Pulpitis

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Oral Pathology I
Third Year

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Pulpitis

  1. 1. Inflammatory Jaw lesions I
  2. 2. Pulpitis Definition: Inflammation of the dental pulp, which can be acute or chronic. Etiology • Dental Caries. • Traumatic exposure. • Fracture of the crown. • Thermal changes. • Chemical irritation. • Cracked tooth syndrome. Types of pulpitis Acute Chronic  Reversible.  Closed.  Irreversible.  Opened (Hyperplastic)
  3. 3. Acute Reversible Pulpitis Etiology: • Dental Caries. • Cavity preparation. • Thermal changes in large metallic fillings. Clinical Features: • Pain: mild to moderate and stimulated. • The etiological factor is obvious. Histopathological Features: • Pulp hyperemia (dilatation of blood vessels). • Exudation. • Inflammatory cell infiltration (neutrophils). • Reactions usually remain localized adjacent to the cause. • Treatment: Remove the cause.
  4. 4. Acute Irreversible Pulpitis Etiology: Clinical Features: • Pain: Sever, spontaneous and • Acute Dental Caries. continuous. • Pulp exposure. • Little response to simple analgesics. • Sever Irritation. • Pain increase when patient lies down. • The etiological factor is obvious. Histopathological Features: • Inflammation involves the whole dental pulp. • Vascular dilatation and edema. • Inflammatory [granular cell] infiltration. • Odontoblasts near to the cause are destroyed. • Formation of a minute pulp abscess. • In a few days pulp undergoes liquefaction and necrosis. • Treatment: RCT.
  5. 5. Chronic Pulpitis Etiology: • Previous acute pulpitis. • Chronic Dental Caries. Clinical Features: • Pain: absent or mild to moderate, dull ache and intermittent. • Reaction to thermal changes is reduced in comparison to acute pulpitis. • The etiological factor is obvious. Histopathological Features: • Mononuclear inflammatory cell infiltration. • Evidence of fibroblastic activity. • Minute abscess if exist it is localized by granulation tissue. • Treatment: RCT.
  6. 6. Chronic Hyperplastic Pulpitis Etiology: Clinical Features: • Opened cavity. • Red pinkish soft nodule protruding • Starts as chronic or into the cavity. acute. • Almost in children and young adults. • Wide apical foramen • Relatively insensitive to manipulation. [Children]. • Most common in deciduous molars. • Must be differentiate from gingival polyp. Histopathological Features: • The polyp consists of granulation tissue. • It contains delicate connective tissue, fibers and blood vessels. • Mononuclear inflammatory cell infiltration. • The polyp is covered with SS epithelium. • Treatment: RCT or extraction of the tooth.
  7. 7. Periapical inflammation Periapical Granuloma Periapical abscess Chronic abscess or osteomyelitis Cellulitis Skin or mucosal sinus Bacteremia Periapical Cyst
  8. 8. Acute Abscess Etiology: • Acute pulpitis. Chronic periapical lesions. Clinical Features: • Pain: sever and increases with percussion. • Non-vital tooth. • The tooth is slightly extruded in its socket. • Fever, malaise & regional lymphadenitis. • Osteomyelitis and swollen adjacent area. Histopathological Features: • Zone of liquefaction composed of: ▫ Exudates. ▫ Necrotic tissue. ▫ Dead neutrophils. • Dilated blood vessels. • Inflammatory [granular cell] infiltration. Treatment: • Drainage. Antibiotics. Supportive Tx.
  9. 9. X-Ray Pulpitis: • Evaluation of the pulp champer. • Evaluation of the periapical region. Acute abscess: • Thickening of periodontal membrane. • Loss of the lamina dura. Electrical Pulp Tester • • • • Acute reversible pulpitis. Acute irreversible pulpitis. Chronic pulpitis. Acute abscess.

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