The document discusses diseases of the dental pulp, including pulpitis and necrosis. It defines the pulp as the formative organ of the tooth that builds dentin. Pulpitis is the most common cause of dental pain and can be reversible or irreversible depending on the severity of inflammation. Untreated pulpitis can lead to necrosis or death of the pulp. Causes include mechanical, thermal, chemical, and bacterial factors. Management involves removal of irritants and root canal treatment if needed.

1. DISEASES OF
THE PULP
Prepared by:
Dr. Rea Corpuz

2. Pulp
 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

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

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

5. Causes of Pulpal
Inflammation
 (1) Mechanical Cause
 (2) Thermal Cause
 (3) Chemical Cause
 (4) Bacterial Cause

6. Causes of Pulpal
Inflammation
 (1) Mechanical Cause
 traumatic accident
 iatrogenic damage for
dental procedure
 atrrition
 abrasion

7. Causes of Pulpal
Inflammation
 (2) Thermal Cause
 uninsulated metallic
restoration
 during cavity preparation
 polishing

8. Causes of Pulpal
Inflammation
 (3) Chemical Cause
 arise from erosion
 or inappropriate use
of acidic dental material

9. Causes of Pulpal
Inflammation
 (4) Bacterial Cause
 can damage pulp
through toxins secreted
by bacteria from caries

10. Classification
 (1) Based on Severity of
Inflammation
 (2) According to Involvement

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

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

13. (1) Based on Severity
of Inflammation
 (2) Irreversible Pulpitis
 Chronic
• Asymptomatic with
pulp exposure
• Hyperplastic
• Internal resorption

14. (1) Based on Severity
of Inflammation
 (3) Pulp Degeneration
 Calcific
 (4) Pulp Necrosis

15. (2) According to
Involvement
 (1) According to Involvement
 (2) According to Severity
 (3) According to presence or
absence of direct
communication
between dental pulp +
oral environment

16. (2) According to
Involvement
 (1) According to Involvement
 Focal or Subtotal or
Partial Pulpitis
 Total or Generalized
Pulpitis

17. (2) According to
Involvement
 (2) According to Severity
 Acute
 Chronic

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

19. Reversible Pulpitis
 mild to moderate inflammatory
condition of pulp
 caused by noxious stimuli
 pulp is capable of returning
to un-inflammed state
 following removal of stimuli

20. Reversible Pulpitis
 Causes
 agent capable of
injuring pulp like:
• trauma
• disturbed occlusal
relationship
• thermal shock

21. Reversible Pulpitis
 Clinical Features
 sharp pain lasting for
a moment
 often brought on by cold
than hot food or beverages
and by cold air

22. Reversible Pulpitis
 Clinical Features
 does not continue
when the cause has been
removed
 tooth responds to electric
pulp testing at lower
current

23. Reversible Pulpitis
 Management
 prevention
 periodic care
 early insertion of filling
if a cavity has developed
 removal of noxious
stimuli

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

25. Focal Reversible
Pulpitis
 Clinical Features
 sensitive to thermal
changes
 particularly to cold
 application of ice or cold
fluids to tooth result in pain

26. Focal Reversible
Pulpitis
 Clinical Features
 disappears upon removal
of thermal irritant or
restoration of normal
temperature
 responds to electrical test
stimulant at lower level
of current

27. Focal Reversible
Pulpitis
 Clinical Features
 indicates lower pain
threshold than that of
adjacent normal
teeth

28. Focal Reversible
Pulpitis
 Clinical Features
 teeth show:
• deep carious lesion
• large metallic restoration
• restoration with defective
margins

29. Focal Reversible
Pulpitis
 Management
 removal of irritants
before the pulp is
severely damaged

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

31. Irreversible Pulpitis
 Causes
 bacteria involvement of
pulp through caries
 chemical
 thermal
 mechanical injury

32. Irreversible Pulpitis
 Clinical Features
Early Stage
 paroxysm of pain
caused by:
• sudden temperature
changes like cold,
sweet, acid foodstuffs

33. Irreversible Pulpitis
 Clinical Features
Early Stage
 pain often continues
when cause has been
removed
 may come and go
spontaneously

34. Irreversible Pulpitis
 Clinical Features
Early Stage
 pain
• sharp
• piercing
• shooting
• generally severe

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

36. Irreversible Pulpitis
 Clinical Features
Late Stage
 pain
• more severe as if tooth is under
• throbbing constant pressure

37. Irreversible Pulpitis
 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

38. Irreversible Pulpitis
 Management
 complete removal of pulp
or pulpectomy
 placement of intracanal
medicament
 to act as disinfectant or
obtundent
• cresatin
• eugenol
• formocresol

39. Clinical Difference
Reversible Pulpitis Irreversible Pulpitis
 pain is generally traceable  more severe
to a stimulus  lasts longer
 cold water  pain may come
 air without
any apparent stimulus

40. Acute Pulpitis
 extensive acute inflammation
of pulp
 frequent sequel of focal
reversible pulpitis

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

42. Acute Pulpitis
 Clinical Features
 severe pain is elicited by
thermal changes
 pain persists even after
thermal stimulus
disappears or been
removed

43. Acute Pulpitis
 Clinical Features
 may be continuous
 intensity may be increased
when patient lies down
 application of heat may
may cause acute
exacerbation of pain

44. Acute Pulpitis
 Clinical Features
 tooth reacts to electric
pulp vitality tester at a
lower level of current
than adjacent normal
teeth

45. Acute Pulpitis
 Clinical Features
 pressure increases
because of lack of
escape of inflammatory
exudate
 rapid spread of inflammation
through pulp with pain
+ necrosis

46. Acute Pulpitis
 Management
 early stages of pulpotomy
(removal of coronal pulp)
 placing material that
favors calcification such
as:
• calcium hydroxide
over entrance of
root canals

47. Acute Pulpitis
 Management
 root canal filing with
inert material like
gutta percha should be
done

48. Chronic Pulpitis
 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

49. Chronic Pulpitis
 Clinical Features
 dull aching type
 more often intermittent
than continuous

50. Chronic Pulpitis
 Management
 root canal therapy
 followed by crown
restoration

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

52. Chronic Hyperplastic
Pulpitis
 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

53. Chronic Hyperplastic
Pulpitis
 Causes
 slow progressive
exposure of pulp
 bacterial infection

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

55. Chronic Hyperplastic
Pulpitis
 Clinical Features
 asymptomatic
 seen only in teeth of children
+ young adults

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

57. Chronic Hyperplastic
Pulpitis
 Clinical Features
 polypoid tissue appears
• sometimes, if mass is
large enough
• interferes with closure
of mouth

58. Chronic Hyperplastic
Pulpitis
 Clinical Features
 polypoid tissue appears
• may cause discomfort
during mastication
• due to pressure of food
bolus

59. Chronic Hyperplastic
Pulpitis
 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

60. Chronic Hyperplastic
Pulpitis
 Management
 elimination of polypoid tissue
 followed by extirpation of pulp
 hyperplastic tissue bleeeding
can be controlled by pressure
 extraction of tooth can also
be done

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

62. Necrosis
 Causes
 sequeala of inflammation
 can also occur following
trauma
• pulp is destroyed before
an inflammatory reaction

63. Necrosis
 Types
 (1) Coagulation Necrosis
 (2) Liquefaction Necrosis

64. Necrosis
 Types
 (1) Coagulation Necrosis
• soluble portion of
tissue is precipitated
• or converted into a solid
material

65. Necrosis
 Types
 (1) Coagulation Necrosis
• tissue is converted into
tissue mass consisting
chiefly of coagulated
 proteins
 fats
 water

66. Necrosis
 Types
 (2) Liquefaction Necrosis
• results when proteolytic
enzymes convert the
tissue into softened mass
liquid or amorphous debris

67. Necrosis
 Clinical Features
 no painful symptoms
 discoloration of tooth
• 1st indication that the pulp
is dead

68. Necrosis
 Clinical Features
 history of pain lasting from
a few minutes to a few
hours followed by
complete + sudden
cessation of pain

69. Necrosis
 Management
 preparation + obturation of
root canals

70. References:
 Books
 Cawson, R.A: Cawson’s Essentials of Oral
Oral Pathology and Oral Medicine,
8th Edition
• (page 60)
 Ghom, Ali & Mhaske, Shubhangi: Textbook of
Oral Pathology
• (pages 420-425)