Pathology

1. Dr. Kadija Bamashmoos

2. introduction
Dental pulpitis:
It means inflammation of dental pulp.

3. causes
The causes of pulpal diseases are:: physical, chemical
and bacterial
1.Physical:
A.Mechanical:
I. Trauma:
II. accidental (contact sports)
III. iatrogenic dental procedures

4. 2. Pathologic wear
3. Cracked tooth syndrome

5. B. Thermal:
a. Heat from cavity preparation
b. Exothermic heat from the setting of cement
c. Conduction of heat and cold through deep fillings
without a protective base
d. Frictional heat produced by polishing a restoration.

6. C. Electrical
galvanic current from dissimilar metallic fillings

7. II. Chemical:
1. Phosphoric acid , acrylic monomer etc
2. Erosion (acids)
III. Bacterial:
Direct invasion of dental caries to the pulp.

8. Physical causes
- Mechanical injuries
- TRAUMA
- More in children
- Due to violent blow to the tooth during a fight ,
sports, accident , habits (opening bobby pins with
teeth and nail biting )

9. - Pathologic wear
The pulp may also be exposed or partially exposed
by pathologic wear of teeth from either abrasion or
attrition or compulsive bruxism

10. Cracked tooth syndrom
• Incomplete fracture through the body of the tooth
• Patient complaints of pain ranging from mild to
excruciating on biting

11. • Close examination of the crown of the tooth may
disclose an enamel crack, which maybe better
visualized using a dye or by transilluminating the
tooth with a fiber optic light .
• The pulp may become necrotic.

12. Thermal injuries
- Heat from cavity preparation
- High speed engines and carbide burs reduce
operating time, but they may also accelerate pulp
necrosis if used without a coolant.
- The heat generated may be sufficient to cause
irreparable pulp damage.

13. - Heat conduction by fillings
- Metallic fillings close to the pulp without an
intermediate cement base may conduct
temperature changes rapidly to the pulp and may
cause irreversible changes.
- Remaining dentin thickness (RDT) under the
restoration should be between 1.1 and 1.5 mm to
protect the pulp

15. - Frictional force during polishing
1. Enough heat may also be generated during
polishing of the filling or during setting of the
cement to cause at least transient pulp injury.
2. These injuries are usually reversible in nature.

17. Chemical causes
- Earlier , the presence of arsenic in silicate cement
powder and the use of a desensitizing paste
containing paraformaldehyde accounted for many
pulp deaths
- To protect the pulp : use calcium hydroxide bases
in deep cavities and calcium hydroxide liners in
shallow cavities.

18. Bacterial causes
- MILLER in 1894 suggested that bacteria were the
most common cause of inflammation in the pulp

19. classification
Diseases of the pulp by grossman
Reversible pulpitis
Irreversible pulpitis
a) acute
1)Abnormally responsive to cold
2)Abnormally responsive to heat
b) Chronic
1)Asymptomatic with pulp exposure
2)Hyper plastic pulpitis
pulpitis
pulp necrosis

20. Reversible pulpitis
- DEFINITION :
Reversible pulpitis denotes a level of pulpal
inflammation in which the tissue is capable of
returning to a normal state of health if the noxious
stimuli are removed.

21. - Clinical features:
• Sharp pain lasting from 5- 15 minutes.
• Brought on by cold stimuli
• Does not occur when stimuli is removed
• It does not occur spontaneously.

22. - HISTOPATHOLOGY:
• Dilated blood vessels
•odontoblasts layer is an intact.

23. - TREATMENT:
It require either direct or indirect pulp capping.

24. Irreversible pulpitis
- DEFINITION:
The pulp has damaged beyond repair and even with
removal of irritant it will not be healed. It is a
persistent inflammatory condition of the pulp.

25. - Divided into :
1) ACUTE
2) CHRONIC

27. 1) Acute pulpitis:
It is that form of pulpitis which rapidly develops
from reversible pulpitis if the invading
microorganisms are sufficiently virulent .

28. - Clinical features:
- Pain continues after removal of the cause.
- Sharp, piercing ,or shooting.
- Change of position ;bending over or lying down
exacerbates the pain
- History of night pain
- Pain referred to adjacent teeth ; to the sinuses when an
upper posterior tooth is involved and to the ear when a
lower posterior tooth is affected

29. - HISTOPATHOLOGY:
a. Degeneration of odontoblasts nuclei.
b. Dilatation and congestion of blood vessels.
c. Infiltration of large numbers of neutrophils into
the surrounding tissue.

30. - TREATMENT:
• RCT (root canal treatment).

31. 2. Chronic pulpitis:
It is that form of pulpitis which develops from acute
pulpitis if the irritant of low virulence.

32. Clinical features:
a. Dull intermittent pain.
b. The pain decreases with temperature changes.

33. Histopathological features:
a. Fibroblastic activity.
b. Formation of small abscesses.
c. Infiltration of large numbers of chronic
inflammatory cells such as lymphocytes and
plasma cells into the surrounding tissue.

34. Treatment :
Root canal treatment

35. Chronic hyper plastic pulpitis –
pulp polyp
- It is that form of chronic pulpitis in which the pulp
tissue is opening to the oral cavity associated with
polyp.

36. Clinical features:
a. It appears as a pinkish globlar mass protruding from
the pulp champer and often filling he entire cavity.
b. It is usually seen in children and young adult.
c. It is usually effects deciduous molars and the first
permanent molars.
d. It is usually painless.
e. It may bleed easily.

37. -
- HISTOPATHOLOGY:
It appears as a granulation tissue consists of collagen
fibers, fibroblasts, chronic inflammatory cell
infiltration and blood vessels.

38. - TREATMENT:
Removal of the pulp polyp with root canal
treatment.

39. Necrosis of the pulp
- Necrosis is the death of the pulp due to untreated
pulpitis.
- It can be partial or total.

40. Clinical features:
a. It is asymptomatic.
b. It may cause discolored tooth due to degeneration
of dentinal tubules caused by death of the pulp.

42. Histopathological features:
It shows either an empty pulp champers and canal or an
isolated empty areas.
Treatment:
Root canal treatment.