This document discusses different types of pulpitis and periapical inflammation. It defines pulpitis as inflammation of the dental pulp that can be acute or chronic. Acute pulpitis is further divided into reversible and irreversible types based on whether the inflammation is localized or involves the entire pulp. Chronic pulpitis can be closed or open (hyperplastic). Periapical inflammation ranges from granulomas and cysts to abscesses. Diagnosis involves x-rays and pulp testing to evaluate the pulp chamber and periapical region. Treatment depends on the specific condition but may include removal of irritants, root canals, drainage or extraction.

1. Inflammatory Jaw
lesions I
Aiman A. Ali, DDS, PhD.

2. Pulpitis
Definition:
Inflammation of the dental
pulp, which can be acute or
chronic.
Aiman A. Ali, DDS, PhD.

3. Etiology
 Dental
Caries.
 Traumatic exposure.
 Fracture of the crown.
 Thermal changes.
 Chemical irritation.
 Cracked tooth syndrome.
Aiman A. Ali, DDS, PhD.

4. Types of pulpitis
Acute
Chronic
 Reversible.
 Closed.
 Irreversible.
 Opened (Hyperplastic)
Aiman A. Ali, DDS, PhD.

5. Acute Reversible Pulpitis
Etiology:
Dental Caries.
 Cavity preparation.
 Thermal changes in large
metallic fillings.

Aiman A. Ali, DDS, PhD.

6. Acute Reversible Pulpitis
Clinical
Features:
Pain: mild to moderate and
stimulated.
 The etiological factor is obvious.

Aiman A. Ali, DDS, PhD.

7. Acute Reversible Pulpitis

Histopathological Features:




Pulp hyperemia (dilatation of blood vessels).
Exudation.
Inflammatory cell infiltration (neutrophils).
Reactions usually remain localized adjacent to
the cause.
Aiman A. Ali, DDS, PhD.

8. Acute Reversible Pulpitis
Treatment:
cause.
Remove the
Aiman A. Ali, DDS, PhD.

10. Acute Irreversible Pulpitis
Etiology:
Acute Dental Caries.
 Pulp exposure.
 Sever Irritation.

Aiman A. Ali, DDS, PhD.

11. Acute Irreversible Pulpitis
Clinical
Features:
Pain: Sever, spontaneous and
continuous.
 Little response to simple
analgesics.
 Pain increase when patient lies down.
The etiological factor is obvious.

Aiman A. Ali, DDS, PhD.

12. Acute Irreversible Pulpitis
 Histopathological






Features:
Inflammation involves the whole dental pulp.
Vascular dilatation and edema.
Inflammatory [granular cell] infiltration.
Odontoblasts near to the cause are destroyed.
Formation of a minute pulp abscess.
In a few days pulp undergoes liquefaction
and necrosis.
Aiman A. Ali, DDS, PhD.

13. Acute Irreversible Pulpitis
Treatment:
RCT.
Aiman A. Ali, DDS, PhD.

14. Aiman A. Ali, DDS, PhD.

15. Chronic Pulpitis
Etiology:
Previous acute pulpitis.
 Chronic Dental Caries.

Aiman A. Ali, DDS, PhD.

16. Chronic Pulpitis
 Clinical



Features:
Pain: absent or mild to moderate, dull
ache and intermittent.
Reaction to thermal changes is reduced
in comparison to acute pulpitis.
The etiological factor is obvious.
Aiman A. Ali, DDS, PhD.

17. Chronic Pulpitis
 Histopathological
Features:
Mononuclear inflammatory cell
infiltration.
 Evidence of fibroblastic activity.
 Minute abscess if exist it is localized
by granulation tissue.

Aiman A. Ali, DDS, PhD.

18. Chronic Pulpitis
Treatment:
RCT.
Aiman A. Ali, DDS, PhD.

19. Aiman A. Ali, DDS, PhD.

20. Chronic Hyperplastic Pulpitis
Pulp Polyp
Etiology:
Opened cavity.
 Starts as chronic or acute.
 Wide apical foramen [Children].

Aiman A. Ali, DDS, PhD.

21. Chronic Hyperplastic Pulpitis
Pulp Polyp
Clinical
Features:
Red pinkish soft nodule protruding into the
cavity.
 Almost in children and young adults.
 Relatively insensitive to manipulation.
 Most common in deciduous molars.
 Must be differentiate from gingival polyp.

Aiman A. Ali, DDS, PhD.

23. Chronic Hyperplastic Pulpitis
Pulp Polyp
 Histopathological
Features:
 The



polyp consists of granulation tissue.
It contains delicate connective tissue, fibers
and blood vessels.
Mononuclear inflammatory cell infiltration.
The polyp is covered with SS epithelium.
Aiman A. Ali, DDS, PhD.

24. Chronic Hyperplastic Pulpitis
Pulp Polyp
 Treatment:
RCT or extraction of the tooth.
Aiman A. Ali, DDS, PhD.

25. Periapical inflammation
Periapical
abscess
Periapical
Granuloma
Chronic abscess or
osteomyelitis
Cellulitis
Skin or mucosal sinus
Bacteremia
Periapical
Cyst

26. Acute Abscess
Etiology:
Acute pulpitis.
 Chronic periapical lesions.

Aiman A. Ali, DDS, PhD.

27. Acute Abscess
Clinical
Features:
Pain: sever and increases with percussion.
 Non-vital tooth.
 The tooth is slightly extruded in its socket.
 Fever and malaise and regional lymphadenitis.
 Osteomyelitis and swollen of the adjacent area.

Aiman A. Ali, DDS, PhD.

28. Acute Abscess
 Histopathological

Features:
Zone of liquefaction composed of:
• Exudates.
• Necrotic tissue.
• Dead neutrophils.
Dilated blood vessels.
 Inflammatory [granular cell]
infiltration.

Aiman A. Ali, DDS, PhD.

29. Acute Abscess
Treatment:
Drainage.
 Administration of antibiotics.
 Supportive treatment.

Aiman A. Ali, DDS, PhD.

30. Aiman A. Ali, DDS, PhD.

31. Aiman A. Ali, DDS, PhD.

36. X-Ray
Pulpitis:
Evaluation of the pulp
champer.
 Evaluation of the periapical
region.

Acute
abscess:
Thickening
of periodontal
membrane.
 Loss of the lamina dura.
Aiman A. Ali, DDS, PhD.

37. Electrical Pulp Tester




Acute reversible pulpitis.
Acute irreversible pulpitis.
Chronic pulpitis.
Acute abscess.
Aiman A. Ali, DDS, PhD.