Pulpal diseases /certified fixed orthodontic courses by Indian dental academy


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Pulpal diseases /certified fixed orthodontic courses by Indian dental academy

  1. 1. PULPAL DISEASES INDIAN DENTAL ACADEMY Leader in Continuing Dental Education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. INTRODUCTION www.indiandentalacademy.com
  3. 3. ETIOLOGYI. Bacterial A. Coronal ingress 1. Caries 2. Fracture a. Complete b. Incomplete (cracks, infraction) 3. Nonfracture trauma 4. Anomalous tract a. Dens invaginatus (aka dens in dente) b. Dens evaginatus c. Radicular lingual groove (aka palatogingival groove) www.indiandentalacademy.com
  4. 4. B. Radicular ingress 1. Caries 2. Retrogenic infection a. Periodontal pocket b. Periodontal abscess 3. Hematogenic www.indiandentalacademy.com
  5. 5. II. Traumatic A. Acute 1. Coronal fracture 2. Radicular fracture 3. Vascular stasis 4. Luxation 5. Avulsion B. Chronic 1. Bruxism 2. Traumatism 3. Attrition or abrasion 4. Erosion www.indiandentalacademy.com
  6. 6. III. Iatral A. Cavity preparation 1. Heat of preparation 2. Depth of preparation 3. Dehydration 4. Pulp horn extensions 5. Pulp exposure 6. Pin insertion 7. Impression taking www.indiandentalacademy.com
  7. 7. B. Restoration 1. Insertion(condensation) 2. Fracture a. Complete b. Incomplete 3. Force of cementing 4. Heat of polishing www.indiandentalacademy.com
  8. 8. C. Intentional extirpation and root canal fillingD. Orthodontic movementE. Periodontal curettageF. ElectrosurgeryG. Laser burnH.Periradicular curettageI. RhinoplastyJ. OsteotomyK. Intubation for general anesthesia www.indiandentalacademy.com
  9. 9. IV. Chemical A. Restorative materials 1. Cements 2. Plastics 3. Etching agents 4. Cavity liners 5. Dentin bonding agents 6. Tubule blockage agents www.indiandentalacademy.com
  10. 10. B. Disinfectants 1. Silver nitrate 2. Phenol 3. Sodium fluorideC. Desiccants 1. Alcohol 2. Ether 3. Others www.indiandentalacademy.com
  11. 11. V. Idiopathic A. Aging B. Internal resorption C. External resorption D. Hereditary hypophosphatemia E. Sickle cell anemia F. Herpes zoster infection G. Human Immunodeficiency Virus (HIV) and Acquired Immune DeficiencySyndrome (AIDS) www.indiandentalacademy.com
  12. 12. Classification of Pulpal Diseases• Ingle’s classificationA. Inflammatory changes 1. Hyperreactive pulpalgia 3. Chronic pulpalgia a. Hypersensitivity 4. Hyperplastic pulpitis b. Hyperemia 5. Pulp necrosis 2. Acute pulpalgia B. Degenerative changes a. Incipient(may be 1. Atrophic pulposis reversible) 2. Calcific pulposis b. Moderate(may be referred) c. Advanced(relieved by cold) www.indiandentalacademy.com
  13. 13. According to Seltzer and Bender(Histological)A. Inflammatory changes 1. Intact pulp with chronic 5. Chronic partial pulpitis inflammatory cells. (hyperplastic form). 2. Acute pulpitis. 6. Pulp necrosis. 3. Chronic partial pulpitis with partial necrosis. B. Degenerative changes 4. Chronic total pulpitis with 1. Atrophic pulp. liquefaction necrosis 2. Dystrophic mineralisation. www.indiandentalacademy.com
  14. 14. REVERSIBLE PULPITIS• It is a mild to moderate inflammation of pulp caused by noxious stimuli in which the pulp is capable of returning to the uninflammed state following removal of the stimuli. www.indiandentalacademy.com
  15. 15. Signs and symptoms• Sharp pain but lasting for a moment• Brought about by cold or hot• Pain disappears when the stimulus is removed• Pain is never spontaneous• Caries, Erosion, Abrasion may be seen• Faulty restoration may be seen www.indiandentalacademy.com
  16. 16. Diagnosis• Chief complaint and history• Examination may show Caries Erosion Abrasion Faulty restoration• Clinical tests: cold test is particularly useful. www.indiandentalacademy.com
  17. 17. HistopathologyCapillary engorgement with inflammatory cells www.indiandentalacademy.com
  18. 18. Differential diagnosis• Cracked tooth syndrome• Hypersensitivity• Trauma• High filling www.indiandentalacademy.com
  19. 19. Treatment• Restoration of caries(temporary /permanent)• Restoration of erosion, abrasion cavities• Correction of faulty restoration• Taking preventive steps to stop recurrences. www.indiandentalacademy.com
  20. 20. IRREVERSIBLE PULPITIS• Irreversible pulpitis is a persistent inflammatory condition of the pulp, symptomatic or asymptomatic, caused by a noxious stimulus. www.indiandentalacademy.com
  21. 21. Signs and symptoms• Pain due to hot, cold, pressure which lasts even after removal of the stimulus• Spontaneous pain described as sharp, piercing or shooting• Pain on bending over and lying down• Referred pain• Pain is increased by heat and relieved by cold.• Inability to recognize the offending tooth www.indiandentalacademy.com
  22. 22. Diagnosis• Chief complaint and history• Examination reveals Extensive caries,(may be exposed pulp) Traumatized tooth Large restoration• Tests : mainly thermal tests are useful www.indiandentalacademy.com
  23. 23. HistopathologyChronic inflammatory cells with bacteriapenetrating and dilated blood vassals www.indiandentalacademy.com
  24. 24. Differential diagnosis Reversible IrreversiblePain Momentary ContinuousStimulus Required SpontaneousHistory Recent restoration Deep caries, trauma cariesReferred pain Negative Common findingPain on lying down Negative May be presentColor No change May be changedElectric pulp test Premature Premature or delayed www.indiandentalacademy.com
  25. 25. Treatment• Complete removal of the pulp however in posterior teeth removal of only coronal pulp and placement of formocresol over the radicular pulp may be considered as an emergency measure.• Subsequent completion of the root canal treatment and restoration. www.indiandentalacademy.com
  26. 26. CHRONIC HYPERPLASIC PULPITISIt is a productive pulpal inflammation due to an extensive carious exposure of a young pulp. www.indiandentalacademy.com
  27. 27. Signs and symptoms• Usually no symptoms• Pressure from food may cause discomfort• Large carious lesion• Polypoid tissue projecting into the caries. www.indiandentalacademy.com
  28. 28. Diagnosis• History taking reveals the age of the patient• A fleshy reddish pulpal mass fills the carious lesion which may blend with the gingiva• This tissue is less sensitive than the pulp but more sensitive than gingiva• Raising the tissue and tracing the stalk differentiate from the proliferating gingival tissue. www.indiandentalacademy.com
  29. 29. HistopathologySurface covered by the stratified epithelial tissue containing the granulation tissue www.indiandentalacademy.com
  30. 30. Differential diagnosis• Proliferating gingival tissue www.indiandentalacademy.com
  31. 31. Treatment• Removal of the polypoid tissue• Initiating the root canal therapy and restoration of tooth. www.indiandentalacademy.com
  32. 32. Internal ResorptionIt is an idiopathic slow or fast progressive resorptive process occurring in the dentin of pulp chamber or root canal.Also called ‘pink tooth of mammary’ www.indiandentalacademy.com
  33. 33. Signs and symptoms• Usually asymptomatic• In crown pink spot may appear which is the granulation tissue showing through the resorbed area. www.indiandentalacademy.com
  34. 34. Diagnosis• History taking may reveal trauma• Usually diagnosed on routine radiography which shows change in appearance of the root canal wall or pulp chamber of the involved tooth. www.indiandentalacademy.com
  35. 35. HistopathologyInternal resorption showing lacune and osteoclasts www.indiandentalacademy.com
  36. 36. Differential diagnosis• Should be distinguished from external resorption especially when there is a perforative type of lesion• In internal resorption the resorptive lesion is more extensive on the pulpal side. www.indiandentalacademy.com
  37. 37. Treatment• Extirpation of the pulp• Root canal treatment and subsequent restoration of the tooth. www.indiandentalacademy.com
  38. 38. Pulp degenerationIt may be- Calcific degeneration. Atrophic degeneration. fibrous degeneration. www.indiandentalacademy.com
  39. 39. Necrosis of the Pulp• Necrosis is the death of the pulp.• It may be complete or incomplete www.indiandentalacademy.com
  40. 40. Histologically Necrosis may be.. Cogulative Necrosis Liquefactive Necrosis www.indiandentalacademy.com
  41. 41. Signs and symptoms• Usually asymptomatic• Opaque appearance or grayish discoloration of the tooth• Is associated with sinus tract in many cases www.indiandentalacademy.com
  42. 42. Diagnosis• History• On examination – Discoloration – Sinus tract – No response to tests (heat or cold) www.indiandentalacademy.com
  43. 43. Treatment• Routine endodontic treatment followed by restoration www.indiandentalacademy.com
  44. 44. www.indiandentalacademy.com