lecture 5, disorders of the dental pulp (slide)

8/3/2019 lecture 5, Disorders of the Dental Pulp (slide)

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Disorders of the Dental Pulp

Dr. Rima SafadiFrom Dr. Huda Hammad lectures


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Pulpitis

Inflammation of the pulpal tissue regardless of infectiveagent

Acute or chronic

Reversible or irreversible With or without sypmtoms

We have to decide:

To restore the tooth

To remove the pulp

To remove the entire tooth

So: we have to decide if the process is reversible or

irreversible


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Causes of Pulpitis

Bacterial:

Caries

Cracks

Periodontal pockets Malformed teeth

Traumatic:

Crown fractures

Root fractures Partial avulsion

Bruxism

Abrasion

Iatrogenic:

Heat generation

Deep preperations

Pulp exposure Filling materials

Toxic disinfictants


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Reversible pulpitis:

Irritated pulp

Mildest forms of inflammatory response Vasodilatation

Some transudation

Slight infiltrate of lymphocytes


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Reversible pulpitis


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Irreversible

Wide spectrum of acute and chronicinflammatory changes

Treatment removal of the pulp


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Acute irreversible pulpitis


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Pain Symptoms

Reversible:

Elicited

Sharp

10-15 minutes

Unaffected by posture

Easily localized

Irreversible:

Spontaneous

Dull

>20 minutes

Affected by bodyposture

Difficult to localize


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Pulp is contained within a solid champer

Has limited blood supply through apicalforamen

Inflammation mechanism gets destructive

Inflammation: dilatation of blood vessels

Leakage of fluid from blood vessels

Migration of cells


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Pulpal Necrosis:

Untreated irreversible pulpitis (infected with bacteria):

Lose acute and chronic symptoms

Degeneration of nerve fibers

Autolysis

Irritation to the periodontal membrane

Extensive pain (limited area), extrusion of tooth

Non infected pulpal necrosis: No symptoms for months

Change in color of the tooth


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Histopathology of Pulpal Disease

It is difficult to correlate clinical signs andsymptoms with the degree of pulpalinflammation

Spectrum of histologic changes betweennormal and necrotic


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Histopathology of Pulpal Disease

Overview:

Low caries level: mildest response:

Diffuse infiltration of lymphocytes andmacrophages

No exudate formation

Bacterial entrance: dilated and congested blood

vessels Exudate formation

Compression of blood vessels

Ischemia and necrosis---- pulp abscess


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Acute Pulpitis

May be confined to one horn of dental pulp (focalacute pulpitis) or involve the whole pulp ( totalacute pulpitis)

Cause:1. Rapid bacterial invasion of dentinal tubules

2. Overheating to the extent of ruptured bloodvessels

Mainly in children and adolescents No possibility of drainage

Build up of pressure


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Acute Pulpitis

Pulp Abscess:

Core: (exudate): PMN cells, fibrin, necroticcells, debris and RBC

Zone of granulation tissue: newly formedblood vessels, young fibroblasts plasma cellsand lymphocytes

No outer surrounding capsule Pus quickly spread reach PDL


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Chronic Pulpitis

When there is little or no penetration into thepulp by large numbers of virulent types ofbacteria.

Older teeth

Scelrotic dentin

Reparative dentin formation


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Chronic Pulpitis

Microscopically:

Loose connective tissue,

Dense Bundles of collagen

Reduction in size and number of blood vessels andnerves

Diffuse infiltrate of lymphocytes and plasma cells

Known as pulp fibrosis

Focal and diffuse calcifications may occur Pulp stones: spherical calcifications

Dystrophic calcifications: linear calcifications


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Pulp Calcification

Pulp stones (denticles): organic core

True pulp stones: contain tubules

False pulp stones: concentric layers of calcified

material Free, adherent, interstitial

Dystrophic calcifications: granular materialscattered along collagen fibers or in largermasses

Mainly in root canals


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Chronic Hyperplastic Pulpitis

1. Opened occlusal cavity

2. Good blood supply through a widely openedapical foramen

3. Regenerative capacity of young pulpal tissue

Stimulation of pulp to proliferate

Excessive overgrowth

Fibrotic Deficient in nerves

May be epithelialized


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lecture 5, disorders of the dental pulp (slide)

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