sequle of pulpitis- Dr.Divya R

1. DIVYA.R
SEQUELAE OF
PULPITIS

2. CONTENTS
 Introduction
 Sequelae of pulpitis
 Focal reversible pulpitis
 Acute pulpitis
 Chronic pulpitis
 Chronic hyperplasic pulpitis
 Apical periodontitis
 Acute apical periodontitis

3.  Chronic apical periodontitis
 Apical periodontal cyst
 Periapical abscess
 Osteomyelitis
 Acute suppurative osteomyelitis
 Chronic suppurative osteomyelitis
 Chronic focal sclerosing osteomyelitis
 Chronic diffuse sclerosing osteomyelitis
 Chronic osteomyelitis with proliferating periostitis
 conclusion

4. INTRODUCTION
• Dental pulp is a delicate connective tissue
interspersed with tiny blood vessels,lymphatics,nerves
and undifferentiated connective tissue cells.
• Reaction to bacterial infection or to other irritant by
inflammatory response -pulpitis

5. SEQUELAE OF PULPITIS
Pulpitis
Acute chronic
Apical periodontitis
Acute Chronic
Periapical abscess Periapical
granuloma
Acute Chronic
Periodontal
cyst
Osteomyelitis
Acute Chronic
Focal
Diffuse

6. FOCAL REVERSIBLE PULPITIS
CLINICAL FEATURES
 Sensitive to thermal changes
 Respond to electric pulp tester at lower
level of current
 Teeth shows deep carious lesion or large metallic
restorations with defective margin
TREATMENT
 Carious lesion extracted/ defective filling replaced

7. ACUTE PULPITIS
 Extensive acute inflammation of dental pulp
 Etiology
 Immediate sequela of focal reversible pulpitis
 Acute exacerbation of chronic inflammatory process

8. CLINICAL FEATURES
 large carious lesion or
 defective restoration with recurrent caries
 Severe pain
 elicited by thermal changes
 Pain persists even after thermal stimulus has
disappeared
 Pulpal pain is poorly localized

9.  Lancinating/throbbing type of pain
 Pain lasts for 10-15min
 Intensity of pain increase when patient lies down
 When cavity is small,
Lancinating pain
Extend to apex
Sensitive to percussion

10. • When large open cavity is present
No pressure built up
No rapid spread of inflammatory process
Pain is a dull,throbbing ache
Mobility and sensitivity to percussion absent

11. TREATMENT
 Pulpotomy-removal of coronal pulp
Placing a bland material that favours calcification like
calcium hydroxide over entrance of root canal
• Filling root canals with inert material , provided pulp
chamber and root canals can be sterilized

12. CHRONIC PULPITIS
• Etiology
Quiescence of previous acute pulpitis
Occurs as chronic type of disease from onset

13. CLINICAL FEATURES
 Pain is not a prominent feature
 mild,dull ache
 Pain often intermittent than continuous
 Reaction to thermal change reduced
 Pulp may become totally necrotic without pain

14. TREATMENT
 Root canal therapy

15. CHRONIC HYPERPLASTIC PULPITIS
 Unique form of pulpitis
 Inflammed pulp,instead of perishing by continued
suppuration reacts by excessive and exuberant
proliferation
• Children and young adults- high degree of tissue
resistance and reactivity.
• Teeth with large, open carious lesions

16. • pulp appears as pinkish red globule of tissue
protruding from pulp chamber
• deciduous molars and 1st permanent molars
Treatment
• extraction of tooth/pulp extirpation

17. APICAL PERIODONTITIS
 Inflammation of periodontal ligament around root
apex
 Resorption of periapical bone and sometimes
root apex
 May be acute or chronic

18.  Etiology
Spread of infection following pulp necrosis
Occlusal trauma from high restoration or
 biting suddenly on a hard object
Pushing infected material into apical portion
Chemical irritation from root canal medicaments

19. ACUTE APICAL PERIODONTITIS
 History of previous pulpitis
 Thermal changes does not induce pain as in
pulpitis
• due to collection of inflammatory oedema in PDL
tooth is slightly elevated in its socket
• cause tenderness while biting/even to mere touch
• severe pain

20. TREATMENT
 If inflammation caused by occlusal trauma-relieved
by selective occlusal grinding
 If it is due to spread of pulpal infection-
extraction/endodontic treatment to drain the exudate

21. CHRONIC APICAL PERIODONTITIS
 Also called periapical granuloma
 Low grade infection
 Most common sequelae of pulpitis
 localized mass of chronic granulation tissue formed
in response to infection
 Spread of infection usually in a periapical direction

22. CLINICAL FEATURES
• Involved tooth is nonvital
• Slightly tender on percussion
• Percussion produce a dull sound
• Mild pain on biting/chewing
• Sensitivity is due to hyperaemia,oedema
and inflammation of apical periodontal
ligament

23. TREATMENT
 Extraction of involved tooth
 Root canal therapy with /without subsequent
apicoectomy
 If left untreated ,it may undergo transformation into
apical periodontal cyst

24. APICAL PERIODONTAL CYST
 Most common odontogenic cyst
 Other names-radicular cyst,periapical cyst,root end
cyst
 Result of
 bacterial infection and
 necrosis of dental pulp following caries

25.  asymptomatic
 20 and 60 years
 maxillary anteriors followed by mandibular
premolars and molars
 tooth is nonvital /
 shows deep cariouslesion or a restoration which is
seldom painful

26. TREATMENT
 Root canal therapy of involved tooth along with
periapical surgery or extraction of involved tooth
followed by periapical curettage
 Cyst does not recur if surgical removal is thorough

27. PERIAPICAL
ABSCESS
 Other names-dentoalveolar abscess,alveolar abscess
 acute / chronic suppurative process of periapical
region
 Develop from
 acute periapical periodontitis /
 from a periapical granuloma
 Acute exacerbation of chronic periapical
lesion is known as phoenix abscess

28. CLINICAL FEATURES
ACUTE PERIAPICAL ABSCESS
 Tenderness of tooth
 Extremely painful
 Slightly extruded from its socket
 Rapid extention to adjacent bone marrow spaces-
produce osteomyelitis
CHRONIC PERIAPICAL ABSCESS
 No clinical features since it is a mild ,well
circumscibed area of suppuration that shows little

29. TREATMENT
• Drainage
 Opening the pulp chamber / extracting the tooth
• In some cases tooth is retained and root canal
therapy is carried out if lesion can be sterilized

30. OSTEOMYELITIS
 Defined as inflammation of bone and its marrow
contents
 Predisposing factors
Fractures due to trauma
Road traffic accidents
Gunshot wounds
Radiation damage
Paget disease and osteoporosis

31. ACUTE SUPPURATIVE
OSTEOMYELITIS
 Serious sequele of periapical infection
 diffuse spread of infection throughout the
medullary spaces
 subsequent necrosis of variable amount of bone
 Polymicrobial
 Most common cause-dental infection
 Other causes-infection due to fracture of jaw,gunshot
or hematogenous spread

32. CLINICAL FEATURES
 Maxilla-localized; mandible-diffuse and widespread
 Severe pain
 Trismus
 Paraesthesia of lips in case of mandibular
involvement
 Elevation of temperature
 Loosening of teeth and exudation of
pus from gingiva

33. TREATMENT
 3D-debridement
drainage
drugs(antimicrobial)
• When intensity of disease become
attenuated,sequestrum begins to separate from living
bone
• Sequestrum-if small, exfoliates through mucosa
if large, surgical removal
• Untreated cases may proceed to development of

34. CHRONIC SUPPURATIVE
OSTEOMYELITIS
 CLINICAL FEATURES
 Pain is less severe
 Temperature is slightly elevated
 Leucocytosis slightly greater
 Fistulous tract may form which open to
surface
 TREATMENT
 Surgery with sustained bacteriocidal antibiotic therapy

35. CHRONIC FOCAL SCLEROSING
OSTEOMYELITIS (CONDENSING
OSTEITIS)
 Unusual reaction of bone to infection
 High degree of tissue resistance and tissue reactivity
 Young adults and children
 Mandibular molars commonly affected
 Symptoms-mild pain due to infected pulp
 Treatment-extraction / endodontic treatment

36. CHRONIC DIFFUSE SCLEROSING
OSTEOMYELITIS
 Proliferative reaction of bone to low grade infection
 CLINICAL FEATURES
 Occur at any age, more predominence in older age
group
 Common in mandible
 Insidious in nature, no clinical indication of its
presence
 Acute exacerbations results in vague pain,unpleasant

37. TREATMENT
 Lesion is too extensive to be removed surgically
 Sclerotic bone is hypovascular and resistant to
antibiotics
 Extraction by surgical approach with removal of liberal
amounts of bone to facilitate increased bleeding
 Antibiotic administration during acute exacerbation
may occur

38. CHRONIC OSTEOMYELITIS WITH
PROLIFERATIVE PERIOSTITIS
• Focal gross thickening of periostium with peripheral reactive
bone formation resulting from mild reaction or infection
• CLINICAL FEATURES
• Children and young adults
• Mandible-bicuspid and molar region
• Tooth ache / pain in jaws
• Bony hard swelling on outer surface of jaw
• TREATMENT
• Extraction / endodontic treatment

39. CONCLUSION
 Establishment of proper diagnosis is of at most
important to carry out the effective clinical
procedure for the benefit of patient
 Review after the treatment is also to be given
importance

40. REFERENCES
 Shafers textbook of oral pathology , 8th edition