Normal Pulp

Reversible Pulpitis
Symptomatic Irreversible Pulpitis
Asymptomatic Irreversible Pulpitis
Pulp Necrosis
Previously Treated
Previously Initiated Therapy
DESCRIPTION
• Clinically symptom free and no radiographic signs of pathosis

VITALITY TESTING
• Normal Response (2 to 3s)

TREATMENT
•☺
DEFINITION
• A clinical condition associated with subjective and objective
findings indicating presence of mild inflammation in the
pulp tissue

• If the cause is eliminated, inflammation will reverse and the

pulp will return to it normal state
CAUSES
• Mild or short-acting stimuli such as incipient caries, cervical
erosion, or occlusal attrition
• Most operative procedures
• Deep periodontal curettage
• Enamel fractures resulting in exposure of dentinal tubule
SYMPTOMS
• Usually asymptomatic
• If present, symptoms follow a pattern
 Application of stimuli, such as cold, hot, or air,
may produce sharp, transient pain
 Removal of these stimuli results in immediate
relief
SYMPTOMS: COLD vs HOT
• When heat is applied = pain is delayed
Intensity of pain increases as the temperature rises

• When cold is applied = pain is immediate!

 Intensity tends to decrease if the cold stimulus is
maintained
TREATMENT
• Removal of irritants
• Sealing and insulating the exposed dentin or vital pulp

 Results in reversal of the inflammatory process

CLASSIFICATION:

1. Symptomatic

2. Asymptomatic
DEFINITION
• Clinical condition associated with subjective and objective
findings indicating the presence of severe inflammation in
the pulp tissue

• Sequel to and a progression from reversible pulpitis

DEFINITION
• This will not resolve even if the cause is removed!

• The pulp is incapable of healing and slowly or rapidly

becomes necrotic
DEFINITION

• Can be symptomatic with spontaneous and lingering

pain

• Can be asymptomatic with no clinical signs and

symptoms
CAUSES
• Sequela to Reversible pulpitis

• Severe pulpal damage from extensive dentin removal during

operative procedures

• Impairment of pulpal blood flow as a result of trauma or

orthodontic movement of teeth
SYMPTOMS

• May be associated with intermittent or continuous episodes of

spontaneous pain  with no external stimuli
(unprovoked/spontaneous)

• Pain may be sharp, dull, localized, or diffuse and can last anywhere
from a few minutes up to a few hours

• Localization of pulpal pain is more difficult then localization of

periradicular pain
DIAGNOSTIC TESTS
• Application of external stimuli (cold/heat) may result in
prolonged pain

• Heat  immediate response

DIAGNOSTIC TESTS

• If inflammation is confined to the pulp and has not

extended periapically, teeth respond within normal
limits to palpation and percussion
TREATMENT

• Root Canal Treatment

• Extraction
DEFINITION
• Also known as pulp polyp

• Is a form of irreversible pulpitis that originates from overgrowth of

a chronically inflamed young pulp onto the occlusal surface

• Usually found in carious crowns of young patients

HISTOLOGIC EXAMINATION

• Shows surface epithelium overlying the inflamed connective tissue

Ample vascularity of the young
pulp, adequate exposure for
drainage, and tissue proliferation
are associated with the formation
of hyperplastic pulpitis
SYMPTOMS
• Usually asymptomatic
• Appears as a reddish cauliflower-like outgrowth of connective tissue
into caries that has resulted in a large occlusal exposure
• Occasionally, associated with clinical signs of irreversible pulpitis, such
as spontaneous pain, as well as lingering pain to cold and heat stimuli
DIAGNOSTIC TESTS

• Respond within normal limits when palpated or

percussed
TREATMENT

• Pulpotomy
• Root Canal Treatment
• Extraction
DEFINITION

• Irreversible pulpitis leads to liquefaction necrosis

• If exudate produced during irreversible pulpitis is absorbed or drains

through caries or through a pulp exposure into the oral cavity,
necrosis is delayed; the radicular pulp may remain vital for long
periods of time
DEFINITION

• Closure or sealing of an inflamed pulp induces rapid and total pulpal

necrosis and periradicular pathosis

• Ischemic necrosis of the pulp occurs as a result of traumatic injury

from disruption of the blood supply

• Is a clinical condition associated with subjective and objective findings

indicated death of the dental pulp
SYMPTOMS
• Is usually asymptomatic

• May be associated with episodes of spontaneous pain and

discomfort or pain (from periradicular tissues) on
pressure
SYMPTOMS
• Pain provoked with application of heat is not due to an
increase in intrapulpal pressure as is with vital pulps

• It is commonly believed (but not proven) that applying heat

to teeth with liquefaction necrosis causes thermal expansion
of gases present in the root canal space, which provokes pain
DIAGNOSTIC TESTS

• cold, heat, or electrical stimuli should produce no

response
DIAGNOSTIC TESTS

• Presence of various degrees of inflammatory response ranging from

reversible pulpitis to necrosis in teeth with multiple canals is possible
and may occasionally cause confusion during testing for
responsiveness
• Because of the spread of inflammatory reactions to periradicular
tissues, teeth are often sensitive to percussion
• Sensitivity to palpation is an additional indication of periradicular
involvement
TREATMENT
• Root canal Treatment
• Extraction
DEFINITION
• The tooth has had partial endodontic therapy

• Teeth in this category can be symptomatic or asymptomatic,

depending on pulpal and periapical conditions
TREATMENT
• Completion of partial root canal treatment
• Extraction
DEFINITION
• The tooth has had complete endodontic therapy

• Teeth in this category can be symptomatic or asymptomatic,

depending on pulpal and periapical conditions
TREATMENT
• Retreatment
• Surgical Endodontic Treatment
• Extraction
 Normal

Reversible Pulpitis
asymptomatic
symptomatic
Irreversible Pulpitis

Necrotic Pulp!
