dental caries is the most common disease with which the tooth gets affected *ps if you treat the tooth like a human being and the pulp as the body parts so what happens to the body part of the tooth when the infection reaches to them ? how would they react?

1. Pulpal Response To Dental Caries.
Milind Chakraborty
Final BDS

2. PULP:-
. It is a connective tissue consisting of Nerves, Blood Vessel , Ground Substance ,
Interstitial Fluid, Odontoblast, Fibroblast and other cellular components and is contained
within rigid dentinal walls
. It has Four Functions :- Formative, Protective, Nutritive, Sensory.
. Zones Of Pulp :- Odontoblastic Zone , Cell- Free zone , Cell- rich zone , Central Zone
. Pulp is the formative organ of the tooth and builds up Primary Dentin during the
development of tooth , Secondary Dentin after tooth eruption and reparative dentin n
response to stimulation as long as the odontoblast remain intact .
. It is a highly resistant organ and as a organ with little resistance or healing ability.

4. Dental Caries:-
. It is defined as a preventable, chronic and biofilm- mediated disease modulated by
diet due to the presence of fermentable dietary carbohydrates on the tooth surface
over time.
. Dental Caries when left untreated in accordance with the host modulation factors
slowly progresses towards the pulp and causes inflammation of the pulp
. It provides severe irritation and the acute , rapidly advancing caries with high levels
of acid production overpowers dentinal defences and results in infection , abscess and
pulp death
. Dental Caries is caused by bacteria which enters the pulp through break in dentin or
from accidental exposure from developmental grooves.

5. . The species from bacteria recovered from the infected pulp or inflamed pulp are many and
varied. Lactobacilli is the most common seen but are seldomly recovered from pulp due to their
low degree of invasiveness
. Streptococci and staphylococci are mainly recovered from the pulp but also Porphyromonas
gingivalis , Fusobacterium nucleatum species are found significantly.
.When the pulp is exposed to Dental Caries by the invading bacteria they first enter a localized
area of pulp and the pulp shows a inflammatory response.
. PMNL reach the area and prevent the dissemination of bacteria further deep into the pulp and
sometimes the inflammatory process becomes severe it may extend deep into the pulp
. Areas of necrosis develops owing to disturbance in nutritional supply, many of the PMNL die and
pus forms further irritating the nerve cells. Tissue pressure is increased resulting in stasis and pulp
necrosis.
.Further in most cases the bacteria many penetrate through the peri apical tissue and may form
abscess which if left untreated may stimulate the epithelial rest and form cyst .

6. . The Dentinal Tubules be infiltrated with products of blood decomposition
, bacteria and occasionally food debris and the dentin discoloured. Such
discolouration is the first clinical sign that the pulp has died.

7. Pulpal Reaction to caries :-
. Protective Pulpal Reaction Includes
1) Decrease in Dentin Permeability
2) Tertiary Dentin Formation
3) Inflammatory and Immune Reactions

8. Decrease in Dentin permeability:-
. It is the First and Fastest Defense To Dental Caries and is called Dental
Sclerosis.
. Increase the deposition Of Mineral Crystals in intratubular dentin followed
by Narrowing the Dentinal Tubules and Decreasing Dentin

9. Tertiary Dentin Formation:-
.Not the most effective pulpal mediated defense
.The Acid byproducts of the carious process – degrade the dentin matrix- liberate
bioactive molecules sequestered during dentinogenesis – reaasume their role in dentin
formation
. The resultant dentinal character is highly Dependent on Stimulus .In Mid Caries
Lesion Odontoblast are activated to elaborate the organic matrix of the dentin(
reactionary dentin) which is similar in morphology to physologic dentin and may be
apparent due to the direction of the new dentinal tubules
.In Aggressive Carious Lesion Repopulation Of the Disrupted Odontoblastic Layer with
Differenciating Progineters forming reparative dentin its Morphology can range from
Organised Tubular Dentin to most Irregular Fibrodentin.

11. Inflammatory and Immune Reactions:-
. These Changes are usually seen to protect the pulp.
. In an advancing infection front of the carious lesion, multiple extrinsic and intrinsic
factors that stimulate the inflammatory reaction provides cellular and humoral
challenges to humoral pathogens.
. The early Inflammatory response can be seen beneath the non cavitated lesions and
non coalesced pit and fissures characterized by focal acculumation of chronic
inflammatory cells.
. It is mediated initially by the odontoblast ; the most peripheral cell in the pulp and
encounter foreign antigen first and later by dendritic cells which are responsible for
antigen presentation and stimulation of T-lymphocytes

12. .Two distinct population of dentritic cells CD 11c+ found in pulp and dentin border
and subadjacent to pit and fissures.
. F4/80+ Concentrated in the peri- vascular spaces in the sub – odontoblastic zone
and inner pulp.
. Odontoblast play a major role in humoral response to caries . IgM ,IgA have been
localized in the cell process of the odontoblast in human carious dentin suggesting
that these cells actively transport antibodies to the infection front

13. .The Pulpal Inflammation may be reversible or irreversible and the pulp may be infected
or sterile
. The pulpal diseases due to dental caries are of 2 types:
a) Reversible pulpitis
b) Irreversible pulpitis
.Reversible is caused by noxious stimuli in which pulp is capable to return to its
uninflamed state following removal of stimuli .
. Reversible has types such as acute and chronic and may be caused due to trauma
,thermal shock, fresh amalgam restoration ,chemical stimulus
. Pain is short ,sharp, specific to a stimulus
. Diagnostic test such as application of ice or hot water can be done to check for
reversible pulpitis.
. Treatment is by removal of the noxious stimuli will usually bring back the pulp back to a
healthy state

14. . Irreversible pulpitis:-
. Persistant inflammatory condition of the pulp , symptomatic or asymptomatic in
nature with the pulp becoming incapable of healing
. 2 types- acute and chronic
. Cause is bacterial involvement of pulp through caries
. Symptoms are pain due to sudden temperature change particularly cold
sponatenous type
. Pain may be intermittent or continuous.
. Nocturnal pain Is seen
. Diagnosis shows a deep cavity extending to pulp or decay under a filling .
. Treatment consist of Complete removal of the pulp or pulpectomy. In posterior teeth
the removal of coronal pulp or pulpotomy should be performed as a emergency
procedure. Surgical removable considered if tooth not restorable.

15. Chronic Hyperplastic Pulpitis:-
.Also known as Pulpal hyperplasia or pulp polyp is a productive Pulpal inflammation
due to an extensive carious exposure of a young pulp.
.Slow, progressive carious exposure of the pulp is the cause .
.It is usaually symptomless but on mastication may provide discomfort.
.It is generally seen in the teeth of children and young adult . The appreance of
polypoid tissue is clinically a fleshy, reddish pulpal mass fills most of the pulp chamber.
. It should be done by the elimination of polypoid tissuefollowed by extirpation of the
pulp, provided the tooth can be restored

16. Internal resorption:-
.Resorption is defined as a condition associated with either a physiologic or a
pathologic process resulting in loss of dentin, cementum,Bone
.It is a slow or fast progressive resorptive process occurring in the dentin of the pulp
chamber or in the root canals of the teeth.
.Exact cause is not known but patient has a history of trauma
.Usaually Asymptomatic but the crown shows a reddish area called pink spot.
.Extirpation of pulp stops the internal resorptive process
. Routine endodontic treatment is indicated but obturation of the defect requies a
special effort , preferably with a plasticized gutta percha method.

17. Pain management
Pain management, both before and after treatment, is usually done
with Nonsteroidal anti-inflammatory (NSAIDs) drugs. These provide relief
from pain and inflammation.
Talk to your dentist about the brand of NSAID and dosage that’s right for
you. If you need a root canal or tooth extraction, your surgeon may
prescribe stronger pain medication.

18. CONCLUSION:-
Pulpal disease are life threatning disease to our tooth as pulp provides blood
supply and essential nutrients to the tooth. So it is best to us to manage
carious or any other disease that may harm the tooth when the disease is at
an early stage.
. Keep your DENTAL HEALTH AT IT BEST .

19. REFERENCES:-
.Grossman endodontic practice.
. Sturdevant
. Pubmed