The document discusses various pathologies that can affect the dental pulp, including pulpitis, pulp necrosis, and pulp degeneration. It defines reversible and irreversible pulpitis, and notes their causes, symptoms, diagnosis, and treatments. Pulp necrosis occurs when the pulp undergoes cell death due to noxious insults like bacteria or trauma. Various forms of pulp degeneration are also outlined. The document provides an overview of common pulp conditions and classifications.

3. Introduction
 The pulp is surrounded by a hard
tissue (dentine), which limits the area
for expansion and restricts the pulp's
ability to tolerate edema.
 The pulp has almost a total lack of
collateral circulation, which severely
limits its ability to cope with
bacteria, necrotic
tissue and inflammation.

4. Normal Pulp:
 Gives moderate response to pulp
test, which subside when the stimulus is
removed.
 The tooth is free of spontaneous pain.
 X-ray shows intact lamina dura.
 There is no signs of any abnormalities (
calcifications and resorption. )

5. CLASSIFICATION OF PULPAL
PATHOLOGIES

6. Grossman’s Clinical
Classification
 I. Pulpitis.
A. Reversible Pulpitis.
B. Irreversible Pulpitis:
i. Acute :
a. Abnormally responsive to cold.
b. Abnormally responsive to heat.
ii. Chronic :
a. Asymptomatic with pulp exposure.
b. Hyperplastic pulpitis.
c. Internal resorption.
 II. Pulp degeneration.
A. Calcific ( Radiographic diagnosis )
B. Other ( Histopathological diagnosis )
 III. Necrosis.

7. PULPITIS

8. Pulpitis
 Is inflammation of the dental pulp due to
dental caries, trauma or dental
procedures.
 Its principle symptom is pain.
 Diagnosis is based on clinical finding and
can be confirmed by X-ray.
 Treatment involves removing the
offending factors.
 It sequelae includes apical
preiodontitis, periapical abscess and
osteomyelitis of the jaw and other life
threading conditions

9. Pulpitis
 It sequelae includes apical
preiodontitis, periapical abscess and
osteomyelitis of the jaw and other life
threading conditions
Spread from maxilla may cause :
Purulent sinusitis, orbital cellulitis and
C.S.T.
Spread from mandibular may cause :
Ludwig’s angina, mediastinitis and
paraphayngeal abscess

10. REVERSIBLE PULPITIS

11. Definition
 It is the general category which may
represent a range of responses varying
from dentin hypersensitivity to an early
phase of inflammation.
 There is a sharp hypersensitive
response to cold but the pain subside
when the stimulus is removed.
 Determination of reversibility is clinical
judgment influenced by history and
clinical evaluation.

12. Etiology
 Dental Caries.
 Trauma.
 Thermal injury.
 Chemical irritation.

13. Symptoms
 Reversible pulpitis is characterized by
sharp pain.
 The pain stay for few minutes,
 Always provoked, never spontaneous.
 disappear by itself or after the patient
takes some analgesic.

14. Diagnosis
 Pain : sharp of brief duration ceasing when
irritant is removed.
 Examination and history: caries, traumatic
occlusion.
 X-Ray: normal PDL and lamina dura. Depth of
caires lesion may be evident.
 Percussion : negative , not tender to percussion.
 Vitality : responds readily to cold and electric test
requires less current to cause pain.

15. Treatment
 No R.C.T is needed.
 Remove the cause, set a pellet of cotton
with eugenol for 5 minutes and Zinc
oxide and Eugenol as Temporary filling.
 After 2 or 3 days in which the tooth has
been asymptomatic final restoration may
be place.

16. Dentinal Hyperesthesia
 Appear when the dentine is exposed
ex: tooth abrasion and periodontal
disease.
 The pain is characterized by a short
duration
(1-2 seconds), which appears always by
stimulus: cold liquids, sweet, air, tooth
brushing and disappear immediately
after the stimulus is removed.
Treatment:
 Application of agents to promote dentinal

17. PULP HYPEREMIA
 Slight pain, always after different
stimulus: cold or hot water, sweets or
food impaction in the cavity, which
disappear when the stimulus is retired
and may stay for few seconds.
 Frequently associated with dental
caries, bad restorations.
Treatment:
 Remove the cause, set the base and
final restoration.

18. IRREVERSIBLE PULPITIS

19. Definition
 It is a persistent inflammatory
condition of the pulp, symptomatic or
asymptomatic, caused by noxious
stimulus.
 It has both acute and chronic stages.

20. Etiology
Untreated or incorrectly treated :
 Dental Caries.
 Trauma.
 Thermal injury.
 Chemical irritation.

21. Symptoms
 rapid onset of pain which remains
after removal of stimulus.
 Pain can be spontaneous in
nature intermittent or continuous
in nature.
 In later stages pain is
sever, boring, throbbing in nature
, increases with hot stimulus.
 Pain is relived by cold water.

22. Diagnosis
 Examination and history: deep carious lesion involving
the pulp or secondary caries.
 X-Ray: Depth and extent of caries lesion may be
evident, normal PDL but slight widening may be seen in
advanced stages.
 Percussion : positive, tooth is tender to percussion.
 Vitality : heat intensifies the response and clod tend to
relieve the pain and electric test requires less current to
cause pain. In initial stages but when the tissue
becomes more necrotic more current is required

23. Treatment
 Root canal treatment

24. CHRONIC PULPITIS

25. Chronic Pulpitis
 It is inflammatory response of pulpal
tissue to an irritant with absence of pain
because of :
a. Low inflammatory activity.
b. Decreased intrapulpal pressure below
the threshold limits of pain receptors.
 Its of 3 forms
a. Ulcerative form.
b. Hyperplastic form.
c. Closed form.

26. Etiology
 Same as acute irreversible pulpitis, in
which the irritant factor in chronic pulpitis
is slow and progressive.
 The nature of pulpal response depends on
:
a. Strength & duration of the irritant.
b. Previous health of pulp.
c. Extent of tissue affected.

27. Symptoms
 Absence of pain.
 Symptoms arise when there is
interference with drainage of exudate.
 Hyperplastic form is seen in children
and adolescents because high
resistance of pulp.

28. Diagnosis
 Pain , is usually absent.
 In Hyperplastic form a reddish pulpal mass filling most
of the pulp chamber is seen.
 X-Ray shows :
- Ch. Apical periodontitis in long standing cases.
- Condensing osteitis, low grade long standing irritation
stimulates periapical bone deposition.
 Vitality Tests shows :
- Usually not responding to thermal test unless extreme
cold is used.
- More current is required.

29. Treatment
Root canal treatment.
Or
 Extraction if the tooth is non –
restorable.

30. PULP NECROSIS

31. Pulp Necrosis
 Is a condition following untreated pulpitis.
 Noxious materials will leak from pulp space
forming lesion of endodontic origin.
 Necrosis may be partial or total, depending
on extent of pulp tissue involvement.
 Pulp necrosis is of 2 types :
a. Coagulation necrosis.
b. Liquefaction necrosis.

32. Etiology
 Is caused by noxious insult and injuries by
:
- Bacteria.
- Trauma.
- Chemical irritation.

33. Symptoms
 Discoloration of tooth – 1st indication of
pulp death.
 History from patient.
 Tooth might be asymptomatic.

34. Diagnosis
 Pain is absent in total necrosis.
 History of patient reveals past trauma or
past history of sever pain which may last
for some time followed by complete and
sudden cessation of pain.
 X-Ray shows :-
- Large cavity or filling or normal
appearance unless there is concomitant
apical periodontitis or condensing ostitis.

35. Diagnosis
Vitality test :-
Single rooted = not responding.
Multi rooted = mixed response.
• Sometimes in liquefaction necrosis may
show positive response to electric test
when the current is conducted through
moisture present in a root canal
• Visual examination shows color change.

36. Treatment
Root canal treatment.
Or
 Extraction if the tooth is non –
restorable.

37. PULP DEGENERATION

38. PULP DEGENERATION
 Is generally present in old people.
 May result from persistent mild irritation in
younger people.
 Is induced by :
- attrition.
- Abrasion.
- Erosion.
- Operative procedures.
- Dental Caries.
- Pulp capping.
- Other.

39. FORMS
Atrophic degeneration and fibrosis.
Decrease in size which occur slowly as the
tooth grows old.
 Calcifications.
Has 3 types :
- Dystrophic Calcifications.
- Diffuse Calcifications.
- Denticles / pulp stones.

40. Classification of Denticles / pulp
stones.
 According to location :-
- Free.
- Embedded.
- Attached.
 According to structure :-
- True.
- False.

41. BIBLIOGRAPHY
 Endodontics. Ingle. 2002. 5th edition.
 Textbook of Endodontics. Nisha
Garg, Amit Garg. 2007.1st edition.