Oral Pathology I Third Year

1. Inflammatory Jaw
lesions I

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. 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.

5. 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.

7. 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.

9. 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.

11. Periapical inflammation
Periapical
Granuloma
Periapical
abscess
Chronic abscess or
osteomyelitis
Cellulitis
Skin or mucosal sinus
Bacteremia
Periapical
Cyst

12. 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.

16. 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
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•
•
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Acute reversible pulpitis.
Acute irreversible pulpitis.
Chronic pulpitis.
Acute abscess.