soft tissue of the tooth needs to diagnosed and treated well

1. Prepared by :
Addisu Dabi (Intern)
Abraham Abebe (Intern)
Temesgen Haregot (Intern)

2. Outline
Introduction
Causes of pulpal diseases
Pathways of bacterial invasion of pulp
Classification of pulpal diseases
.Reversible pulpitis
.Irreversible pulpitis
.Pulp polyp
.Internal resorption(pulp/root)
.Pulp degeneration
.Pulp necrosis

3. Introduction
• Dental pulp consists of vascular connective
tissue contained within the rigid dentin walls.
• It is the principal source of pain within the
mouth and also a major site of attention in
endodontics and restorative treatment.

4. PATHWAYS OF BACTERIAL INVASION OF PULP
A) Direct invasion by way of the dentin such as
• Caries
• Fracture of crown or root
• Exposure during cavity preparation
• Attrition, abrasion ,erosion
• Crack in crown
B) Invasion through open blood vessels or lymphatics –periodontal
diseases, an accessory canal in furcation area, gingival infection.
C) Invasion through blood such as during infectious diseases or
transient bacteremia.

5. Grossman’s clinical classification of pulpal diseases
1. Pulpitis
 a. Reversible
– Symptomatic (Acute)
– Asymptomatic (Chronic)
 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
 2. Pulp degeneration
a. Calcific (Radiographic diagnosis)
b. Other (Histopathological diagnosis)
 3. Necrosis

6. REVERSIBLE PULPITIS
Definition:
Reversible pulpitis is a mild to moderate
inflammatory condition of pulp caused by noxious
stimuli in which the pulp is capable of returning to un
inflamed state following removal of stimulus.

7. Cause:
Trauma
Disturbed Occlusal relationship
Thermal shock
Overheating during polishing a filling
Excessive dehydration of a cavity
Symptoms:
Sharp pain lasting for a moment which is mainly
caused by cold beverages than hot foods.

8. Diagnosis:
By the study of patients symptoms and by
clinical tests, pain is sharp, lasts for few seconds and
disappears when stimulus is removed.
Differential diagnosis:
Irreversible pulpitis.
Treatment:
Periodic care to prevent development of
caries, early insertion of filling, desensitization of
necks of teeth, use of cavity varnish or base.

9. IRREVERSIBLE PULPITIS
Definition:
Irreversible pulpitis is a persistent
inflammatory condition of pulp, symptomatic
or asymptomatic caused by a noxious
stimulus.
Cause:
Caries
Chemical ,thermal or mechanical irritation

10. Symptoms:
• A paroxysm of pain is caused by sudden
temperature change, pressure from packing foods
into a cavity .
• Pain continues on removal of cause has been
removed.
• Pain comes spontaneously without apparent cause.
• Pain is of sharp piercing type.
• It may be continuous or intermittent.
• Change of position may increase intra pulpal
pressure which may exacerbate the pain.

11. Differential diagnosis:
Reversible pulpitis
Asymptomatic irreversible pulpitis.
Treatment:
Complete removal of pulp or
pulpectomy and the placement of an intra canal
medicament.

12. CHRONIC HYPERPLASTIC PULPITIS/PULP
POLYP
Definition:
Chronic hyperplastic pulpitis or pulp polyp is a productive
pulpal inflammation due to an extensive carious exposure of a
pulp.

13. Cause:
• Slow ,progressive carious exposure of the pulp
is the cause.
Symptoms:
• This condition is symptomless, except during
mastication when pressure of food bolus may
cause discomfort.

14. Diagnosis:
 Fleshy reddish pulpal mass fills most of pulp
chamber or extends beyond the confines of
tooth
This is characteristic feature of pulp polyp
which is seen mostly in teeth of children and
young adults .
Radiographs show a large open cavity with
direct access to pulp.
 More current than normal is required to elicit
response by means of electric pulp tester.

15. Differential diagnosis:
Proliferating gingival tissue.
Treatment:
Elimination of polypoid tissue followed by
extirpation of pulp.

16. INTERNAL RESORPTION
Definition:
Internal resorption is an idiopathic slow or fast
progressive resorptive process occurring in the
dentin of the pulp chamber or root canals of
the teeth.
Cause:
Cause is not known.
Often history of trauma present.

17. Symptoms:
Internal resorption in root is asymptomatic.
In crown it is seen as pink spot.
Diagnosis:
Internal resorptions are usually diagnosed during routine
radiographic examination.
Radiographically there will be a change in the wall of root
canal or pulp chamber with a round or ovoid radiolucent
area

18. Differential diagnosis:
External root resorption.
Treatment:
Extirpation of pulp.
Routine endodontic treatment.
Obturation with plasticized guttapercha technique.

20. PULP DEGENERATION
• It seen mostly in older people.
Symptoms:
• Early stages of pulpal degenerations are
clinically asymptomatic.
• In later stages tooth becomes discolored and
pulp will not respond to stimulation.
• Continuous degeneration of the tissue results
in necrosis.

21. Cause:
• Persistent and mild irritation in the younger
people.
• The various pulpal degenerations are:
Calcific degeneration
Atrophic/resorptive degeneration
Fibrous degeneration

22. Calcific degeneration:
In calcific degeneration part of pulp tissue is replaced
by calcific material, that is pulp stones or denticles
are formed.
Atrophic/resorptive degeneration:
In atrophic degeneration fewer stellate cells are
present in pulp and intercellular fluid is increased.
Fibrous degeneration:
In this type of degeneration pulp is characterized
by replacement of cellular elements fibrous
connective tissue

23. Pulp stone Atrophic changes of pulp
with age
….Continuous degeneration of the tissue
results in necrosis…..

24. NECROSIS OF PULP
Definition:
Necrosis is death of the pulp.
• It may be partial or total, depending on
whether part of or entire pulp is involved.
Cause:
Caused by any noxious insult injurious to the
pulp.

25. Necrosis is of 2 types -
Coagulative necrosis:
 sudden interruption of blood vessels
 Protoplasm of all cells becomes fixed and opaque.
 Cell mass is recognizable histologically, intracellular
details lost.
Liquefactive necrosis
 Degradation of tissue
 The entire cell outline is lost
 The liquefied area is surrounded by dense zone of PMNL
(dead or drying), chronic inflammatory cells.

26. Symptoms:
Discoloration of teeth-Greyish or brownish discoloration.
No painful symptoms.
Partial necrosis responds to thermal changes.
Diagnosis:
• Radiograph shows thickening of periodontal ligament.
• Necrosed pulp does not respond to thermal test
Treatment:
• Endodontic treatment

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