Pathology of Pulpitis Flashcards
What happens in term of acute inflammation and what are the outcomes for this?
Acute inflammation:
- Immediate and response to insult
- Dilation and increased permeability of microvasculature
- Exudation of fluid
- Emigration of leukocytes (particularly neutrophils)
Outcomes:
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 happens in terms of chronic inflammation with pulpitis?
Prolonged response to persistent stimuli
Involves lymphocytes, plasma cells and macrophages
Coexisting injury, inflammation and repair
What are the 3 main causes of pulpitis?
- Microbial
- Thermal
- Chemical
Explain how microbiology causes pulpitis?
Bacteria can damage the pulp through toxins or directly though extension.
They gain access through:
Carious cavitation (most common)
Attrition/abrasion/erosion
Fracture
Perio-endo lesion
Iatrogenic (caused by dental instruments)
What are the 5 ways that pulpitis is classified?
- Acute or chronic
- Reversible or irreversible
- Open or closed
- Subtotal or generalised
- Sterile or infected
Why is inflammation in the pulp different to that in the skin?
Pulp cannot expand as surrounded by hard tissue
Not many blood vessels meaning limited bloody supply through apical foramen
Increase in pulpal pressure is then due to swelling. This is venous stasis leading to ischemia leading to necrosis
Pulpitis usually results in pulp necrosis with periapical periodontitis as an outcome.
What are the local and systemic factors that influence the healing of pulpitis?
Local
- Blood supply
- Degree of infection
- Persistant irritation
- Mobility
Systemic
- Age
- Nutrition
- Pre-existing medical condition
What factors affect the progress of pulpitis?
Host factors:
- Pulpal anatomy
- Apical blood flow
- Pre-exisiting state of pulp
Irritant:
- Nature
- Severity
- Duration
Give the two details on acute and chronic pulpitis
Similar to inflammation in other parts of the body.
Necrosis is more common here due to the local anatomy
Give the names of things that occur during acute inflammation in the pulp
- Initial constriction then dilation of vessels
- Increased blood flow
- Formation of exudate
- Neutrophils (lots)
- Oedema
- Destruction of odontoblasts and adjacent pulpal tissue
- Variable necrosis
- Variable abscess formation
Give the details of 2 extra things that occur in chronic inflammation
- Lymphocytes, plasma cells, macrophages
- Variable necrosis of pulp
What are some pain symptoms of pulpitis?
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
What are the differences in symptoms between reversible and 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 and spontaneous. Reduced or no response to vitality testing.
Reversible pulpitis
•Hyperaemia, oedema,
•Chronic inflammatory cells underlying the area of affected dentinal tubules
•Scattered acute inflammatory cells are found occasionally
•Can see reparative secondary dentine
Irreversible pulpitis
•Often congestion of venules that results in focal necrosis
•Surrounding pulp tissue can show fibrosis
•Mixture of neutrophils, plasma cells, lymphocytes and macrophages
What are the typical treatments which are reversible and irreversible?
Reversible = removal of local irritant (usually caries removal)
Irreversible = tooth extraction or root canal treatment
Give some details on open/closed pulpitis?
Open or closed pulpitis
•Vast majority of pulpitis closed
•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
