5. Pathology Of Pulpitis Flashcards
LOs
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
What is acute inflammation
what happens?
Acute inflammation
* Immediate response to injury
- Dilation and increased permeability of
microvasculature - Exudation of fluid
- Emigration of leukocytes (particularly neutrophils)
Outcomes of Acute Inflammation?
- 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
What is chronic inflammation?
- Prolonged response to persistent stimuli
- Involves lymphocytes, plasma cells (which are terminally differentiated b lymphocytes) and
macrophages - Co-existing injury, inflammation and repair.
what is pulpitis?
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
pulpitis aetiology?
- microbial (most common cause - mostly seen in practice)
- thermal (EG. insufficient cooling of dental handpiece)
- chemical
Pulpitis aetiology
MICROBIAL
- what is it?
- gain access through?
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)
classification of pulpitis?
- 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?)
Acute and chronic inflammation of pulp VS
everywhere else in body?
DIFF??
Acute and chronic pulpitis
*Similar to other other parts of the body
*But: Necrosis more common owing to the local
anatomy
- we would see this increased hydrostatic pressure in an inflamed state
Factors Influencing Healing
LOCAL (secondary)
* Blood supply
* Degree of Infection
* Persistent irritation
* Mobility
SYSTEMIC
* Age
* Nutrition
* Pre-existing medical
condition
Factors Influencing progress of pulpitis
what happens during acute inflammation in the pulp
- 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)
what do we see in chronic inflammation in the pulp?
- Lymphocytes, plasma cells (terminal differentiated b lymphocytes), macrophages and
- Variable necrosis
Histology (min 9-11)
Pulpitis symptoms?
- 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
How do you know if it’s reversible or irreversible pulpitis?
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
Is there a link between histopathological and clinical findings?
Can be a lack of correlation between histopathologic findings and the clinical symptoms of pulpitis
features of reversible pulpitis/ what you’ll see?
- 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
features of irreversible pulpitis/ what you’ll see?
*Often congestion of venules that results in focal
necrosis
*Surrounding pulp tissue can show fibrosis
*Mixture of neutrophils, plasma cells, lymphocytes and macrophages
treatment of pulpitis?
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
open or closed pulpitis
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
What is chronic hyperplastic pulpitis (pulpal polyp)?
*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
histology of chronic hyperplastic pulpitis (pulpal polyp)
