DEPARTMENT OF ORAL

PATHOLOGY

DR. TAHERA AYUB

PULPAL DISEASES
PULPITIS
DEFINATION
It is the inflammation of the pulp .

ETIOLOGY
Bacterial
Thermal or Chemical
Barotrauma: Pressure related (Aircrue
flying high altitude unpressurized air crafts or
Divers subjected to too rapid decompression)
CLASSIFICATION
 Open or closed
 Acute or chronic
 Exudative or Suppurative
 Reversible or irreversible
 Partial or Total
TYPES OF PULPITIS
ACUTE PULPITIS
 Severe continuous sharp shooting throbing
lancination pain of short duration.
 Difficult to localize
 Precipitate by hot and cold sensation
 Recumbent position, pain is not relieved by analgesics

Pathogenesis ---------- Pain is due to pressure on nerve

ending by inflammatory infiltrate and substance
released by damage tissue
Chronic pulpitis

 Spontaneous dull aching mild pain last for 1 to 2

hours
Whether reversible or irreversible pulpitis

 @Age
 @Size of the lesion
 @Presence or absence of lesion
 @Vitality of the tooth
 @Radiographic Evidence
 @Clinical observation
HISTOPATHOLOGY

Inflammation------- Oedema-------- inc pressure in

pulp due to exudates------- Collapse of venous part
of microcirculation------ tissue hypoxia or
anoxia----------- localized necrosis-------- released
of mediators-------- further inflammation and
Oedema-------- total necrosis of the pulp
FACTORS INFLUENCE OUT COME OF
INFLAMATION
PULP VITALITY TESTS
 Cold test
a,Ice stick
b,Carbon dioxide snow
c,Ethyl chloride
d,Cold water
e,Blow of air stream
 Hot test
a,Hot gutta percha
b,Rubber wheel
c,Electric heater tip
d,Hot tap water in the syringe
 Electric pulp testing

 Laser Doppler flowmetry

 Application of local anaesthesia

 Test cavity
Treatment Options for Pulpitis
 Reversible pulpitis
Indirect pulp capping or Direct pulp capping

 Irreversible pulpitis and Necrosis

Root canal treatment
 PULP POLYP
 It is the granulation tissue that grows out of the
boundary of the pulp chamber to form pulp polyp and
such lesions are described as chronic hyperplastic
pulpitis
 Common in teeth of patient with ehleves—danlos
(Floppy Joint syndrome )

PREVALANCE
 Decidous molar
 Permanent molars with wide carious cavity and good
apical supply
TYPES

1. Epithelialized Polyp__ They are

epithelialize by spontaneous grafting of the
Oral Epithelial cells. They are firm,pinkish
white , does not bleed on probing and
devoid of sensation
2. Ulcerated pulp polyp-------- Dark red with
yellow fleck fleshy mass, bleed on probing
with no sensation .
PULP CALCIFICATION
Pulp Stone
 Calcified bodies with organic matrix common in
coronal pulp
 True pulp stone has tubule whereas false stone has
concentric layer of calcified material with no
tubular structure.
 Can be free, adherent, or interstitial when are
surrounded by secondary dentine
 They inc in size and number with age
 Can be seen on radiographs when large
 Are symptomless
 Dystrophic calcification
Pulp consist of amorphous calcific granules
which may be scattered along collagen fiber
or aggregated to form large masses
Common in root canal
Significance
Can obliterate root canal RCT become difficult
Pulp obliteration

 Traumatic injury to the apical blood vessel results

in irregular dentine formation in pulp chamber
and root canal

 Common in DI & DD
 Pulp Necrosis
 Traumatic injury to the apical blood vessels
which cuts off.
 Ischemia results in coagulative necrosis
and if pulpitis occurs breakdown of
inflammatory cells result in liquifective
necrosis.
Age changes in pulp
 Dec in pulp volume

 Dec in vascularity

 Dec in cellularity

 Inc in collagen fiber content

THANK YOU