Introduction   The pulp is surrounded by a hard    tissue (dentine), which limits the area    for expansion and restricts...
Normal Pulp:   Gives moderate response to pulp    test, which subside when the stimulus is    removed.   The tooth is fr...
CLASSIFICATION OF PULPAL     PATHOLOGIES
Grossman’s Clinical    Classification   I. Pulpitis.A. Reversible Pulpitis.B. Irreversible Pulpitis:i. Acute :a. Abnormal...
PULPITIS
Pulpitis   Is inflammation of the dental pulp due to    dental caries, trauma or dental    procedures.   Its principle s...
Pulpitis   It sequelae includes apical    preiodontitis, periapical abscess and    osteomyelitis of the jaw and other lif...
REVERSIBLE PULPITIS
Definition   It is the general category which may    represent a range of responses varying    from dentin hypersensitivi...
Etiology   Dental Caries.   Trauma.   Thermal injury.   Chemical irritation.
Symptoms   Reversible pulpitis is characterized by    sharp pain.   The pain stay for few minutes,   Always provoked, n...
Diagnosis   Pain : sharp of brief duration ceasing when    irritant is removed.   Examination and history: caries, traum...
Treatment   No R.C.T is needed.   Remove the cause, set a pellet of cotton    with eugenol for 5 minutes and Zinc    oxi...
Dentinal Hyperesthesia Appear when the dentine is exposed  ex: tooth abrasion and periodontal  disease. The pain is char...
PULP HYPEREMIA   Slight pain, always after different    stimulus: cold or hot water, sweets or    food impaction in the c...
IRREVERSIBLE PULPITIS
Definition   It is a persistent inflammatory    condition of the pulp, symptomatic or    asymptomatic, caused by noxious ...
EtiologyUntreated or incorrectly treated :   Dental Caries.   Trauma.   Thermal injury.   Chemical irritation.
Symptoms rapid  onset of pain which remains  after removal of stimulus. Pain can be spontaneous in  nature intermittent ...
Diagnosis   Examination and history: deep carious lesion involving    the pulp or secondary caries.   X-Ray: Depth and e...
Treatment   Root canal treatment
CHRONIC PULPITIS
Chronic Pulpitis It is inflammatory response of pulpal  tissue to an irritant with absence of pain  because of :a. Low in...
Etiology   Same as acute irreversible pulpitis, in    which the irritant factor in chronic pulpitis    is slow and progre...
Symptoms   Absence of pain.   Symptoms arise when there is    interference with drainage of exudate.   Hyperplastic for...
Diagnosis   Pain , is usually absent.   In Hyperplastic form a reddish pulpal mass filling most    of the pulp chamber i...
TreatmentRoot canal treatment.Or   Extraction if the tooth is non –    restorable.
PULP NECROSIS
Pulp Necrosis   Is a condition following untreated pulpitis.   Noxious materials will leak from pulp space    forming le...
Etiology   Is caused by noxious insult and injuries by    :-   Bacteria.-   Trauma.-   Chemical irritation.
Symptoms   Discoloration of tooth – 1st indication of    pulp death.   History from patient.   Tooth might be asymptoma...
Diagnosis   Pain is absent in total necrosis.   History of patient reveals past trauma or    past history of sever pain ...
DiagnosisVitality test :-Single rooted = not responding.Multi rooted = mixed response.•   Sometimes in liquefaction necro...
TreatmentRoot canal treatment.Or   Extraction if the tooth is non –    restorable.
PULP DEGENERATION
PULP DEGENERATION   Is generally present in old people.   May result from persistent mild irritation in    younger peopl...
FORMSAtrophic degeneration and fibrosis.Decrease in size which occur slowly as the tooth grows old. Calcifications.Has 3...
Classification of Denticles / pulpstones.    According to location :- -   Free. -   Embedded. -   Attached.    According...
BIBLIOGRAPHY   Endodontics. Ingle. 2002. 5th edition.   Textbook of Endodontics. Nisha    Garg, Amit Garg. 2007.1st edit...
Inflammatory conditions of the pulp
Inflammatory conditions of the pulp
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Inflammatory conditions of the pulp

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Inflammatory conditions of the pulp

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Inflammatory conditions of the pulp

  1. 1. Introduction The pulp is surrounded by a hard tissue (dentine), which limits the area for expansion and restricts the pulps ability to tolerate edema. The pulp has almost a total lack of collateral circulation, which severely limits its ability to cope with bacteria, necrotictissue and inflammation.
  2. 2. Normal Pulp: Gives moderate response to pulp test, which subside when the stimulus is removed. The tooth is free of spontaneous pain. X-ray shows intact lamina dura. There is no signs of any abnormalities ( calcifications and resorption. )
  3. 3. CLASSIFICATION OF PULPAL PATHOLOGIES
  4. 4. Grossman’s Clinical Classification I. Pulpitis.A. Reversible Pulpitis.B. Irreversible Pulpitis:i. Acute :a. Abnormally responsive to cold.b. Abnormally responsive to heat.ii. Chronic :a. Asymptomatic with pulp exposure.b. Hyperplastic pulpitis.c. Internal resorption. II. Pulp degeneration.A. Calcific ( Radiographic diagnosis )B. Other ( Histopathological diagnosis ) III. Necrosis.
  5. 5. PULPITIS
  6. 6. Pulpitis Is inflammation of the dental pulp due to dental caries, trauma or dental procedures. Its principle symptom is pain. Diagnosis is based on clinical finding and can be confirmed by X-ray. Treatment involves removing the offending factors. It sequelae includes apical preiodontitis, periapical abscess and osteomyelitis of the jaw and other life threading conditions
  7. 7. Pulpitis It sequelae includes apical preiodontitis, periapical abscess and osteomyelitis of the jaw and other life threading conditionsSpread from maxilla may cause :Purulent sinusitis, orbital cellulitis and C.S.T.Spread from mandibular may cause :Ludwig’s angina, mediastinitis and paraphayngeal abscess
  8. 8. REVERSIBLE PULPITIS
  9. 9. Definition It is the general category which may represent a range of responses varying from dentin hypersensitivity to an early phase of inflammation. There is a sharp hypersensitive response to cold but the pain subside when the stimulus is removed. Determination of reversibility is clinical judgment influenced by history and clinical evaluation.
  10. 10. Etiology Dental Caries. Trauma. Thermal injury. Chemical irritation.
  11. 11. Symptoms Reversible pulpitis is characterized by sharp pain. The pain stay for few minutes, Always provoked, never spontaneous. disappear by itself or after the patient takes some analgesic.
  12. 12. Diagnosis Pain : sharp of brief duration ceasing when irritant is removed. Examination and history: caries, traumatic occlusion. X-Ray: normal PDL and lamina dura. Depth of caires lesion may be evident. Percussion : negative , not tender to percussion. Vitality : responds readily to cold and electric test requires less current to cause pain.
  13. 13. Treatment No R.C.T is needed. Remove the cause, set a pellet of cotton with eugenol for 5 minutes and Zinc oxide and Eugenol as Temporary filling. After 2 or 3 days in which the tooth has been asymptomatic final restoration may be place.
  14. 14. Dentinal Hyperesthesia Appear when the dentine is exposed ex: tooth abrasion and periodontal disease. The pain is characterized by a short duration (1-2 seconds), which appears always by stimulus: cold liquids, sweet, air, tooth brushing and disappear immediately after the stimulus is removed.Treatment: Application of agents to promote dentinal
  15. 15. PULP HYPEREMIA Slight pain, always after different stimulus: cold or hot water, sweets or food impaction in the cavity, which disappear when the stimulus is retired and may stay for few seconds. Frequently associated with dental caries, bad restorations.Treatment: Remove the cause, set the base and final restoration.
  16. 16. IRREVERSIBLE PULPITIS
  17. 17. Definition It is a persistent inflammatory condition of the pulp, symptomatic or asymptomatic, caused by noxious stimulus. It has both acute and chronic stages.
  18. 18. EtiologyUntreated or incorrectly treated : Dental Caries. Trauma. Thermal injury. Chemical irritation.
  19. 19. Symptoms rapid onset of pain which remains after removal of stimulus. Pain can be spontaneous in nature intermittent or continuous in nature. In later stages pain is sever, boring, throbbing in nature , increases with hot stimulus. Pain is relived by cold water.
  20. 20. Diagnosis Examination and history: deep carious lesion involving the pulp or secondary caries. X-Ray: Depth and extent of caries lesion may be evident, normal PDL but slight widening may be seen in advanced stages. Percussion : positive, tooth is tender to percussion. Vitality : heat intensifies the response and clod tend to relieve the pain and electric test requires less current to cause pain. In initial stages but when the tissue becomes more necrotic more current is required
  21. 21. Treatment Root canal treatment
  22. 22. CHRONIC PULPITIS
  23. 23. Chronic Pulpitis It is inflammatory response of pulpal tissue to an irritant with absence of pain because of :a. Low inflammatory activity.b. Decreased intrapulpal pressure below the threshold limits of pain receptors. Its of 3 formsa. Ulcerative form.b. Hyperplastic form.c. Closed form.
  24. 24. Etiology Same as acute irreversible pulpitis, in which the irritant factor in chronic pulpitis is slow and progressive. The nature of pulpal response depends on :a. Strength & duration of the irritant.b. Previous health of pulp.c. Extent of tissue affected.
  25. 25. Symptoms Absence of pain. Symptoms arise when there is interference with drainage of exudate. Hyperplastic form is seen in children and adolescents because high resistance of pulp.
  26. 26. Diagnosis Pain , is usually absent. In Hyperplastic form a reddish pulpal mass filling most of the pulp chamber is seen. X-Ray shows :- Ch. Apical periodontitis in long standing cases.- Condensing osteitis, low grade long standing irritation stimulates periapical bone deposition. Vitality Tests shows :- Usually not responding to thermal test unless extreme cold is used.- More current is required.
  27. 27. TreatmentRoot canal treatment.Or Extraction if the tooth is non – restorable.
  28. 28. PULP NECROSIS
  29. 29. Pulp Necrosis Is a condition following untreated pulpitis. Noxious materials will leak from pulp space forming lesion of endodontic origin. Necrosis may be partial or total, depending on extent of pulp tissue involvement. Pulp necrosis is of 2 types :a. Coagulation necrosis.b. Liquefaction necrosis.
  30. 30. Etiology Is caused by noxious insult and injuries by :- Bacteria.- Trauma.- Chemical irritation.
  31. 31. Symptoms Discoloration of tooth – 1st indication of pulp death. History from patient. Tooth might be asymptomatic.
  32. 32. Diagnosis Pain is absent in total necrosis. History of patient reveals past trauma or past history of sever pain which may last for some time followed by complete and sudden cessation of pain. X-Ray shows :-- Large cavity or filling or normal appearance unless there is concomitant apical periodontitis or condensing ostitis.
  33. 33. DiagnosisVitality test :-Single rooted = not responding.Multi rooted = mixed response.• Sometimes in liquefaction necrosis may show positive response to electric test when the current is conducted through moisture present in a root canal• Visual examination shows color change.
  34. 34. TreatmentRoot canal treatment.Or Extraction if the tooth is non – restorable.
  35. 35. PULP DEGENERATION
  36. 36. PULP DEGENERATION Is generally present in old people. May result from persistent mild irritation in younger people. Is induced by :- attrition.- Abrasion.- Erosion.- Operative procedures.- Dental Caries.- Pulp capping.- Other.
  37. 37. FORMSAtrophic degeneration and fibrosis.Decrease in size which occur slowly as the tooth grows old. Calcifications.Has 3 types :- Dystrophic Calcifications.- Diffuse Calcifications.- Denticles / pulp stones.
  38. 38. Classification of Denticles / pulpstones.  According to location :- - Free. - Embedded. - Attached.  According to structure :- - True. - False.
  39. 39. BIBLIOGRAPHY Endodontics. Ingle. 2002. 5th edition. Textbook of Endodontics. Nisha Garg, Amit Garg. 2007.1st edition.
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