This document discusses dental pulp inflammation. It defines dental pulp as the soft tissue within the tooth surrounded by dentin. The pulp has different zones including an odontoblastic zone, cell-free zone, cell-rich zone, and central zone containing various cells, blood vessels, and nerves. The pulp functions to induce dentin formation, provide nutrition, defend against trauma, and allow sensation. Causes of pulpitis include mechanical, thermal, chemical, and bacterial factors. Pulpitis is classified as reversible or irreversible, partial or total, acute or chronic, and open or closed based on severity and communication with the oral environment. Symptoms, clinical features, management, and types of chronic pulpitis are described.

1. PULP INFLAMMATION
By / Ahmed Elgamal

2. DEFINITION
 Dental pulp is the soft CT of the tooth that supports
and surrounded by dentin

3. DENTAL PULP ZONES
The odontoblastic zone
Consists of :
 Cell body
 Odontoblastic process
which extend into predentin matrix
The cell free zone
Contain :
 Blood capillaries
 very small nerve fibers
Function ?!!
The cell rich zone
Contain :
 Blood vessels & nerves
The central zone
Contains :
 Cells embedded in collagen matrix
 Blood vessels
 Lymphatics
 Nerves
Ahmed Elgamal

4. FUNCTION OF DENTAL PULP
Induction
Pulp induce dentine formation which induce enamel formation
Dentin formation
Nutrition
Supplies nutrients essential for dentin via DT
Defense
 Form tertiary dentin in response to trauma
 Immunologic inflammatory reaction
Sensation
Pulp is innervated by both sensory and autonomic nerve
fibers

8. Causes of
pulpitis
mechanical
traumatic iatrogenic attrition abrasion
thermal
Metallic
R
Cavity
prep
chemical
erosion
Acidic
materials
bacterial
Open
cavity
Periapical
inf

9. CLASSIFICATION
pulpitis
involvement
involvement
partial
total
severity
acute
chronic
Communication
between pulp &
oral
environment
Open
pulpitis
Closed
pulpitis
severity
reversible irreversible Pulp
degeneration
Pulp
necrosis

10. REVERSIBLE PULPITIS
Early mild transient pulpitis Called pulp hyperemia
stimuli
- Dilatation of pulpal BV
- Collection of edematous fluid
- increase pressure inside pulp
pain

11. REVERSIBLE PULPITIS
Clinical features
 Sensitive to thermal change ( COLD )
 Sharp pain lasting for a moment
 Disappears after removal of stimuli
 No history of spontaneous pain
 No sensitivity to percussion
 teeth show :
( deep caries & large metallic R & restoration with defective margins )

12. MANAGEMENT
Diagnosis should be confirmed by a cold test
Remove the cause before the pulp is severely damaged
If the lesion is untreated , the duration of pain
upon stimulation can become IRREVERSIBLE
PULPITIS

13. IRREVERSIBLE PULPITIS
Why an inflamed pulp might be
symptomatic or asymptomatic ?

14.  Persistent inflammatory condition of pulp
 Caused by ( chemical , thermal , mechanical , bacterial )
 Pressure increases because of lack of escape of
inflammatory exudate
ACUTE PULPITIS

15. ACUTE PULPITIS
Early stage
Pain with cold and
relived by heat
Continuous &
spontaneous sever pain
even after removing
stimulus
Pain with lying down
due to change in
intrapulpal pressure
Late stage
More sever and throbbing
pain even the tooth under
constant pressure
Pt. awake at night due
to pain
pain with heat and may
relived by cold
Clinical features
 Pain may be referred
EX : lower molars referring pain to the ear

16. Why
Pt. has pain with cold in case of reversible and
early stage of irreversible pulpitis ?! but in case of
late stage has pain with hot ?!
Pt. has pain with sweets ?!
Referred pain with acute pulpitis and not
with reversible pulpitis ?!

21. CLASSIFICATION OF CHRONIC PULPITIS
Chronic closed
pulpitis
Chronic open
ulcerative
pulpitis
Chronic open
hyperplastic
pulpitis
Chronic open
pulpitis

23.  There are fibroblastic activity
 Newly formed capillaries
 Deposition of collagen fibers
( as a local protective barrier to wall the infection )
 Pulp abscess may present with granulation tissue
Chronic pulpitis

26. CHRONIC OPEN ULCERATIVE PULPITIS
 Entire or the greater part of pulp shows chronic
inflammatory changes
 The pulp is exposed to outside ( no dentine roof )
 Edema escapes through the exposure
 Minimum dull pain that become worse by thermal
changes

27. CHRONIC HYPERPLASTIC PULPITIS
 Also called pulp polyp
 Essentially an excessive exuberant proliferation of
chronically inflamed dental pulp tissue
 Development of granulation tissue
 Covered at time by epithelium
 The tooth is VITAL

28. CAUSES
 Long standing low grade infection
 extensive carious exposure of a young pulp
 Bacterial infection

29. CLINICAL FEATURES
 Most commonly involved are primary molars & 1st
permanent molar >> due to
 Excellent blood supply
 Large root opening
 Asymptomatic except of feeling of pressure during
mastication
 in children and young adults
 Tooth may or may not respond to thermal test

30.  Polypoid tissue appears
Fleshy
Reddish pulpal mass filling most of pulpal
chamber
May interferes with mouth closure
Easily bleeds ( rich blood vessels )

41. The cause of pain in case of
necrotic pulp ?!