• 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
• Its resistance depends on cellular activity, nutritional
supply, age and other metabolic and physiologic
Causes of pulp disease
T causes of pulp disease are
hysical, Chemical and B
. Iatrogenic dental procedures
- Crack through body of tooth
eat from cavity preparation
xothermic heat from setting of cements
lectrical ( galvanic current from dissimilar
hosphoric acid, acrylic monomer, etc.
oxin associated with caries
-Direct invasion of pulp from caries or trauma
icrobial colonization in the pulp by blood-borne
Diseases of the pulp
Inflammation of the pulp or pulpitis
-Irreversible pulpitis (Acute & Chronic)
Necrosis of pulp
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
INICAL F AT
ooth is sensitive to thermal changes, especially cold.
P - short duration, disappears on withdrawal of thermal
here is reparative dentin disruption of the odontoblast layer.
Dilation of pulp blood vessels.
xtravasation of edema fluid.
resence of immunologically competent chronic inflammatory
lacement of a fresh amalgam filling in contact with, or
occluding, cast restoration
xcessive dehydration of cavity or irritation of exposed
dentin at the neck of a tooth
T E M NT & P
R AT E
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.
Irreversible pulpitis is a persistent inflammatory
condition of the pulp ,symptomatic or
asymptomatic, caused by a noxious stimulus.
It may be acute or chronic.
T post capillary venules becomes congested,
hese attract the polymorph nuclear leukocytes, by
chemotaxis and start an acute inflammatory reaction
T inflammatory reaction produces micro-abscesses(acute
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
No microorganisms are found in the center of the
abscess because of the phagocytic activity of the
polymorph nuclear leukocytes.
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
acterial involvement of pulp by caries
•P caused by sudden thermal change particularly cold or
•P is boring, gnawing or throbbing or as if tooth under
•P is sharp, piercing, or shooting and is generally sever,
•It may be intermittent or continues
ending or lying down increase pain.
•P is already exposed and are may see layer of greyish ,
scum-like layer over the exposed pulp and surrounding
adiograph may show exposed pulp and caries under
TREATMENT & PROGNOSIS:
Complete removal of pulp (RCT pulpectomy.
xtraction of tooth, if tooth is not restorable.
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.
T surface of the pulp polyp is usually covered by
stratified squamous epithelium.
Such epithelium may be derived from gingiva or from
freshly desquamated epithelial cells of mucosa and
T granulation tissue is young, vascular connective
tissue containing polymorph nuclear neutrophils,
lymphocytes and plasma cells.
Slow, progressive carious of the pulp is the causes .
F development of hyperplastic pulpitis, a large , open
cavity :a young resistant pulp, and chronic , low-grade
stimulus are necessary .
echanical irritation from chewing or bacterial infection
often provide the stimulus.
It is symptomless, except during mastication, when the
pressure of food bolus may cause discomfort.
T AT E & P
RE M NT
xtraction of tooth or pulp extirpation.
It is idiopathic slow or fast progressive resorption
process occurring in dentin of pulp chamber or root
canals of teeth.
It is a result of osteoclast activity
here is resorptive process is characterized by lacunae
,which may be by osteoid tissue.
ultinucleated giant cell dentinoclast are present.
etaplasia of pulp.
It is unknown but may be there is history of trauma.
In root of a tooth is asymptomatic.
In crown it may be manifested as reddish area called
It is diagnosed during routine radiographic examination .
T appearance of the “pink spot” occurs late in the
resorptive process, when the integrity of the crown has
been compromised .
T radiograph usually show a change in the appearance
of the wall in root canal or pulp chamber, with a round or
ovoid radiolucent area.
reatment and prognosis
Routine endodontic treatment is indicated ,
B obturation of the defect requires a special effort
,preferred with a plasticized gutta-percha method .
hen root is perforated, then mineral trioxide aggregate
(M A) is used to repair.
T prognosis is favorable before perforation of the root
or crown occurs.
P degeneration is usually present in teeth of old
It may also result in persistent, mild irritation in teeth of
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
skin of an onion, and lies unattached within the body of
2. Atrophic degeneration
In this type, observed histopathological in pulp of older
ewer stellate cells are present and intercellular fluids is
T pulp tissue is less sensitive than normal.
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.
Necrosis of Pulp
It is death of pulp
It may be partial or total, depending on whether part,
or the entire pulp is involved.
It can be due to any noxious insult injurious to the
pulp, such as bacteria, trauma and chemical irritation.
no painful symptoms.
discoloration of tooth, tooth is grayish or brownish in
Pulp is dead .
preparation + obturation of root canals