The document summarizes various abnormalities and diseases that can affect the dental pulp and periapical tissues, including: 1) Pulp calcification, which involves mineralization within the pulp chamber or root canals and can occur as denticles, pulp stones, or diffuse linear calcifications. 2) Resorption of teeth, which can be physiological for deciduous teeth but pathological for permanent teeth. 3) Diseases of periapical tissues including periapical abscesses, granulomas, radicular cysts, phoenix abscesses, and condensing osteitis. These conditions are responses to dental infection and inflammation and can develop from other lesions if left untreated.

1. ABNORMALITI
ES OF THE
PULP
Prepared by:
Dr. Rea Corpuz

2. Pulp Calcification
 may be located
 pulp chamber
OR
 root canals

3. Pulp Calcification
 Cause
 no clear-cut etiology
 no relation between
inflammation + irritation
• since pulp calcification
can be found in unerupted
teeth

4. Sundell Schematic
Presentation
Local
Metabolic Hyalinization Vascular
Trauma
Dysfunction of injured cell Damage
Thrombosis
Growth
Mineralization Fibrosis Vessel Wall
Damage
Pulp Stones

5. Classification
 Three types :
 (1) Denticles
 (2) Pulp stones
 (3) Diffuse linear calcifications

6. (1) Denticles
 believed to form as a result
of epitheliomesenchymal
interaction within
developing pulp
 form during period of root
development
 occur in root canal + pulp
chamber adjacent to furcation
areas of multirooted teeth

7. (2) Pulp Stones
 believed to develop around
central nidus of pulp tissue
examples:
 collagen fibril
 ground substance
 formed within coronal portions
of pulp

8. (2) Pulp Stones
 may arise as part of age-
related or local pathologic
changes
 most develops after tooth
formation is completed
 usually free or attached
 some instances, may be embedded

9. (3) Diffuse Linear
Calcifications
 doesn’t demonstrate lamellar
organization of pulp stones
 exhibit areas of:
 fine
 fibrillar
 irregular calcification
 may be present in pulp
chamber or canals
 frequency increases with age

10. (3) Diffuse Linear
Calcifications
 Clinical Significance:
 very little clinical significance
 except insofar as they may
obstruct endodontic treatment

11. (3) Diffuse Linear
Calcifications
 Clinical Significance:
 discovered on radiograph
only as radioopacity
 may cause pain from
mild pulpal neuralgia to
severe excruciating pain
resembling tic douloureux
• as denticle may impinge
on nerve of pulp

12. (3) Diffuse Linear
Calcifications
 Clinical Significance:
 difficulty may be encountered
in extirpating pulp
during root canal therapy

13. (3) Diffuse Linear
Calcifications
 Treatment & Prognosis
 No treatment is required

14. Resorption of the Teeth
 deciduous teeth are progressively
loosened
 result of progressive
resorption of roots
 physiological process arising
from pressure of underlying
successors
 resorption of permanent is
always pathological

15. Resorption of the Teeth
 Pathology
 pressure is probably main
factor
 resorption is mainly carried
out by osteoclast
 humoral mediators, such
as prostgalndins
• may contribute to resorption

16. Idiopathic Resorption
 (1) Internal Resorption
 (2) External Resorption

17. Idiopathic Resorption
 Internal Resorption
 pink spot
 curious + uncommon
condition
 dentin is resorbed from
within the pulp

18. Idiopathic Resorption
 (1) Internal Resorption
 tends to be localized
 well-defined rounded area
of rediolucency in crown
 can affect any part of teeth
 NO signs until pulp is
opened + allows access to
infection

19. Idiopathic Resorption
 (1) Internal Resorption
 may be detected by chance
in routine radiograph

20. Idiopathic Resorption
 (1) Internal Resorption

21. Idiopathic Resorption
 (1) Internal Resorption

22. Idiopathic Resorption
 (2) External Resorption
 may be localized or
generalized
 unkown cause
 mild degree of inflammation
is often suspected

23. Idiopathic Resorption
 (2) External Resorption

24. Idiopathic Resorption
 (2) External Resorption
Heithersay Classification

25. Idiopathic Resorption
 (2) External Resorption
 usually a limited area of
root is attacked from
external surface near
amelocemental junction
• resorption goes on until
pulp is reached

26. Idiopathic Resorption
 (2) External Resorption
 often preferentially
destroys root before
penetrating the pulp

27. Idiopathic Resorption
 (2) External Resorption
 accessible defects may be
amenable to restoration
with mineral trioxide or
other materials
 long term success in infrequent;
unpredictable

28. Idiopathic Resorption
 (2) External Resorption
 Pathology
• vascular granulation
tissue replaces part
or periodontal ligament
or pulp
• osteoclasts border the
affected dentin or enamel

29. Idiopathic Resorption
 (2) External Resorption
 Treatment
• usually untreatable
• if a pink spot in an incisor
tooth is noticed at an early
stage
 endodontic treatment should
be carried out before

30. Idiopathic Resorption
 (2) External Resorption
 Treatment
• resorption of teeth may
result from pressure
exerted by impacted teeth
 indication for removal
of unerupted teeth

31. DISEASES OF
PERIAPICALTISSU
ES
Prepared by:
Dr. Rea Corpuz

32. Diseases of Periapical Tissues
 (1) Periapical Abscess
 (2) Periapical Granuloma
 (3) Radicular Cyst
 (4) Phoenix Abscess
 (5) Condensing Osteitis

33. (1) Periapical Abscess
 also known as Dento-alveolar
Abscess; Alveolar Abscess
 acute or chronic supporative
process of dental periapical
region
 usually arises as a result of
infection

34. (1) Periapical Abscess
 abcess ay develop directly
as an acute apical periodontitis
following an acute pulpitis
 but more commonly it
originates in an area of
chronic infection

35. (1) Periapical Abscess
 Clinical Feature
 presents features of
acute inflammation of
apical peridontium
 tooth is extremely painful
 slightly extruded from its
socket

36. (1) Periapical Abscess
 Clinical Feature
 chronic periapical
abscess generally presents
no clinical features
 mild, circumscribed area
of suppuration that shows
little tendency to spread from
local area

37. (1) Periapical Abscess
 Radiographic Feature
 except for SLIGHT thickening
of periodontal membrane
 no roentgenographic
evidence of its presence
 chronic abscess, developing
in a periapical granuloma
• radioluscent area at apex

38. (1) Periapical Abscess

39. (1) Periapical Abscess
 Histopathologic Features
 area of suppuration is
composed chiefly of central
area of disintegrating
polymorphonuclear
leukocytes
 dilation of blood vessels
in periodontal ligament

40. (1) Periapical Abscess
 Histopathologic Features
 tissue surrounding area
of suppuration contains
serous exudate

41. (1) Periapical Abscess
 Treatment & Prognosis
 drainage must be
established
• open pulp chamber
• extract the tooth

42. (1) Periapical Abscess
 Treatment & Prognosis
 under some circumstances
tooth may be retained
• root canal therapy

43. (1) Periapical Abscess
 Treatment & Prognosis
 left untreated, spread
of infection
• osteomyelitis
• cellulitis
• bacterimia
• formation of fistulous
tract opening on skin
or oral mucosa

44. (2) Periapical Granuloma
 also known as Apical
Periodontitis
 one of the most common
sequeala of pulpitis
 localized mass of chronic
granulation tissue
 response to infection

45. (2) Periapical Granuloma
 Clinical Features
 1st evidence; spread beyond
confines of tooth pulp
 may be noticeable sensitivity
of involved tooth to
percussion
 mild pain when biting or
chewing on solid food

46. (2) Periapical Granuloma
 Clinical Features
 some cases tooth feels
elongated in its socket
 sensitivity is due to
• hyperemia
• edema
• inflammation of apical
periodontal ligament

47. (2) Periapical Granuloma
 Radiographic Features
 earliest evidence,
thickening of ligament at root
apex
 proliferation of granulation
tissue
 concomitant resorption of bone
continue

48. (2) Periapical Granuloma
 Radiographic Features
 appear as a radiolucent
area of variable size
seemingly attached to
root apex
 some cases, well
circumscribed lesion
• definitely demarcated
from surrounding bone

49. (2) Periapical Granuloma
 Histologic Features
 arises as chronic process
from onset
 does not pass through an
acute phase

50. (2) Periapical Granuloma
 Histologic Features
 begins as:
• hyperemia
• edema of periodontal
ligament with infiltration
of chronic inflammatory cells
 chiefly lymphocytes
 plasma cells

51. (2) Periapical Granuloma
 Histologic Features
 inflammation + locally
increased vascularity
of tissue
• induce resorption
of supporting bone
adjacent to this area

52. (2) Periapical Granuloma
 Histologic Features
 as bone is resorbed
• proliferation of fibroblast
+ endothelial cells
• formation of more tiny
vascular channels
• numerous delicate connective
tissue fibrils

53. (2) Periapical Granuloma
 Treatment & Prognosis
 extraction of involved
teeth
 under certain conditions,
root canal therapy with or
without subsequent
apicoectomy

54. (2) Periapical Granuloma
 Treatment & Prognosis

55. (2) Periapical Granuloma
 Treatment & Prognosis
 left untreated, may
undergo transformation
into an apical periodontal
cyst
• proliferation of epithelial
rests in the area

56. (3) Radicular Cyst
 also known as Apical
Periodontal Cyst;
Periapical Cyst;
Root End Cyst
 common
 not inevitable sequela of
periapical granuloma originating
as a result of:
 bacterial infection
 necrosis of dental pulp
 following carious involvement of tooth

57. (3) Radicular Cyst
 Pathogenesis
 initial reaction leading
to cyst formation
• proliferation of epithelial
rest in the periapical
area involved by granuloma
• epithelial proliferation
follows an irregular pattern of
growth

58. (3) Radicular Cyst
 Clinical Features
 asymptomatic
 present no clinical evidence
of their presence
 seldom painful or even
sensitive to percussion

59. (3) Radicular Cyst
 Clinical Features
 represents chronic
inflammatory process
• develops only over
a long period of time

60. (3) Radicular Cyst
 Radiographic Features
 identical with periapaical
granuloma
 since the lesion is a chronic
progressive one developing
in a pre-existing granuloma
• cyst may be of greater
size than granuloma
• due to longer duration

61. (3) Radicular Cyst
 Radiographic Features
 occasionally, exhibits
thin, radioopaque line
around the periphery
of radiolucent area
• indicates reaction of
bone to slowly expanding
mass

62. (3) Radicular Cyst
 Radiographic Features

63. (3) Radicular Cyst
 Histologic Features
 epithelium lining apical
periodontal cyst is usually
stratified squamous in
type

64. (3) Radicular Cyst
 Treatment & Prognosis
 similar to periapical
granuloma
• involved tooth may be
removed
• periapical tissue carefully
curetted

65. (3) Radicular Cyst
 Treatment & Prognosis
 under some condition;
• root canal therapy
• with apicoectomy
of cystic lesion

66. (3) Radicular Cyst

68. (4) Phoenix Abscess
 localized collection of pus
 surrounded by an area of
inflammed tissue
 hyperemia
 infiltration of leucocytes

69. (4) Phoenix Abscess

70. (4) Phoenix Abscess

71. (4) Phoenix Abscess
 can occur immediately
following root canal treatment
 another cause is due to untreated
necrotic pulp (chronic apical
periodontitis)
 result of inadequate debridement
during endodontic procedure

72. (4) Phoenix Abscess
 Bacteriology
 Staphylococci are frequently
associated with pus formation
• produce enzyme called
coagulase
• causes fibrin formation
• helps in walling off of lesion

73. (4) Phoenix Abscess
 Bacteriology
• coagulase promotes
virulence by inhibiting
phagocytosis

74. (4) Phoenix Abscess
 Clinical Features
 when palpated clinically
• superficial abscess is
fluctuant
 offending tooth is carious
+ mobile
 symptoms of acute inflammation
• swelling
• fever

75. (4) Phoenix Abscess
 Treatment
 repeating endodontic
treatment with improved
debridement
 tooth extraction
 antibiotics may be indicated
to control a spreading or
systemic infection

76. (5) Condensing Osteitis
 also known as Chronic
Focal Sclerosing Osteomyelitis
 unusual reaction of bone
 occuring in instances of
extremely high tissue resistance
 or in cases of low grade infection

77. (5) Condensing Osteitis
 Clinical Features
 occurs in almost young
person before the age of
20 years old
 commonly affected is
mandibular 1st molar
with large carious lesion

78. (5) Condensing Osteitis

79. (5) Condensing Osteitis

80. (5) Condensing Osteitis
 Clinical Features
 associated with non vital
teeth or teeth undergoing
process of degeneration
 tooth is usually asymptomatic
 some cases, pain or tenderness
• percussion
• palpation

81. (5) Condensing Osteitis
 Radiographic Features
 well circumscribed
radiopaque mass of
sclerotic bone surrounding
 extending below apex of
one or more roots

82. (5) Condensing Osteitis
 Histologic Features
 dense mass of bony trabeculae
with little interstitial
marrow tissue

83. (5) Condensing Osteitis
 Histologic Features
 dense mass of bony trabeculae
with little interstitial
marrow tissue
 chronic inflammatory cells;
plasma cells, lymphocytes
are seen scanty in bone
marrow

84. (5) Condensing Osteitis
 Treatment & Prognosis
 endodontic treatment
 extraction
 surgical removal of sclerotic
should not be attempted
unless symptomatic

85. References:
 Books
 Cawson, R.A: Cawson’s Essentials of Oral
Oral Pathology and Oral Medicine,
8th Edition
• (page 70-72)
 Ghom, Ali & Mhaske, Shubhangi: Textbook of
Oral Pathology
• (pages 429-433)
 Neville, et. al: Oral and Maxillofacial Pathology
3rd Edition
• (pages 127-138)
Shafer, et al: A textbook of Oral Pathology,
3rd Edition