The document outlines pulpitis, which is the inflammation of dental pulp that can be acute or chronic and can lead to severe complications if untreated. It describes the causes, classifications, sequelae, diagnosis methods, and treatment options for pulpitis, highlighting the importance of managing both reversible and irreversible cases. Key symptoms and diagnostic approaches include pain comparison, radiographic findings, and vitality tests, with specific treatment strategies for different stages of pulpitis.

1. NAME:RIFAT ALAM
ROLL:19
GROUP:B
Pulpitis
1.Define pulpitis.(Ru-Aug12)
PULPITIS: An inflammation of the pulpal tissue that may be acute or chronic, with or without symptoms, and
reversible or irreversible. (Ref. Contemporary oral and maxillofacial pathology) or
Pulpitis medical symtoms in which dental pulp becomes inflamed . (lecture )
2.Enumerate the causes of pulpitis.(Ru-Aug12,Feb-10)
Causes of pulpitis:-
BACTERIAL
Caries
Cracks in crown
Periodontal pockets
Malformed teeth
TRAUMATIC
Crown fractures
Root fractures
Partial avulsion
Bruxism
Abrasion
IATROGENIC
Heat generation
Depth of preparation
Dehydration of tubules
Pulp exposure
Volatile/toxic disinfectants
Filling materials
Thermul iniury. Severethermal stimuli can be transmitted
through large uninsulated metallic restorations
or may occur from such dental procedures as
cavity preparation, polishing and exothermic
chemical reactions of dental materials.
Chemical irritation. Chemical-related damage can
arise from erosion or from the inappropriate use of
acidic dental materials. (Ref.Contemporary oral and maxillofacial pathology) (Oral and maxillofacial
pathology,Naville)
3.Write down the sequele of pulpitis. (Ru-Feb-10,12)
Sequele of pulpitis
pulpitis---untreated---death of pulp---spread of infection through apical foramina into
periapical tissue---periapical periodontitis. ( Ref.Cawson's essentials of oral pathology and oral medicine)
Infectious sequelae of pulpitis include apical periodontitis, periapical abscess, cellulitis, and osteomyelitis of

2. the jaw. Spread from maxillary teeth may cause purulent sinusitis, meningitis, brain abscess, orbital cellulitis,
and cavernous sinus thrombosis. Spread from mandibular teeth may cause Ludwig angina, parapharyngeal
abscess, mediastinitis, pericarditis, empyema, and jugular thrombophlebitis.
4.Classification of pulpitis.
a)Based on severity of inflammation:- 1.Reversible Pulpitis 2. Irreversible Pulpitis 3.Pulp Degeneration
4.Pulp Necrosis .
b)According to involvement :- 1.Focal or Subtotal or Partial Pulpitis 2.Total or Generalized Pulpitis.
c)According to severity :- 1.Acute Pulpitis 2.Chronic Pulpitis .
d)According to presence or absence of direct communication between pulp and oral environment : 1.Pulpitis
Aperts (open pulpitis) 2.Pulpitis Clausa ( closed pulpitis).
Nice to know:-
Mechanism of pulpitis : Pulpitis is the name given to any inflammation of the pulp regardless of the presence of an
infectious agent. Because the pulp is contained within a solid unyielding chamber with an limited blood supply through
the apical foramen and no collateral support, the inflammatory process that is so beneficial in the healing process in
other parts of the body often becomes a mechanism of destruction in this confined location.
Inflammation is by nature an expansile process consisting of dilation of blood vessels, leakage of fluids from blood
vessels into the surrounding connective tissue, and migration of cells into the immediate area.The active
dilation of the arterioles leads to increased pulpal pressure and secondary compression of the venous
return, which can lead to strangulation of the arterial inflow. The increased pulpal pressures,combined
with the accumulation of mediators, can lead to vessel damage, pulpal inflammation. and tissue necrosis.
Severe localized pulpal damage can spread progressively to involve the more apical portion of the pulp.
5.Diagnosis of pulpitis (Du-Feb 12,13) (Ru-Aug 10)
a) Pain:
Comparison of Pain Symptoms in Reversible
and Irreversible Pulpitis
REVERSIBLE IRREVERSIBLE
Elicited Spontaneous
Sharp Dull
<20 minutes’ duration >20 minutes’ duration
Unaffected by body position Affected by body position
Easily localized Often difficult to localize.
Comparison of pain symptoms in acute and chronic pulpitis
ACUTE CHRONIC
severe,sharp,stabbing in character . dull in character if present.
stabbing pain due to thermal changes reaction to thermal changes also reduces
start spontaneously,when patient is pain is absent and have any relation with the position of pt.
trying to get sleep.
Pain is absent in total necrosis.
spontaneous pain, or diffuse nature of pain resembling trigeminal neuralgia.

3. b) Radiographic findings:-
Reversible pulpitis:- Normal.
Irreversible pulpitis:- Depth and extent of caries lesion may be evident, normal PDL but slight widening may
be seen in advanced stages.
Acute pulpitis:- Tooth with large cariuos lesion.
Chronic pulpitis:- chronic apical periodontitis in long standing cases.Condensing osteitis, low grade long
standing irritation stimulates periapical bone deposition.
Pulp necrosis:- Large cavity or filling or normal appearance unless there is concomitant apical peridontitis or
condensing ostitis.
Pulp degeneration:-
c) Vitality Test:-
Reversible pulpitis:- Tooth responds to electric pulp testing at lower current. Pain brought on by cold than
hot food or beverages and by cold air.
Irreversible pulpitis:- Heat intensifies the response and cold tend to relieve the pain and electric test requires
less current to cause pain but more current is required when the tissue becomes more necrotic.
Acute pulpitis:-Tooth reacts to electric pulp vitality tester at a lower level of current than adjacent normal
teeth.pain persists even after thermal stimulus disappears or been removed.
Chronic pulpitis:-Usually not responding to thermal test unless extreme cold is used. more current is
required in electric pulp testing .
Pulp necrosis:- Single rooted= not responding
multi rooted=mixed response
in liquefaction necrosis , electric test is positive when current is conducted through moisture present in a
root canal.
d) Visual examination:-
Pulp necrosis:- show discoloration of tooth.
Chronic hyperplastic pulpitis:- fleshy reddish pulpal mass filling most of pulp chamber or cavity or even
beyond confines of tooth.
6. Treatment or Management of pulpitis.
Reversible pulpitis: a) prevention b)periodic care c)remove the irritant d) dental filling apply.
Irreversible pulpitis: a)pulpectomy b)placement of intracanal medicament c) to act as disinfectant or
obtundent like cresatin,eugenol,formoeresol.
Acute pulpitis:- a)removal of coronal pulp b)placing materials that favors calcification such as calcium
hydroxide over entrance of root canals. c)root canal filling with inert material like gutta percha should be
done.
Chronic pulpitis:- a)root canal treatment b)extraction
Chronic hyperplastic pulpitis:- a) elimination of polypoid tissue b)followed by extirpation of pulp c) extraction
Pulp necrosis:- a) root canal treatment b) extraction
FIGURES RELATED TO THIS TOPIC:-

4. Acute pulpitis. Tooth exhibiting a focal area of intrapulpal
hemorrhage and acute pulpitis resulting from overheating during
crown preparation
Chronic pulpitis.

5. Chronic pulpitis
Pulpal necrosis. Darkened central incisor caused by penetration
of the tissue remnants of nonvital pulp into the dentin
tubules. The small nodule on the gingiva above the tooth
(parulis) is the surface opening of a drainage tract from a periapical
abscess.

6. Hyperplastic pulpitis. A, Clinical appearance of pulp polyp in a grossly carious right
mandibular first molar
Microscopic appearance of grossly carious tooth and fibrotic pulp
polyp with a stratified squamous epithelium on the surface.
ALL THE INFORMATION ARE COLLECTED FROM LECTURE AND TEXTBOOKS AND ALSO FROM NET.

7. Hyperplastic pulpitis. A, Clinical appearance of pulp polyp in a grossly carious right
mandibular first molar
Microscopic appearance of grossly carious tooth and fibrotic pulp
polyp with a stratified squamous epithelium on the surface.
ALL THE INFORMATION ARE COLLECTED FROM LECTURE AND TEXTBOOKS AND ALSO FROM NET.