pulp within normal causes of pulpits diagnosis laser Doppler thermographe pulpoximetry electric pulp tester

1. Good afternoon

3. The dental pulp
loose connective tissue occupying
a cavity lying in center of dentin.

4. Morphology

5. FUNCTIONS OF DENTAL PULP
• Nutrition : blood supply
• Sensation : temp – vibration – chemicals
• Formative : maintain of dentin
• Protective : formation of tertiary dentin
• Defensive : inflammatory response

6. Dentin
Pulp
corePredentin
Odontoblasts
layer
Cell free
zone
Cell rich zone Histology

7. Undifferentiated cell
Odontoblast
Odontoblast
like cellOdontaclast

8. The nerve of pulp consist of :
• Afferent nerves : conduct impulses to be
received as a pain
• Sympathetic fibers : regulation of micro
circulation in pulp

9. Sensory
fibers
Large myelinated
A-fibers
A-alpha
Touch
pressure
A-beta vibration
A-gamma
Mechano-
receptor
A-delta
Pain
temp
Intermediate efferent
B-fibers
Small unmyelinated
C-fibers
Pain
temp

10. C fibersA-delta fibers
UnmylinatedMylinatedMylenation
2 m/s20 m/sConduction velocity
DeepSuperficialLocation of terminals
Throbbing dull
But less bearable
Sharp - fast
But bearable
Pain character
High by tissue damageLow by hydrodynamicStimulation threshold

11. Dentin
sensitivity

12. Normal pulp
Free of spontaneous pain
Moderate response to stimulus
Response disappear when removal

13. Diagnosis
Objective Subjective
• Visual and tactile
• Thermal testes
• Electrical testes
• Recent
• pain

15. Wein classification
1891
Bacterial
Traumatic
Iatrogenic
Idiopathic

16. 1. Bacterial
A- coronal ingress
• Caries: the most common cause
of ingress of bacteria to pulp
• Fractured crown
• Anomalous tract: as dens invaginatus ,
dens evaginatus and radicular lingual groove

17. B- radicular ingress
• Caries: less common than
coronal caries
• Retrogenic infection:
periodontal pocket
• Hematogenic infection:
anachoresis

18. 2. Traumatic
A- acute
• Coronal fracture
• Radicular fracture
• Luxation
• Avulsion

19. B- chronic
• Attrition: physiological wear
• Abrasion: mechanical loss of
tooth structure
• Erosion: chemical loss of
tooth structure

20. 3. Iatrogenic
• Cavity preparation
Heat
Depth
Desiccation
Vibration
Acid etching

21. • Restoration
Fractured restoration
Leaky restoration
Acid containing restorations

22. • Periodontal curettage
• Periradicular curettage
• Rhinoplasty
• Osteotomy

23. • local anesthesia
• Orthodontic movement
• Intubation for general anesthesia

24. 4. Idiopathic
• Aging
• Internal resorption
• Hereditary hypophosphatemia

25. Classification
Acc. to type
Bacterial
Physical
Mechanical
Chemical

26. Physical
 Thermal :
. Large metallic restorations without base .
. cavity preparation .
. setting of some cements e.g. Acrylic resin .

27.  Pressure
 Speed
 Depth of cutting
 presence or absence of insulating base

28.  Electrical :
presence of two dissimilar metals ( galvanism ) .
 Radiation :
-Direct effect
-Indirect effect

29. Mechanical
 Trauma
 cracked tooth syndrome
 Abrasion
 Lack of temporary
coverage after crown-
bridge preparation

30.  operative procedures :
operative procedures must taken during cavity preparation,
‫ــ‬ cavity depth
‫ــ‬ pulp exposure
‫ــ‬ pin insertion

31.  Orthodontic movements :
orthodontic movement , can lead to devitalization of the pulp
and pulpal hemorrhage .

32.  Deep periodontal curettage
Deep periodontal curettage, leads to damaging the pulpal
vessels, so it should be done after R.C.T

33. Chemical
 Dental materials
 Antibacterial agents

34.  Dental materials
* monomer in composite restorations .
* Amalgam, has cytotoxic effect .
*cements, some has potential irritation to pulp
e.g. Free phosphoric acid in phosphate cements .
* Etching agents , if placed over 15 seconds in dentin
can cause chronic inflammation of the pulp .

35.  Antibacterial agents
* Antibacterial agents as silver nitrate, phenol and eugenol which was used
to sterilize the cavity preparation have shown cytotoxic effects and causes
inflammatory changes

36. Barodontalgia / Aerodontalgia
symptom rather than a pathological
pain caused by a change in barometric pressure

38. Gomaa
Eslam
Khaled
By
Abanoub
Andrew
Samir
Abdallah