4 - Classification of Pulpal Diseases Flashcards
does clinical diagnosis always correspond to histologic findings
no
pulpal diseases are classified according to what
clinical symptoms and findings
the pulp is either ___ or ___
vital or necrotic
what are the different pulpal diagnoses
- normal pulp
- reversible pulpitis
- irreversible pulpitis
- hyperplastic pulpitis
Why do we need to establish a baseline for comparison
determining what normal pulp is
does vital pulp mean it’s healthy?
NO! bital means the pulp is still alive
what pulp can recover without sacrificing pulp
reversible pulpitis
what pulp cannot recover without sacrificing pulp
irreversible
what is pulp death called
pulpal necrosis
T/F: determining what is normal in the pulp is subjective
TRUE
in normal pulp, are there symptoms reported in pt
no
in normal pulp, is there quick sharp response to cold application and immediate relief when removing from cold
yes
does normal pulp have sensitivity to percussion
NO
is there radiographic evidence of PA pathology in normal pulp
NO
in normal pulp, ___ and ___ should be in line with control teeth (what’s normal for one patient might not be normal for another)
cold, EPT
what does EPT stand for
electric pulp testing
what are subjective symptoms? example?
symptoms that are reported by the patient
e.g., “my tooth hurts when I chew”
what are objective symptoms? example?
something that is observable to the dentist
e.g., swelling or radiographic changes
are soft tissue diseases of the pulp visible on radiographs?
NO!! REMEMBER THIS!
what pulpitis:
inflammation is not severe. if the cause is eliminated, the pulp may return to normal
reversible pulpitis
what soft tissue disease?
SOFT TISSUE DISEASES OF PULP ARE NOT VISIBLE ON RADIOGRAPHS! must do pulp testing to diagnose
describe pain in reversible pulpitis
stimulated, sharp, and transient
does the removal of stimulus result in immediate relief in REVERSIBLE pulpitis?
YES
whats the difference between reversible pulpitis and normal pulp
Very similar but reversible pulpitis
stands out more
The tooth is more sensitive than the
surrounding teeth but pain does not
linger
what is severe inflammation that will not resolve even if the cause is removed
irreversible pulpitis
what are the types of irreversible pulpitis
Symptomatic Irreversible Pulpitis
Asymptomatic Irreversible Pulpitis
what pulpitis is associated with spontaneous pain (does not need to be stimulated)
symptomatic irreversible pulpitis
is the characteristic of pain in symptomatic irreversible pulpitis variable
yes
how long does symptomatic irreverisble pulpitis last
minutes to hours
can you locate pain of symptomatic irreversible pulpitis
yes but localization is difficult due to proprioceptive nerve fibers
what can prolong pain in symptomatic irreversible pulpitis
stimuli (cold, hot)
in advanced cases of symptomatic irreversible pulpitis, ___ provides relief and ___ worsens pain
cold = relief
heat = worsens
describe histology of symptomatic irreversible pulpitis
- dilated blood vessels
- intense infiltration by neutrophils (PMNs)
- sometimes confined areas of lysis
if patient complains of cold sensitivity, the first thing you think about is that pulp is ___
VITAL
what are 2 key symptoms that allow you to say that your pt has symptomatic ireversible pulpitis
- Spontaneous Pain
- Persistent pain after a stimulus has been removed
irreverible pulpitis is usually ___ or the patient only reports ___
asymptomatic; mild symptoms
in asymptomatic irreversible pulpitis, is the diagnosis presumptive?
yes
what pulpitis is undiagnosed many times
asymptomatic irreversible pulpitis
histology of asymptomatic irreversible pulpitis
- Lymphocytes
- Plasma Cells
- Macrophages
- Some PMN’s
- Less fibroblasts
- More Collagen Fibers
what is an overgrowth of pulp tissue into open carious lesion
hyperplastic pulpitis (pulp polyp)
hyperplastic pulpitis is [small or large] carious lesion
large (open caries allows for drainage)
hyperplastic pulpitis occurs in [young or old] patients
young
hyperplastic pulpitis is usually [symptomatic or asymptomatic]
asymptomatic -> open caries allows for draininge
what is hyperplastic pulpitis also called
pulp polyp
histology of hyperplastic pulpitis
- Connective tissue stroma
- Chronic inflammatory cells
- Very vascularized
- No nerve fibers
- Lined by stratified squamous epithelium
hyperplastic pulpitis requires what tx
endodontic therapy
what occurs when the pulp is transformed into vascularized inflammatory tissue with dentinoclastic activity
internal resorption
is internal resorption a type of irrevresible pulpitis
yes
is internal resorption symptomatic?
no! asymptomatic
what has PINK TOOTH syndrome
internal resorption
what has an irregular enlargement of canal space seen on radiographs BUT pulp tests are usually within normal range
internal resorption
histology of internal resorption
- Chronic inflammatory cells
- Multinucleated Giant Cells (Dentinoclasts)
- Giant cells have brush like projections
- Giant cells secrete acid
- Howship’s lacunae
what is the tx of internal resorption
IMMEDIATE removal of pulp tissue and institution of root canal treatment
what is pulpal necrosis
dead pulp because pulp is encased in rigid walls and has poor collateral circulation
when pulp is encased in rigid walls and has poor collateral circulation, the venules and lymphatic collapse under the increased tissue pressure leading to ___
pulp necrosis
does pulp necrosis mainly look dry or liquid
dry
if you seen bleeding, pulp is what
vital
___ will inevitable lead to bacterial colonization of pulp space with or without PA involvement
pulpal necrosis
what are the types of pulp tests
- cold test
- electric pulp test
- heat test (occasional with hard to find tooth)
what do you do during pulp test
- test suspected tooth
- test other teeth for comparison (called control teeth)
how to do cold test
apply cold directly to tooth with cotton pellet
how to record response to cold test
- No response (-)
- Mild response (+)
- Moderate response (++)
- Severe response (+++)
how to take electric pulp test
- Applies electrical current to tooth
- Simply record number when patient responds
- also use control teeth
- use toothpaste as conducting media
is pulp test asymptomatic many times
yes
if pain is present in pulpal necrosis, it’s usually from what?
periradicular tissues or partial necrosis
is partial pulpal necrosis painful
YES! can be very painful
what does pain from partial pulpal necrosis come from
from remaining pulp tissue
what is the last tissue to die in partial pulpal necrosis
nerve tissue
partial pulpal necrosis is diagnosed as what
pulpal necrosis
once the pulp dies in pulpal necrosis, what does it become susceptible to
bacterial invasion
with pulpal necrosis, bacteria and byproducts have an effect on what tissues
surrounding periapical tissues
is pulp calcification the same as a disease
no, it’s a physiological thing
what are types of pulpal calcifications
- pulp stones
- difuse calcificaiton (denticle)
- calcific metamorphosis
what pulp stone resembles dentin
true
what pulp stone is concentric rings of amorphous mass of calcified tissue
false
are pulp stones attached or free?
BOTH! attached or free
where are pulp stones present
pulp chamber/ coronal pulp
most pulp stones are true or false
false
diffuse calcification are present where
radicular pulp; root canal
what can be an obstruction to root canal treatment
diffuse calcifications
what is a partial or complete RADIOGRAPHIC obliteration of pulp space
calcific metamorphosis
histologically, there is always a canal present where
calcific metamorphosis
what is a yellowish coloration of teeth
calcific metamorphosis
response to what is delayed or sometimes absent in calcific metamorphosis
response to cold/electrical sitmulus
is calcific metamorphosis pathologic? does it require RCT?
NOT pathologic; does NOT require RCT
tooth discoloration can occur with what
- pulpal necrosis
- internal resorption
- calcific metamoprhosis
what is this
pulpal necrosis
what is this
internal resorption
what is this
calcific metamorphosis
always make 2 diagnoses: what are they
- pulp
- PA tissue
