CHAPTER VII: DISEASE OF THE PULP Flashcards
- Refers to early pulpal changes
- Mild transient pulpitis (pulp inflammation)
- First sign of distress of pulp localized chiefly to pulpal ends of irritated dentinal tubules.
FOCAL REVERSIBLE PULPITIS or PULP HYPEREMIA
REVERSIBLE PULPAL CHANGES
CLINICAL FEATURES of FOCAL REVERSIBLE PULPITIS or PULP HYPEREMIA
- Ordinarily painless
- Sensitive to thermal changes particularly to cold
3.Can be seen in teeth with deep carious lesions, large metallic restoration and with defective margins
TREATMENT/ PREVENTION of FOCAL REVERSIBLE PULPITIS or PULP HYPEREMIA
- Reduction in frequency of simple carbohydrate ingestion
- Restoration of the tooth
- Excavation of infected dentin
- Creation of an effective seal
- Untreated advancing carious lesion
- Increased inflammatory response as stimulus intensifies
- Irreversibly inflamed pulp may be characterized by pulpal micro-abscess formation
IRREVERSIBLE PULPAL CHANGES
- Hyperactivity of exudative inflammatory forces
- Close to the source of injury or infection.
- Immediate sequela of focal reversible pulpitis
- Cold and heat causes immediate & prolonged response
ACUTE PULPITIS
coronal pulp is removed, and preserving the radicular pulp
Pulpotomy
coronal pulp and radicular pulp are removed. Done in a live tooth
Pulpectomy
removing the infection inside the tooth. It starts with pulpectomy, but the tooth gets a permanent filling or
crown. Teeth are no longer vital.
Root Canal Therapy
TYPES OF ACUTE PULPITIS
- ACUTE SEROUS PULPITIS
- ACUTE SUPPURATIVE PULPITIS
- ADVANCED ACUTE PULPITIS
- Earliest stage of acute pulpitis
- Caused by diffusion of toxic products of bacteria
- Results to escape of plasma from distended blood vessel wall forming serous exudates on affected pulp.
Acute Partial Serous Pulpitis
Clinical Features of Acute Partial Serous Pulpitis
- Sensitivity to hot and cold stimuli
- Pain persists even after removal of irritant
- Involved tooth usually has extensive caries that reach already the pulpal area
- Almost entire pulp is involved
- Can see serous exudates on the area
Acute Total Serous Pulpal
Clinical Features of Acute Total Serous Pulpal
- Severe, persistent throbbing pain
- Pain worsens in recumbent position
- Heat initiates lancinating pain
- Cold seems to relieve the pain
- Sensitive to percussion
- Progressive type of pulpitis
- Acute inflammation of unexposed pulp with PULPAL MICRO-ABSCESS
ACUTE SUPPURATIVE PULPITIS
ACUTE SUPPURATIVE PULPITIS
FORMATION
- Recognized clinically by presence of small beads of PUS extruding from pulp usually followed exudates but may have insufficient drainage
- Formed due to breakdown of infected pulp tissue by bacteria
- Contained in small cavities known as abscess
PUS
contains infected blood and pus, bacteria, and dead neutrophils or PMNs
Abscess
CLINICAL FEATURES of ACUTE SUPPURATIVE PULPITIS
- Intense, pulsating pain which later
becomes intermittent, throbbing pain - Continuous pain
- Worsens with heat but temporarily
relieved with cold stimulus. - Referred pain to opposite jaw or ear
or anterior to an offending one] - Radiographically reveals periapical
changes if inflammation progresses to
the apex - Tooth sensitive to percussion.
Extensive coronal necrosis
ADVANCED ACUTE PULPITIS
ADVANCED ACUTE PULPITIS
Cold stimuli: (2 reactions of tooth)
- Will not increase pain if peripheral coronal receptors are necrotic
- Relieves pain immediately
- Proliferating phase of the inflammatory process
- Low grade irritation to the pulp is neutralized by effective tissue resistance
- Formation of granulation or granulomatous tissue in the areas peripheral to the exudative zone = tissue resistance
CHRONIC PULPITIS
COMPONENTS OF GRANULOMATOUS TISSUE
- Granulation tissue
- Chronic inflammatory cells
TYPES OF CHRONIC PULPITIS
A. CHRONIC HYPERPLASTIC PULPITIS or PULP POLYP
B. CHRONIC OPEN ULCERATIVE PULPITIS
C. CHRONIC CLOSED ULCERATIVE
Usually involves DECIDUOUS molars, 1st permanent molars
CHRONIC HYPERPLASTIC PULPITIS or PULP POLYP
CHRONIC HYPERPLASTIC PULPITIS or PULP POLYP
CLINICAL FEATURES
- It is essentially an excessive, exuberant proliferation of chronically inflamed pulp tissue
- Appears as a pinkish red globule of tissue protruding from pulp chamber and often filling the entire cavity
- Insensitive to manipulation because it has few nerves
- The lesion may or may not bleed readily depending on the vascularity of the tissue
- Second common type of chronic pulpitis
- Deposition of collagen fibers on the inflamed area
- Color black area
- Present in teeth with wide open carious lesion
CHRONIC OPEN ULCERATIVE PULPITIS
- Most common type of pulpitis
- Inflamed pulp does not permit release of exudative pressure and this constitutes an increased hazard to the integrity of the pulpal circulation
CHRONIC CLOSED ULCERATIVE
