  since the lesion is a chronic progressive one developing in a pre-existing granuloma • cyst may be of greater size than granuloma • due to longer duration
    • (3) Radicular Cyst Radiographic Features  occasionally, exhibits thin, radioopaque line around the periphery of radiolucent area • indicates reaction of bone to slowly expanding mass
    • (3) Radicular Cyst Radiographic Features
    • (3) Radicular Cyst Histologic Features  epithelium lining apical periodontal cyst is usually stratified squamous in type
    • (3) Radicular Cyst Treatment & Prognosis  similar to periapical granuloma • involved tooth may be removed • periapical tissue carefully curetted
    • (3) Radicular Cyst Treatment & Prognosis  under some condition; • root canal therapy • with apicoectomy of cystic lesion
    • (3) Radicular Cyst
    • (4) Phoenix Abscess localized collection of pus surrounded by an area of inflammed tissue  hyperemia  infiltration of leucocytes
    • (4) Phoenix Abscess
    • (4) Phoenix Abscess
    • (4) Phoenix Abscess can occur immediately following root canal treatment another cause is due to untreated necrotic pulp (chronic apical periodontitis) result of inadequate debridement during endodontic procedure
    • (4) Phoenix Abscess Bacteriology  Staphylococci are frequently associated with pus formation • produce enzyme called coagulase • causes fibrin formation • helps in walling off of lesion
    • (4) Phoenix Abscess Bacteriology • coagulase promotes virulence by inhibiting phagocytosis
    • (4) Phoenix Abscess Clinical Features  when palpated clinically • superficial abscess is fluctuant  offending tooth is carious + mobile  symptoms of acute inflammation • swelling • fever
    • (4) Phoenix Abscess Treatment  repeating endodontic treatment with improved debridement  tooth extraction  antibiotics may be indicated to control a spreading or systemic infection
    • (5) Condensing Osteitis also known as Chronic Focal Sclerosing Osteomyelitis unusual reaction of bone occuring in instances of extremely high tissue resistance or in cases of low grade infection
    • (5) Condensing Osteitis Clinical Features  occurs in almost young person before the age of 20 years old  commonly affected is mandibular 1st molar with large carious lesion
    • (5) Condensing Osteitis
    • (5) Condensing Osteitis
    • (5) Condensing Osteitis Clinical Features  associated with non vital teeth or teeth undergoing process of degeneration  tooth is usually asymptomatic  some cases, pain or tenderness • percussion • palpation
    • (5) Condensing Osteitis Radiographic Features  well circumscribed radiopaque mass of sclerotic bone surrounding  extending below apex of one or more roots
    • (5) Condensing Osteitis Histologic Features  dense mass of bony trabeculae with little interstitial marrow tissue
    • (5) Condensing Osteitis Histologic Features  dense mass of bony trabeculae with little interstitial marrow tissue  chronic inflammatory cells; plasma cells, lymphocytes are seen scanty in bone marrow
    • (5) Condensing Osteitis Treatment & Prognosis  endodontic treatment  extraction  surgical removal of sclerotic should not be attempted unless symptomatic
    • References: Books  Cawson, R.A: Cawson’s Essentials of Oral Oral Pathology and Oral Medicine, 8th Edition • (page 70-72)  Ghom, Ali & Mhaske, Shubhangi: Textbook of Oral Pathology • (pages 429-433)  Neville, et. al: Oral and Maxillofacial Pathology 3rd Edition • (pages 127-138) Shafer, et al: A textbook of Oral Pathology, 3rd Edition