This document provides an overview of diseases of the pulp. It discusses pulpitis, which is inflammation of the pulp that can be reversible or irreversible depending on the severity. Reversible pulpitis involves mild inflammation that can return to normal, while irreversible pulpitis is persistent and may lead to necrosis without treatment. Other topics covered include causes of pulp inflammation, classifications of pulpitis, features of acute and chronic pulpitis, necrosis, and management approaches for different pulp conditions. The document aims to inform pediatric dentists about diseases that can affect the pulp.

1. Diseases of the Pulp
Presented by
Dr Rahul Katyayan
For the- Faculty of
Pediatric dentistry.

2. CONTENTS
⚫ INTRODUCTION
⚫ PULPITIS
⚫ SEQUELAE
⚫ CAUSES
⚫ CLASSIFICATION
⚫ REVERSIBLE PULPITIS
⚫ FOCAL REVERSIBLE PULPITIS
⚫ IRREVERSIBLE PULPITIS
⚫ ACUTE PULPITIS
⚫ CHRONIC PULPITIS
⚫ NECROSIS
⚫ REFERENCES

3. ⮚ formative organ of tooth
⮚ builds primary dentin
during development of tooth
⮚ secondary dentin after
tooth eruption
⮚ reparative dentin in response
to stimulation as long as
odontoblast remain vital
Pulp

4. ⮚ most common cause of
dental pain
⮚ loss of teeth in younger
persons
⮚ usual cause is caries
penetrating the dentin
Pulpitis

5. Pulpitis
UNTREATED
Death of pulp
Spread of Infection through
apical foramina into periapical tissues
Causes Periapical Periodontitis

6. ⮚ (1)Physical Cause
a)Mechanical
b)Thermal
⮚ (2) Chemical Cause
⮚ (3) Bacterial Cause
Causes of Pulpal
Inflammation

7. ⮚ (a) Mechanical Cause
A. trauma
a) accident (contact sports)
b) iatrogenic damage due to dental procedure
(during cavity or crown preparation)
B. Pathologic wear ( atrrition, abrasion)
C. Cracked tooth syndrome
D. Barometric changes
Causes of Pulpal
Inflammation

8. ⮚ (b) Thermal Cause
✔ uninsulated metallic
restoration
✔ during cavity preparation
✔ polishing
Causes of Pulpal
Inflammation

9. ⮚ (2) Chemical Cause
✔ arise from erosion
✔ or inappropriate use
of acidic dental material
Causes of Pulpal
Inflammation

10. ⮚ (3) Bacterial Cause
✔ can damage pulp
through toxins secreted
by bacteria from caries
✔Microbial colonization in
the pulp by blood borne
microorganisms
(anachoresis).
Causes of Pulpal
Inflammation

11. ⮚ (1) Based on Severity of
Inflammation
⮚ (2) According to Involvement
Classification

12. ⮚ (1) Reversible Pulpitis
⮚ (2) Irreversible Pulpitis
⮚ (3) Pulp Degeneration
⮚ (4) Pulp Necrosis
(1) Based on Severity
of Inflammation

13. ⮚ (1) Reversible Pulpitis
✔ Symptomatic (acute)
✔ Aysptomatic (chronic)
⮚ (2) Irreversible Pulpitis
✔ Acute
• Abnormally responsive to cold
• Abnormally responsive to heat
(1) Based on Severity
of Inflammation

14. ⮚ (2) Irreversible Pulpitis
✔ Chronic
• Asymptomatic with
pulp exposure
• Hyperplastic
• Internal resorption
(1) Based on Severity
of Inflammation

15. ⮚ (3) Pulp Degeneration
✔ Calcific
⮚ (4) Pulp Necrosis
(1) Based on Severity
of Inflammation

16. ⮚ (1) According to extent of inflammation
⮚ (2) According to Severity
⮚ (3) According to presence or
absence of direct
communication
between dental pulp +
oral environment
(2) According to
Involvement

17. ⮚ (1) According to extent of inflammation
✔ Focal or Subtotal or
Partial Pulpitis
✔ Total or Generalized
Pulpitis
(2) According to
Involvement

18. ⮚ (2) According to Severity
✔ Acute
✔ Chronic
(2) According to
Involvement

19. ⮚ (3) According to presence or
absence of direct
communication
between dental pulp +
oral environment
✔ Pulpitis Aperts (open pulpitis)
✔ Pulpitis Clausa (closed pulpitis)
(2) According to
Involvement

20. ⮚ mild to moderate inflammatory
condition of pulp
✔ caused by noxious stimuli
✔ pulp is capable of returning
to un-inflammed state following removal of stimuli
Reversible Pulpitis

21. ⮚ Causes
✔ agent capable of
injuring pulp like:
• trauma
• disturbed occlusal
relationship
• thermal shock
Reversible Pulpitis

22. ⮚ Clinical Features
✔ sharp pain lasting for
a moment
✔ often brought on by cold
than hot food or beverages
and by cold air
Reversible Pulpitis

23. ⮚ Clinical Features
✔ does not continue
when the cause has been
removed
✔ tooth responds to electric
pulp testing at lower
current
Reversible Pulpitis

24. ⮚ Management
✔ prevention
✔ periodic care
✔ early insertion of filling
if a cavity has developed
✔ removal of noxious
stimuli
Reversible Pulpitis

25. ⮚earliest form
⮚ also known as pulp hyperemia
⮚ excessive accumulation of
blood within pulp tissue
⮚ leads to vascular congestion
Focal Reversible
Pulpitis

26. ⮚ Clinical Features
✔ sensitive to thermal
changes
✔ particularly to cold
✔ application of ice or cold
fluids to tooth result in pain
Focal Reversible
Pulpitis

27. ⮚ Clinical Features
✔ disappears upon removal
of thermal irritant or
restoration .
✔ responds to electrical test
stimulant at lower level
of current
Focal Reversible
Pulpitis

28. ⮚ Clinical Features
✔ indicates lower pain
threshold than that of
adjacent normal
teeth
Focal Reversible
Pulpitis

29. ⮚ Clinical Features
✔ teeth show:
• deep carious lesion
• large metallic restoration
• restoration with defective
margins
Focal Reversible
Pulpitis

30. ⮚ Management
✔ removal of irritants
before the pulp is
severely damaged
Focal Reversible
Pulpitis

31. ⮚ persistent inflammatory
condition of pulp
⮚ may be symptomatic or
asymptomatic
⮚ caused by noxious stimulus
Irreversible Pulpitis

32. ⮚ Causes
✔ bacteria involvement of
pulp through caries
✔ chemical
✔ thermal
✔ mechanical injury
Irreversible Pulpitis

33. ⮚ Clinical Features
Early Stage
✔ paroxysm of pain
caused by:
• sudden temperature
changes like cold,
sweet, acid foodstuffs
Irreversible Pulpitis

34. ⮚ Clinical Features
Early Stage
✔ pain often continues
when cause has been
removed
✔ may come and go
spontaneously
Irreversible Pulpitis

35. ⮚ Clinical Features
Early Stage
✔ pain
• sharp
• piercing
• shooting
• generally severe
Irreversible Pulpitis

36. ⮚ Clinical Features
Early Stage
✔ pain
• bending over exacerbates pain which
• lying down is due to change in
• change of position intrapulpal pressure
Irreversible Pulpitis

37. ⮚ Clinical Features
Late Stage
✔ pain
• more severe as if tooth is under
• throbbing constant pressure
Irreversible Pulpitis

38. ⮚ Clinical Features
Late Stage
✔ pain
• patient is often awake
at night due to pain
• increased by heat and
sometimes relieved by cold,
although continued application
of cold may intensify pain
Irreversible Pulpitis

39. ⮚ Management
✔ complete removal of pulp
or pulpectomy
✔ if the time is a factor, pulpotomy
should be done as an emergency
procedure
✔ Surgical removal should be considered if the tooth
is not restorable.
Irreversible Pulpitis

40. Clinical Difference
Reversible Pulpitis Irreversible Pulpitis
⮚ pain generally lasts for few
seconds
⮚ the pain produced by thermal
stimulus disappears as soon as
the stimulus is removed
Pain may last several
minutes or later
⮚ pain lingers even after
the stimulus is removed
⮚ pain may come without
any apparent stimulus

41. ⮚ extensive acute inflammation
of pulp
⮚ frequent sequel of focal
reversible pulpitis
Acute Pulpitis

42. ⮚ Causes
✔ tooth with large carious
lesion
✔ defective restoration
where there has been
recurrent caries
✔ pulp exposure due to
faulty cavity preparation
Acute Pulpitis

43. ⮚ Clinical Features
✔ severe pain is elicited by
thermal changes
✔ pain persists even after
thermal stimulus
disappears or been
removed
Acute Pulpitis

44. ⮚ Clinical Features
✔ may be continuous
✔ intensity may be increased
when patient lies down
✔ application of heat
may cause acute
exacerbation of pain
Acute Pulpitis

45. ⮚ Clinical Features
✔ tooth reacts to electric
pulp vitality tester at a
lower level of current
than adjacent normal
teeth
Acute Pulpitis

46. ⮚ Clinical Features
✔ pressure increases
because of lack of
escape of inflammatory
exudate
✔ rapid spread of inflammation
through pulp with pain
+ necrosis
Acute Pulpitis

47. ⮚ Management
✔ early stages of acute pulpitis pulpotomy
(removal of coronal pulp)
✔ placing material that
favors calcification such
as:
• calcium hydroxide
over entrance of
root canals
Acute Pulpitis

48. ⮚ Management
✔ root canal filling with
inert material like
gutta percha should be
done
Acute Pulpitis

49. ⮚ may develop with or
without episodes of
acute pulpitis
⮚ many pulps under large
carious cavities die painlessly
⮚ 1st indication is then
development of periapical
periodontitis, either with pain
or seen by chance in radiograph
Chronic Pulpitis

50. ⮚ Clinical Features
✔ dull aching type
✔ more often intermittent
than continuous
Chronic Pulpitis

51. ⮚ Management
✔ root canal therapy
✔ followed by crown
restoration
Chronic Pulpitis

52. ⮚ also called as pulp polyp
or pulpitis aperta
⮚ essentially an excessive
exuberant proliferation
of chronically inflammed
dental pulp tissue
Chronic Hyperplastic
Pulpitis

53. ⮚ pulpal inflammation due
to an extensive carious
exposure of a young pulp
⮚ development of granulation
tissue
⮚ covered at times by epithelium
⮚ resulting from long standing
low grade infection
Chronic Hyperplastic
Pulpitis

54. ⮚ Causes
✔ slow progressive
exposure of pulp
✔ bacterial infection
Chronic Hyperplastic
Pulpitis

55. ⮚ Clinical Features
✔ most commonly involved
are deciduous molars +
1st permanent molar
• excellent blood supply
• large root opening
Chronic Hyperplastic
Pulpitis

56. ⮚ Clinical Features
✔ asymptomatic
✔ seen only in teeth of children
+ young adults
Chronic Hyperplastic
Pulpitis

57. ⮚ Clinical Features
✔ polypoid tissue appears
• fleshy
• reddish pulpal mass filling
most of pulp chamber
or cavity
• or even extend beyond
confines of tooth
Chronic Hyperplastic
Pulpitis

58. ⮚ Clinical Features
✔ polypoid tissue appears
• sometimes, if mass is
large enough
• interferes with closure
of mouth
Chronic Hyperplastic
Pulpitis

59. ⮚ Clinical Features
✔ polypoid tissue appears
• may cause discomfort
during mastication
• due to pressure of food
bolus
Chronic Hyperplastic
Pulpitis

60. ⮚ Clinical Features
✔ polypoid tissue appears
• tissue easily bleeds
because of rich network
of blood vessels
• tooth may respond or
not at all to thermal test
Chronic Hyperplastic
Pulpitis

61. ⮚ Management
✔ elimination of polypoid tissue
✔ followed by extirpation of pulp
✔ hyperplastic tissue bleeeding
can be controlled by pressure
✔ pulpectomy or extraction of tooth can also
be done if the tooth is not restorable.
Chronic Hyperplastic
Pulpitis

62. ⮚ death of pulp
⮚ may be partial or total
depending on whether part
or the entire pulp is
involved
Necrosis

63. ⮚ Causes
✔ sequeala of inflammation
✔ can also occur following
trauma
• pulp is destroyed before
an inflammatory reaction
Necrosis

64. ⮚ Types
✔ (1) Coagulation Necrosis
✔ (2) Liquefaction Necrosis
Necrosis

65. ⮚ Types
✔ (1) Coagulation Necrosis
• soluble portion of
tissue is precipitated
or converted into a solid
material
Necrosis

66. ⮚ Types
✔ (1) Coagulation Necrosis
• tissue is converted into
tissue mass consisting
chiefly of coagulated
▪ proteins
▪ fats
▪ water
Necrosis

67. ⮚ Types
✔ (2) Liquefaction Necrosis
• results when proteolytic
enzymes convert the
tissue into softened mass
liquid or amorphous debris
Necrosis

68. ⮚ Clinical Features
✔ no painful symptoms
✔ discoloration of tooth
• 1st indication that the pulp
is dead
Necrosis

69. ⮚ Clinical Features
✔ history of pain lasting from
a few minutes to a few
hours followed by
complete + sudden
cessation of pain
Necrosis

70. ⮚ Management
✔ preparation + obturation of
root canals
Necrosis

71. References:
❖ Books
⮚ Grossman’s endodontic practice twelfth edition
⮚Textbook of oral pathology shafers
⮚Cawson, R.A: Cawson’s Essentials of Oral Pathology and
Oral Medicine, 8th Edition.(page 60)
⮚ Ghom, Ali & Mhaske, Shubhangi: Textbook of Oral
Pathology. (pages 420-425)

72. References:
⮚Adrian,J.C.,et al.:J. Am. Dent. Assoc.,83:113,
1971.
⮚Allard, U., et al.:Oral Surg.,48:454, 1979.
⮚Austin, L.T.:J. Am. Dent. Assoc.,17:1930, 1930.
⮚Baume, L.: SSO Schweiz. Monatsschr.
Zahnheilkd.,77:1082, 1965.

73. References:
⮚Baume, L.: Transactions of the Fourth
International Conference on Endodontics.
Philadelphia: University of Pennsylvania
press, 1968, p. 66 .
⚫Baume, L.J.: Monogr. Oral Sci.,8:1-
220, 1980.

74. THANK
YOU