Classification of Pulpal Disease Flashcards
What is a normal pulp?
no symptoms reported, quick sharp response to cold application immediate relief when removing cold
no sensitivity to percussion
no radiographic evidence of PA pathology
Cold and EPT results should be in line w/ control teeth
Soft tissue diseases of the pulp are not visible on radiographs!
Soft tissues diseases of the pulp are not visible on radiographs!
Reversible Pulpitis
inflammation is not severe, if the cause is eliminated, the pulp may return to normal.
pain is stimulated, sharp and transient, removal of the stimulus results in immediate relief
Difference b/n reversible pulpitis and a normal pulp?
very similar but reversible pulpitis stands out more
The tooth is more sensitive than the surrounding teeth but pain does not linger
Irreversible Pulpitis
severe inflammation will not resolve even if the cause is removed
symptomatic vs asymptomatic irreversible
Symptomatic Irreversible Pulpitis (associated w/ spontaneous pain)
pain is variable, min-hours, localization of pain is difficult, stimuli (hot/cold) can prolong pain, cold provides relief and heat worsens pain
Histology: dilated blood vessels, intense infiltration by neutrophils, sometimes confined areas of lysis
If patient complains of cold sensitivity the first thing you think about is that the pulp is:
Vital
2 key symptoms that will allow you to say that your patient has symptomatic irreversible pulpitis?
spontaneous pain
persistent pain after a stimulus has been removed
Asymptomatic Irreversible Pulpitis
Irreversible pulpitis is asymptomatic, or pt only reports mild symptoms, diagnosis is presumptive, many times undiagnosed
Histology: lymphocytes, plasma cells, macrophages, some PMN’s, less fibroblasts, more collagen fibers
Hyperplastic Pulpitis (Pulp Polyp)
Overgrowth of pulp tissue into open carious lesion
large carious lesion, occurs in young patients, usually asymptomatic
Histology: CT stroma, chronic inflammatory cells, vascularized, no nerve fibers, lined by stratified squamous epithelium
Internal Resorption
The pulp is transformed into vascularized inflammatory tissue with dentinoclastic activity
usually asymptomatic, pink tooth, irregular enlargement of canal space seen on radiographs, pulp tests are usually w/in normal range
Histology: chronic inflammatory cells, multinucleated giant cells (dentinoclasts), giant cells have brush like projections, giant cells secrete acid, Howship’s lacunae
Internal resorption treatment
Immediate removal of pulp tissue and institution of root canal treatment
Pulpal necrosis
Dead pulp
B/c pulp is encased in rigid walls and has poor collateral circulation, venules and lymphatic collapse under inc tissue pressure leading to pulp necrosis
Will lead to bacterial colonization of pulp space w/ or w/out periapical involvement
asymptomatic, pain from periradicular tissues
Pulp Test - Cold test
apply cold directly to tooth and record as follows: no response (-) mild response (+) moderate response (++) severe response (+++)
Pulp Test - Electric Pulp Test
Applies electrical current to tooth
Simply record number when patient responds
Also use control teeth
