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BDS2 HHD - Pathology > 5. Pathology Of Pulpitis > Flashcards

5. Pathology Of Pulpitis Flashcards

1
Q

LOs

A

Learning outcomes

  • Describe the features of acute and chronic inflammation in the context of the dental pulp situated within a non-expansile chamber
  • List and explain the causes and sequalae of pulpitis
  • Describe the histopathological and clinical features of acute pulpitis, pulpal abscess and chronic pulpitis
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2
Q

What is acute inflammation
what happens?

A

Acute inflammation
* Immediate response to injury

  • Dilation and increased permeability of
    microvasculature
  • Exudation of fluid
  • Emigration of leukocytes (particularly neutrophils)
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3
Q

Outcomes of Acute Inflammation?

A
  • Complete resolution occurs with regeneration of native cells and restoration to normalcy
  • Healing by connective tissue replacement (fibrosis) occurs after substantial tissue destruction and in non- regenerating tissues
  • Progresses to chronic inflammation
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4
Q

What is chronic inflammation?

A
  • Prolonged response to persistent stimuli
  • Involves lymphocytes, plasma cells (which are terminally differentiated b lymphocytes) and
    macrophages
  • Co-existing injury, inflammation and repair.
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5
Q

what is pulpitis?

A

inflammation of the pulp

  • pulp
  • -itis = inflammation of that tissue

EXTRA
IN DIAGRAM
- shows single rooted tooth
- blood supply to pulp chamber + and to root canal system comes in through the apical foramen at the apex of the tooth

  • surrounding pulp chamber + root canal = hard dentine
  • this is surrounded by cementum
  • this is surrounded by bone
  • crown of tooth, surrounding dentine= hard enamel
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6
Q

pulpitis aetiology?

A
  1. microbial (most common cause - mostly seen in practice)
  2. thermal (EG. insufficient cooling of dental handpiece)
  3. chemical
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7
Q

Pulpitis aetiology
MICROBIAL

  1. what is it?
  2. gain access through?
A

1.
- Bacteria can damage the pulp through toxins or
directly after extension into pulp chamber

  • mainly caused by bacterial infection which
    itself is a secondary development of caries

2.
Gain access through:
*Carious cavitation
*Attrition/Abrasion/Erosion
*Fracture, cracked tooth
*Perio-endo lesion
*Iatrogenic (dentist caused it, eg prepping tooth and accidentally enter pulp chamber)

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8
Q

classification of pulpitis?

A
  • V helpful to classify, help us to understand what disease state means + how to treat

*Acute or chronic: Clinical and Histological

*Reversible or irreversible: Clinical (most commonly used classification)

*Open or closed

*Subtotal or generalized (small area)

*Sterile or infected (bacteria gotten in?)

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9
Q

Acute and chronic inflammation of pulp VS
everywhere else in body?
DIFF??

A

Acute and chronic pulpitis
*Similar to other other parts of the body
*But: Necrosis more common owing to the local
anatomy

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10
Q
A
  • we would see this increased hydrostatic pressure in an inflamed state
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11
Q

Factors Influencing Healing

A

LOCAL (secondary)
* Blood supply
* Degree of Infection
* Persistent irritation
* Mobility

SYSTEMIC
* Age
* Nutrition
* Pre-existing medical
condition

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12
Q

Factors Influencing progress of pulpitis

A
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13
Q

what happens during acute inflammation in the pulp

A
  • Initial constriction then dilatation of vessels
  • Increased blood flow
  • Formation of exudate
  • Neutrophils (moving from blood vessels into surrounding tissues)
  • Oedema
  • Destruction of odontoblasts and adjacent
    pulpal tissue
  • odontoblast = dentine forming cells
    = line outer layer of pulp chamber lying adjacent to the dentine
    = these can be destroyed in the inflamed pulp
  • Variable necrosis
  • Variable abscess formation (collection of exudate
    consisting of neutrophils, the liquefied debris of necrotic cells, and oedema fluid)
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14
Q

what do we see in chronic inflammation in the pulp?

A
  • Lymphocytes, plasma cells (terminal differentiated b lymphocytes), macrophages and
  • Variable necrosis
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15
Q

Histology (min 9-11)

A
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16
Q

Pulpitis symptoms?

A
  • Pain
  • Pulps of individual teeth not precisely represented in the sensory cortex
  • Therefore pain can be poorly localized
  • Can be felt in the upper or lower jaw or more rarely distant sites such as the ear
  • Pain not provoked by pressure to surface of tooth
    (biting, percussion) as infection/inflammation not spread to periapical tissues
17
Q

How do you know if it’s reversible or irreversible pulpitis?

A

REVERSIBLE PULPITIS
- Hypersensitive to hot and cold
- Pain subsides on removal of the stimulus
- Positive response to vitality testing

IRREVERSIBLE PULPITIS
- As inflammation progresses, pain becomes persistent + spontaneous
- Reduced or no response to vitality testing

18
Q

Is there a link between histopathological and clinical findings?

A

Can be a lack of correlation between histopathologic findings and the clinical symptoms of pulpitis

19
Q

features of reversible pulpitis/ what you’ll see?

A
  • It is a reversible condition provided the irritant is removed before the pulp is damaged
  • Hyperaemia, oedema,
    *Chronic inflammatory cells underlying the area of
    affected dentinal tubules
    *Scattered acute inflammatory cells are found
    occasionally
    *Can see reparative secondary dentine
20
Q

features of irreversible pulpitis/ what you’ll see?

A

*Often congestion of venules that results in focal
necrosis
*Surrounding pulp tissue can show fibrosis
*Mixture of neutrophils, plasma cells, lymphocytes and macrophages

21
Q

treatment of pulpitis?

A

treatment depends on whether the pulpitis is classified as reversible or irreversible

REVERSIBLE PULPITIS
- treated by removal of the local irritant (usually = carious tissue) - can be done as long as pulp is not damaged

IRREVERSIBLE PULPITIS
- treated by tooth extraction or root canal treatment

22
Q

open or closed pulpitis

A

CLOSED
*Vast majority of pulpitis closed

OPEN
*In open pulpitis, pulp survives chronically inflamed beneath a large exposure despite heavy infection
*Often associated with open apices (see in
children) giving a good blood supply

23
Q

What is chronic hyperplastic pulpitis (pulpal polyp)?

A

*Deciduous molars or first permanent molars in
children (have large pulp chambers)

*Large carious exposures of the pulp in which entire dentinal roof often missing

*Chronic inflammation produces hyperplastic
granulation tissue that extrudes from the pulp
chamber

*The apex may be open and reduces the chance of
pulpal necrosis

*Tooth is asymptomatic except for a possible feeling of pressure

  • The surface of the polyp may or may not be
    covered with stratified squamous epithelium (surface epithelium covering your oral mucosa) that can migrate from adjacent gingiva
24
Q

histology of chronic hyperplastic pulpitis (pulpal polyp)

A
25
Q

other pulpal changes that can occur (not related to pulpitis)
EXTRA

A

BDS2 HHD - Pathology (9 decks)

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