This document discusses diagnosis of pulp pathology. It begins by defining the dental pulp and its relationship to dentin. It then discusses diagnostic procedures, noting that diagnosis involves evaluating signs and symptoms along with results from diagnostic tests like medical/dental history reviews, radiographs, and clinical examinations. The document outlines specific examination steps including evaluating the coronal and pulpal areas, along with history and radiograph findings, to make a diagnosis. It also discusses various pulp testing methods like thermal, electric, percussion, and introduces newer methods like laser Doppler flowmetry, pulse oximetry, and duel wavelength spectrometry to objectively assess pulp vitality.

1. NAVODAYA DENTAL COLLEGE
DEPARTMENT OF PEDODONTICS
STAFF NAME – Dr VINOD KUMAR
Professor and Head of department
TOPIC NAME –Diagnosis of pulp pathology

2. INTRODUCTION
• D ental pulp may be defined as, “ a special organ with a
unique environment of the unyielding dentin surrounding a
resistant,resilient soft tissue of mesenchymal origin
reinforced with a ground substance.”
• It has a close relationship between its peripheral
cells,the odontoblasts a n d the dentin thereby making it a
functional entity sometimes refered to as „pulp-dentin
complex‟.
• The dental pulp is a delicate connective tissue
liberally interspersed with tiny blood
vessels,lymphatics,nerves, & undifferentiated CT cells.
• The enclosure of the pulp tissue within the rigid
calcified walls of dentin precludes the excessive
swelling of tissue that occur in hyperemic phases of
inflammation in other tissues.
• Pulpal injury  frequently irreversible & painful

3. DIAGNOSTIC PROCEDURES
• Diagnosis is the process of identifying a medical condition
or disease by proper evaluation of signs & sypmtoms &
from the results of various diagnostic procedures.
• Diagnostic procedure should follow a consistent & logical
order & include review of medical & dental histories
,radiographic examination & clinical examination.
• Pulp is the essence of the tooth. It is the structure that makes
the tooth vital.
• A n understanding of the possible underlying pathological
process ,combined with a n exact assessment of pain history
& appropriate clinical tests should aid the practitioner in
determining the nature of the pulpal inflammation.
• Operative diagnosis  there a r e instances when a final
diagnosis can be reached only on direct evaluation of
pulp tissue & decission about treatment can be made
accordingly.
eg:

4. • History
• Recollecting -1st step towards establishing a diagnosis.
• M a y not determine treatment but may influence modification in
treatment modalities as according to the person‟s health
status.
• Detailed history of pain
• Extra-Oral Examination
• For localized swelling,changes in color or bruises,abrasions,cuts or
scars & similar signs of disease,trauma or previous T/t.
• Enlarged lymphnodes important in denoting spread of infection.
• Intra-Oral Examination
• Examination of oral mucosa for any abnormality
• Carious lesions ,discolorations & other obvious abnormalities asstd
with the teethshould be noted.
• Coronal Evaluation
 by using a mouth mirror & explorer a n d possibly a fiber optic light
source.
Suspected tooth carefully & thoroughly examined for
caries,defective restoration,discoloration,enamel loss or defects that
allow direct passage of stimuli to pulp.
• Pulpal Evaluation
Clinical condition of the pulp evaluated by thermal
stimuli,percussion,palpation & vitality tests.

5. • Pulpal Evaluation + History+ R/G findings Diagnosis
• The various pulpal evaluation methods are:
i) Pulp testing
ii) Percussion
iii) Radiographs
Dental Pulp Testing
• A useful & essential diagnostic aid in endodontics
• A n investigation that provide valuable diagnosis &
treatment planning information.
• Help in the assessment of pulp health based on its
qualitative sendory response.
• 3 types
Pulp vitality testing assessment of pulp‟s blood supply
eg: Laser Doppler
Flowmetry Pulse
oximetry
Pulp sensibility testing assessment of pulp‟s sensory
response.
eg: Thermal & electric pulp testing
Pulp sensitivity condition of pulp being very responsive to

6. • Conventional Pulp
Testing
Method Technique/Material Symptom/Interpretation
1. Thermal
Cold
Heat
•Ethyl chloride,ice,air blast
•Hot water,heated gutta
parcha (used for location of
symptomatic tooth)
•Hypersensitivity/subsiding
pain- reversible pulpitis.
•Lingering pain-irreversible pulpitis
•No response-pulpal necrosis
2.Electirc •Odontometer •Respond to lower level of
current- reversible pulpitis
•Respond to higher level of
current- Irreversible
•No response-necrosis
3.Percussion •Vertical
•Lateral
•Apical periodontitis(irreversible
pulpitis if due to caries)
•Lateral periodontal
space inflammation
4.Radiograph •IOPA •Furcation involvement /thickening
of the PDL space-indicates
periapical infection(usually
accompanied with irreversible
pulpitis)
Pulp sensibility tests unrelaible in children,recently traumatized & multi
rooted teeth.

7. • Newer Methods
• Laser Doppler Flowmetry
• Developed in 1970s to measure the velocity of RBCs in capillaries.
• A non-invasive,objective,painless alternative to traditional neutral-
stimulation methods promising test for children.
• Vital teeth-produce regular signal fluctuations
• Non-vital teeth-no synchronous signals;produced irregular fluctuations
or
very steep spike traces that a r e attributed to a movement artefact.
• Useful in assessment of post-traumatized incisors aswell.
• Pulse Oximetry
• Direct measurement of pulp circulation-real measure of pulp vitality.
• Pulp oximetry-completely objective estimates blood oxygen saturation
levels by measuring & comparing amplitudes of the ratios of
transmitted infra-red with red light.
• The ratio varies with relative fractions of oxygen saturated
to unsaturated H b & is used to calculate oxygen saturation.
• Capable of evaluating the blood vasculature status within a tooth &
therefore pulp vitality.
• Disadvantage –dependance on a pulsatile blood flow

8. • Duel Wavelength Spectrometry
• Measures blood oxygenation change within the capillary bed
of dental tissue & tus not dependent on a pulsatile blood flow.
• Hughes Probeye Camera
• Used in detecting temperature change a s small a s 0.1 C
,hence
,been used to test pulp vitality experimentally.
Odontomet
er
Laser Doppler
Flowmeter

9. Pulse
Oximeter