Pulpitis refers to inflammation of the dental pulp and can be acute or chronic. Acute pulpitis is reversible or irreversible, with irreversible pulpitis involving more severe pain. Chronic pulpitis presents with dull, continuous pain. Complications of pulpitis include periapical periodontitis, periapical abscess, periapical granuloma, and radicular cyst formation. Left untreated, pulpitis and its complications can spread and cause cellulitis or other severe infections.

1. Vivek Narayan
Oral Medicine and Radiology

2. 
It is a microbial disease of the calcified tissues
of the tooth (enamel & dentin), characterized
by the demineralization of the inorganic
components and the dissolution of the organic
components of the tooth.
Dental caries

4. 
Pulpitis is defined as the inflammation of the dental pulp
Pulpitis ???
PULPITIS
ACUTE
REVERSIBLE
IRREVERSIBLE
CHRONIC
CHRONIC
HYPERPLASTIC
PULPITIS

5. PULPITIS
Mechanical
Thermal
Chemical
Microbial
Etiology

6. 
Clinical features
 Shorter duration.
 Sensitivity to cold temperatures.
 Mild or moderate pain.
 Pain is relieved on removal of the stimulus.
 Tests positive for EPT at low current.
 Minimal inflammation.
Treatment
 Removal of the irritant.
 Removal of caries and restoration of the tooth.
 Replacement of any defective fillings.
 Analgesics and anti-inflammatories for the pain.
Acute pulpitis – Reversible pulpitis

7. 
Clinical features
 Shorter duration.
 Pain is severe & spontaneous sometimes.
 Pain aggravated by extremes of temperature.
 Pain is not relieved even after removal of the stimulus.
 Radiating pain.
 Pain is also aggravated in supine position – ‘nocturnal pain’.
 Severe inflammation.
Treatment
 Same as reversible pulpitis.
Acute pulpitis – Irreversible
pulpitis

8. 
Clinical features
 Symptoms are milder than the acute form.
 Pain is dull & continuous in nature.
 EPT threshold is increased.
 Presence of a large carious lesion majority of the
time.
Treatment
 Root canal therapy.
 Extraction.
Chronic pulpitis

10. 
Excessive & exuberant
proliferation of the dental pulp as
a result of chronic inflammation.
Clinical features
 Occurs mostly in children &
young adults.
 Large carious lesions.
 Appears as pinkish red mass
protruding out of the carious
tooth.
 May or may not bleed when
probed.
 Deciduous & first permanent
molars are frequently affected.
Treatment
 Extraction of the affected teeth.
Chronic hyperplastic pulpitis
(pulp polyp)

12. 
Spread of infection to the apical
periodontal ligament region.
Clinical features
 Acute or chronic.
 Mild pain while chewing.
 Pain on percussion and on periapical
palpation.
 Tooth feels slightly elevated due to
inflammation & edema in the apical
region.
Radiographic features
 Loss of lamina dura in the periapical
region.
 Widened periodontal ligament space.
Treatment
 Endodontic treatment.
Periapical periodontitis

13. It is a localized mass of granulation
tissue formed at the apex.
Clinical features
 Asymptomatic.
 Mild pain present.
 Pain present while chewing.
 Tooth is elevated from the socket.
Radiographic features
 Radiolucent area present attached
to the tooth apex.
 Well circumscribed & demarcated
from the surrounding bone.
Treatment
 Extraction of the affected tooth.
 Apicectomy in some cases.
Periapical granuloma

14. Acute or chronic suppurative process of the periapical
region of the tooth.
Clinical features
 Carious or a discolored tooth.
 Tooth is very painful & is extruded from the socket.
 Regional lymphadenitis & fever.
 Chronic form generally presents with no features.
 Sinus tract openings.
Radiographic features
 Ill defined periapical radiolucency.
Treatment
 Drainage of pus.
 Extraction of the affected tooth.
 Endodontic treatment done sometimes.
Periapical abscess

15. ABSCESS
Organism - staphylococcus
Coagulase secretion
Fibrinogen (from exudate) Fibrin
Fibrin barrier
Localization of pus
SPREADING INFECTION
Organism - streptococcus
Streptokinase & hyaluronidase
secretion
Breakdown of hyaluronic acid
(cement substance)
Streptococci consumes local O₂
creates anaerobic environment
Growth of anaerobes -
collagenase
Perforation of bone
Spread of infection

16.  Infection gone beyond the alveolar
bone & involves the neighbouring
soft tissues as a localized form.
 Pain is continuous and may be
described as extreme, growing,
sharp, shooting, or throbbing in
nature.
 Acute onset.
 Localized intraoral & extraoral
swelling.
 Trismus.
 Lymphadenitis.
 Pyrexia.
Dentoalveolar abscess

17. 
Cellulitis
Spread of infection diffusely into fascial planes of soft
tissues.
Cellulitis
Ludwig’s angina
Cavernous sinus
thrombosis

18. 
Clinical features
 Edematous periorbital
enlargement.
 Canine space is infected.
 Ptosis.
 Induration of the swelling.
 Fever, headache, nausea.
 CNS spread leads to meningitis.
Treatment
 Surgical drainage.
 High dose antibiotics.
 Extraction of affected tooth.
 Anticoagulants.
Continued…

19. Clinical features
 Chronic in nature & asymptomatic.
 Mostly associated with a non vital tooth.
 Swelling is present if the cyst expands by destroying bone.
 Initially swelling is bony hard but later exhibits ‘egg shell’ crackling.
 Due to acute exacerbation, the cyst can turn into an abscess.
Radiographic features
 Well circumscribed radiolucency in the periapical region.
 Radiolucency surrounded by sclerotic border.
 Radiolucency is bigger than that of a periapical granuloma.
 Root resorption.
Treatment
 Extraction of the affected tooth.
 Endodontic therapy.
 Marsupialization.
Periapical cyst (radicular cyst)

20. Caries in enamel
Caries in dentin
Caries in pulp - pulpitis
Acute pulpitis Chronic pulpitis
Acute periapical
periodontitis
Chronic periapical
periodontitis
Chronic periapical
abscess
Acute periapical
abscess
Dentoalveolar abscess
Periapical granuloma
Radicular cystCellulitis
Sequel
Of
Pulpitis