1. Diseases Of Pulp
By
Mhmood M.H. Radhi
BDS- Final Year

2. Diseases Of Dental Pulp

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. 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. 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. 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. 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. 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.  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. 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.  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. Acute pulpitis with
Intrapulpal abscess

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. TREATMENT & PROGNOSIS:
Complete removal of pulp (RCT pulpectomy.
)or
E
xtraction of tooth, if tooth is not restorable.
P
ROGNOSIS
-favorable.

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. Stratified
sq.
epithelium
covering
polyp

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. 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. 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.

21. 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.

22. 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

23. 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.

24. 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.

25.  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.

26. Necrosis of pulp

27. References
 Grossman’s endodontic practice 12th edition