Pulpitis refers to inflammation of the dental pulp within a tooth. It is usually caused by bacterial infection from dental caries, tooth fractures, chemical or thermal irritants, or traumatic exposure. There are two main types - reversible pulpitis, which causes temporary pain that resolves on its own, and irreversible pulpitis, which leads to permanent pulp necrosis if left untreated. Symptoms include tooth pain exacerbated by hot or cold that may become constant in irreversible pulpitis. Histopathological examination shows varying degrees of inflammatory cell infiltration and destruction depending on the severity and duration of the insult. Treatment involves root canals or extractions to remove non-vital pulp tissue.

1. Groap 2

2. Outline
• Definition.
• Causes.
• Types.
• Pulpitis - Histopathology.
• References.

3. Definition
• Pulpitis refers to the
inflammation of the dental
pulp within the tooth.
• The pulp contains:
– the blood vessels.
– the nerves.
– connective tissue inside a
tooth, provides nutrients.

4. Causes
Inflammation of the dental pulp, usually due
to:
 Bacterial infection in dental caries.
 Tooth fracture.
 Chemical irritants.
 Thermal factors.
 Traumatic exposure.
Any condition that cause exposure of the
tooth pulp.

5. Types
Once the pulp has become inflamed the tooth
can be diagnostically divided into two
categories:
1. Reversible pulpitis.
2. Irreversible pulpitis.
A. Pulp Necrosis.
B. Acute Pulpitis.
C. Chronic inflammation

6. Reversible Pulpitis (pulp hyperemia).
• A common condition affecting a tooth
accompanied by short-lived pain following
application of heat or cold; the pulp usually
recovers.
• It does not have to be treated as it will heal on
its own over time.

7. Irreversible Pulpitis: Pulp Necrosis
• A general term referring to
a dead pulp (one that does
not respond to standard
pulp tests); pulp death may
have been preceded by
acute or chronic
inflammation.

8. Irreversible Pulpitis: Acute Pulpitis
• A common condition affecting a tooth
accompanied by severe, relentless pain; the
acute inflammation associated with it
invariably causes pulp death requiring pulp
extirpation or extraction.

9. Irreversible Pulpitis: Chronic Pulpitis
• A common condition affecting a tooth
accompanied by dull, bearable pain; the
chronic inflammation associated with it
usually causes pulp death requiring pulp
extirpation or tooth extraction.

10. Symptoms and Signs
Acute pulpitis is usually associated
with:
 severe tooth pain.
The tooth becomes sensitive to hot or
cold foots and pressure, such as might
occur with chewing.
Acute reversible: sensitive to cold.
Acute irreversible: sensitive to hot &
cold.
Swelling.

11. Pulpitis - Histopathology
Poor correlation between microscopic changes & clinical
symptoms.
Inflammatory process may be modified by several factors :
1 : Nature, severity and duration of insult.
2 : Efficiency of host defenses.
3 : Efficiency of pulpo-dentinal complex defenses.
4 : Special anatomy of pulp: surrounded by hard tissue and
cannot tolerate edema.

12. Pulpitis - Histopathology
• Immune reactions in inflamed tissue may
contribute to tissue damage.
• Rate of progression of pulpitis is variable, but
end result of untreated pulpitis is total
necrosis except in the case of pulp polyp
formation.

13. Closed pulpitis:
whether acute or chronic, may
progress to necrosis due to limited
ability of pulp to withstand
inflammatory edema since it is
surrounded by hard tissues.

14. Closed pulpitis (general feature) :
• First type Acute closed pulpitis :
- Initiation of hyperaemia.
- Infiltration by inflammatory cells & destruction of adjacent
odonoblast.
- Formation of a little abscess.
- Pulp is obliterated by dilated BV & acute inflammatory cells.
• Second type Chronic closed pulpitis :
- main feature are a predominantly mononuclear cells.
- More vigorous connective tissue reaction.
- Small necrosis area + pus formation (granulation tissue)
- little abscess may form.

15. Open pulpitis or chronic hyperplastic
pulpitis (pulp polyp):
• Pulp is survive but large carious cavities.
• Young molar teeth with wide apices and good
blood supply.
• Usually devoid of sensation on gentle probing.
• Polyp consists of chronically inflamed
hyperplastic granulation tissue protruding from
pulp cavity.

16. Open pulpitis or chronic hyperplastic
pulpitis (pulp polyp):
• May become epithelialized by spontaneous
grafting of desquamated oral epithelial cells
from saliva.
• Histologically, odontoblasts survive & the pulp
is replaced by granulation tissue.

17. Treatment
 1-Drilling and filling for reversible pulpitis
 2-Root canal and crown for irreversible pulpitis
 3-or extraction
Causes of endodontic treatment failure:
 Presence of infected and necrotic pulp tissue in root
canal. (main cause)
 Over or incompletely filled teeth
 Excessive hemorrhage
 Chemical irritants (Hypersensitivity to the materials
used)

19. References
• Burket's Oral Medicine:
Diagnosis and Treatment.
• www.medicinenet.com
• www.ada.org
• Regazi , Oral Pathology.
• Mosby, Dental drug reference.