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Diseases of pulp


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Diseases of pulp

  1. 1. Diseases Of Pulp By Mhmood M.H. Radhi BDS- Final Year
  2. 2. Diseases Of Dental Pulp
  3. 3. Introduction • The pulp is the formative organ of the tooth. • The pulp has been described as highly resistant organ and as organ with little resistance or recuperating ability. • Its resistance depends on cellular activity, nutritional supply, age and other metabolic and physiologic parameters.
  4. 4. Causes of pulp disease  T causes of pulp disease are he P hysical, Chemical and B acterial. 1.P sical hy a. Mechanical -T rauma: . Accidental . Iatrogenic dental procedures -P athological wear - Crack through body of tooth b. T hermal -H eat from cavity preparation -E xothermic heat from setting of cements c. E lectrical ( galvanic current from dissimilar metallic filling)
  5. 5. 2. Chem ical -P hosphoric acid, acrylic monomer, etc. -E rosion (acids) 3. Bacterial -T oxin associated with caries -Direct invasion of pulp from caries or trauma -M icrobial colonization in the pulp by blood-borne microorganisms.
  6. 6. Diseases of the pulp  Inflammation of the pulp or pulpitis -Reversible pulpitis -Irreversible pulpitis (Acute & Chronic)  P degeneration ulp -Calcific degeneration -Atrophic degeneration -F ibrous degeneration  Necrosis of pulp
  7. 7. Reversible Pulpitis It is a mild to moderate inflammatory condition of the pulp caused by noxious stimuli in which pulp is capable of returning to uninflamed state following removal of the stimuli. CL INICAL F AT E URE S: T ooth is sensitive to thermal changes, especially cold. P - short duration, disappears on withdrawal of thermal ain irritant.
  8. 8. HISTOLOGICAL FEATURES: T here is reparative dentin disruption of the odontoblast layer. Dilation of pulp blood vessels. E xtravasation of edema fluid. P resence of immunologically competent chronic inflammatory cells.
  9. 9.  causes: T rauma T hermal shock Chemical stimulus P lacement of a fresh amalgam filling in contact with, or occluding, cast restoration E xcessive dehydration of cavity or irritation of exposed dentin at the neck of a tooth  T E M NT & P R AT E ROGNOSIS: Carious lesion should be excised & restored or defective filling is replaced. If primary cause is not corrected, extensive pulpitis may result in death of pulp.
  10. 10. Irreversible pulpitis Irreversible pulpitis is a persistent inflammatory condition of the pulp ,symptomatic or asymptomatic, caused by a noxious stimulus. It may be acute or chronic. Histopathology:  T post capillary venules becomes congested, he T hese attract the polymorph nuclear leukocytes, by chemotaxis and start an acute inflammatory reaction  T inflammatory reaction produces micro-abscesses(acute his pulpitis).  Microscopically one sees area of abscess and a zone of necrotic tissue, with microorganisms present in the late carious state, along with lymphocytes, plasma cells and
  11. 11.  No microorganisms are found in the center of the abscess because of the phagocytic activity of the polymorph nuclear leukocytes. T hen the caries reaches the pulp , the histological picture changes , then sees an area of ulceration (chronic ulcerative pulpitis), zone of infiltration of P Ns leukocytes and zone of proliferating M fibroblasts. Causes B acterial involvement of pulp by caries  Chemical T hermal M echanical
  12. 12. Acute pulpitis with Intrapulpal abscess
  13. 13. Clinical futures •P caused by sudden thermal change particularly cold or ain food stiff, •P is boring, gnawing or throbbing or as if tooth under ain contact pressure, •P is sharp, piercing, or shooting and is generally sever, ain •It may be intermittent or continues •B ending or lying down increase pain. Diagnosis •P is already exposed and are may see layer of greyish , ulp scum-like layer over the exposed pulp and surrounding dentin . •R adiograph may show exposed pulp and caries under
  14. 14. TREATMENT & PROGNOSIS: Complete removal of pulp (RCT pulpectomy. )or E xtraction of tooth, if tooth is not restorable. P ROGNOSIS -favorable.
  15. 15. Chronic Hyperplastic Pulpitis It is also called as pulp polyp It is a productive pulpal inflammation due to extensive carious exposure of a young pulp. HISTOLOGIC FEATURES: T surface of the pulp polyp is usually covered by he stratified squamous epithelium. Such epithelium may be derived from gingiva or from freshly desquamated epithelial cells of mucosa and tongue . T granulation tissue is young, vascular connective he tissue containing polymorph nuclear neutrophils, lymphocytes and plasma cells.
  16. 16. Stratified sq. epithelium covering polyp
  17. 17. CAUSE S Slow, progressive carious of the pulp is the causes . F development of hyperplastic pulpitis, a large , open or cavity :a young resistant pulp, and chronic , low-grade stimulus are necessary . M echanical irritation from chewing or bacterial infection often provide the stimulus. symptoms It is symptomless, except during mastication, when the pressure of food bolus may cause discomfort. T AT E & P RE M NT ROGNOSIS: E xtraction of tooth or pulp extirpation.
  18. 18. Internal resorption  It is idiopathic slow or fast progressive resorption process occurring in dentin of pulp chamber or root canals of teeth. H istopathology  It is a result of osteoclast activity T here is resorptive process is characterized by lacunae ,which may be by osteoid tissue. M ultinucleated giant cell dentinoclast are present. M etaplasia of pulp. Causes  It is unknown but may be there is history of trauma.
  19. 19. Symptoms  In root of a tooth is asymptomatic. In crown it may be manifested as reddish area called “pink spot”. Diagnosis It is diagnosed during routine radiographic examination . T appearance of the “pink spot” occurs late in the he resorptive process, when the integrity of the crown has been compromised .  T radiograph usually show a change in the appearance he of the wall in root canal or pulp chamber, with a round or ovoid radiolucent area.
  20. 20. T reatment and prognosis  Routine endodontic treatment is indicated ,  B obturation of the defect requires a special effort UT ,preferred with a plasticized gutta-percha method . W hen root is perforated, then mineral trioxide aggregate (M A) is used to repair. T  T prognosis is favorable before perforation of the root he or crown occurs.
  21. 21. Pulp degeneration  P degeneration is usually present in teeth of old ulp people.  It may also result in persistent, mild irritation in teeth of young patients. 1.Calcific degeneration :  In calcific degeneration part of pulp tissue is replaced by calcific material i.e., stone or denticles .  It may occur in root canal or pulp chamber .  T calcific material has a limitation structure, like the he skin of an onion, and lies unattached within the body of
  22. 22. 2. Atrophic degeneration  In this type, observed histopathological in pulp of older people, F ewer stellate cells are present and intercellular fluids is increased.  T pulp tissue is less sensitive than normal. he 3. F ibrous degeneration  In this type the pulp is characterized by replacement of the cellular elements by fibrous connective tissue .  On removal of root canal, such pulp has the characteristic appearance of leathery fibrous.
  23. 23. Necrosis of Pulp  It is death of pulp  It may be partial or total, depending on whether part, or the entire pulp is involved. T ypes : 1.Coagulation 2.Caseation 3.L iquefaction  Causes  It can be due to any noxious insult injurious to the pulp, such as bacteria, trauma and chemical irritation.
  24. 24.  Clinical features  no painful symptoms.  discoloration of tooth, tooth is grayish or brownish in color .  Pulp is dead . Management  preparation + obturation of root canals P ROGNOSIS  -favorable.
  25. 25. Necrosis of pulp
  26. 26. References  Grossman’s endodontic practice 12th edition