Reversable pulpitis - hyperemia

D e f

Irreversible pulpitis
Acute pulpitis ( painful ) Occurs when the amount of irritation intensifies causing great increase in the interpulpal pressure beyond the threshold limits of the sensory nerves causing variables degrees of pain. Chronic pulpitis (painless) Chronic ulcerative pulpitis Chronic hyperplastic pulpitis ( pulp polyp) Chronic inflammation of cariously Chronic inflammation of cariously exposed pulp characterized by exposed pulp characterized by ana formation of abcess at the point over growth of granulomatous of exposure leading to ulceration. tissue into the carious cavity forming a polyp. This response may arise at the end of acute phase or may develop from onset in case where the irritant is of low grade. Usually seen secondry to acute pulpitis

Pulpal necrosis
Pulp undergo necrosis ass a sequel of acute or chronic pulpitis , as the inflammation progress tissue continue to disintegrate until entire pulp is necrotic .

E t i o l o g y

Incipient caries Cervical erosion Occlusal attrition Deep periodontal curettage Filling without insulation Leaking restoration Exposed dentinal tubules Acute Irreversible , starts initial then moderate & lastly advanced Nature of pain: Type of pain : Initially :mild shooting By time: sharp shooting ( by lying down) Stimulus: initially : cold (last 4 few mins) By time: spontaneous without stimulus Course of pain : initially : intermittent By time: continues Vitality testing : normal Palpitation & percussion test : -ve Stimulus : initially : cold Followed by a stage : cold & hot Advanced stage : heat causes sever pain( relieved 4 few sec.s by cold application Hot tooth ) Pain referred neighboring teeth , opposing dentition & temporal area & ear Distribution of pain: always diffuse , cannot localize correctly offended tooth . Pain control : initially : by analgesics Advanced stage : nothing can stop pain

S i g n s & -

Its a reversible inflammation , if cause eliminated , inflammation reverse pulp will return to normal Nature of pain: Type of pain : Sharp transient pain Stimulus : cold ( immediately after removal of stimulus) Course of pain :transient Vitality testing : normal Palpitation & percussion : -ve

Nature of pain: Pain : usually abscent as no accumulation of fluids occur iside pulp & intra-pulpal pressure does not rise Stimulus: heat sometimes

Nature of pain: Pain : usually polyp not painful , it bleeds easily on probing ( open apex)

Nature of pain:

Pain:very mild & mostly abscent

s y m p t o m s

Vitality testing : respond at higher stimulation Palpitation & percussion : -ve Visual examination reveals the presence of long standing carious cavity

Vitality testing : pulp responds Palpitation & percussion : -ve This form seen in young patients where this polyp appears as pinkish red globule of tissue protruding from the pulp chamber.

Vitality testing : negative Palpitation & percussion : -ve

h i s t o

Local vasodilatation & in permeability of blood vessels can cause slight in local pulpal pressure. Infiltration for few numbers of inflammatory cells . if irritation of pulp continues or , case changesto irreversible pulpitis & eventually necrosis. Normal

pulpal pressure , tissue damage & bacterial toxins lead to formation of micro-abcesses at the site of the carious exposure. The neutrophils are the primary cells present. Surrounding the abcess , a dense infiltration of lymphocytes, plasma cells & macrophages is seen.

A zone of necrosis is seen at the surface of the pulp followed by a zone of leukocytic infiltration. Beyond this zone, a zone of proliferating fibroblasts is seen.

The polyp is a complex of new capillaries, proliferating fibroblasts & inflammatory cells.

R a d i o g r a p h i c

No radiographic changes except Advanced stage :some widening in the periodontal membrane space

No changes seen, except in some cases there can be some widening in the periodontal membrane space.

No changes seen, except in some cases there can be some widening in the periodontal membrane space.

No changes seen, except some cases there can be some widening in the periodontal membrane space.