Topic 34.

Chronic hypertrophic pulpitis: pathomorphology, clinic, diagnostics,

differential diagnostics.

1. A 18-year-old patient complains of a cavity in the 27th tooth, pain when eating
solid food. Anamnesis: severe pain in 27 tooth a year ago, did not go to the doctor.
Objectively: on the chewing surface of tooth 27, there is a deep carious cavity
connected to the pulp chamber, filled with the growth of granulation tissue, which
covers almost the entire carious cavity. Probing granulation results in bleeding and
minor pain. Percussion is painless. EDI - 45 mkA. Determine the diagnosis:
Chronic hypertrophic pulpitis
Chronic fibrous pulpitis
Chronic hypertrophic gingivitis
Chronic granulating periodontitis
Chronic fibrous periodontitis

Solution algorithm:

1. Pay attention to complaints. Pain while eating solid foods is characteristic of

hypertrophic gingivitis and complications of dental caries.
2. Pay attention to the patient's age - 18 years (hypertrophic changes in the pulp
are found in children and at a young age).
3. Pay attention to the medical history. Carious lesions develop from 1 month to 1
year and are not accompanied by severe pain. In this case, severe pain in the
27th tooth appeared a year ago, I did not go to the doctor, which indicates a
complication of the carious process.
4. Pay attention to the localization of the carious process and the depth of the
lesion. On the chewing surface of the 27 tooth, there is a deep carious cavity
filled with the growth of granulation tissue, which covers almost the entire
carious cavity, which is characteristic of hypertrophic gingivitis. In this case,
the carious cavity is connected to the pulp chamber, which is typical for
hypertrophic changes in the pulp.
5. Pay attention to the diagnostic methods - probing of granulations (leads to
bleeding and minor pain), percussion is painless, and EOD is 45 mkA, which is
typical for changes in all structural elements of the pulp in chronic
hypertrophic pulpitis.
2. A 16-year-old patient is worried about bleeding from the tooth cavity when eating.
Objectively: at 16 on the chewing surface, there is a deep carious cavity, filled with
growths of soft purple-red tissue, which bleeds easily when touched. Probing of the
neoplasm is slightly painful. Ro-gram showed no pathological changes in the hard
tissues of the tooth and periapical tissues. What is the most likely diagnosis?
Chronic hypertrophic pulpitis
Chronic granulomatous periodontitis
Chronic granulating periodontitis
Chronic gangrenous pulpitis
Hypertrophic papillitis
Solution algorithm:
1. Pay attention to complaints: bleeding from the tooth cavity when eating. It is
characteristic of hypertrophic papillitis and carious complications.
2. Pay attention to the patient's age -16 years (hypertrophic changes in the pulp
are found in children and at a young age).
3. Pay attention to the localization of the carious process and the depth of the
lesion. At 16, on the chewing surface, there is a deep carious cavity, filled with
growths of soft tissue of a purple-red color, which bleeds easily when touched
(characteristic of hypertrophic papillitis and chronic hypertrophic pulpitis).
4. Notice the color of the granulation tissue - soft, purplish red that bleeds easily
when touched (the pulp is usually young granulation tissue). Probing of the
neoplasm is slightly painful.
5. Pay attention to the radiograph: Ro-gram of pathological changes in hard
tissues of the tooth and periapical tissues was not found, which excludes
periodontal disease, but is characteristic of changes in all structural elements of
the pulp in chronic hypertrophic pulpitis.

3. A 21-year-old patient complains that blood is released from the cavity in the tooth
in the upper jaw when eating. Objectively: in the 27th tooth, on the approximal
chewing surface, there is a deep carious cavity filled with the proliferation of purple-
red soft tissues, bleeding easily when touched with the probe. Probing is slightly
painful. The reaction to a cold stimulus is slightly painful. EOD - 60 mkA. No
pathological changes were found on the Ro-gram. What is the most likely diagnosis?
Chronic hypertrophic pulpitis
Chronic gangrenous pulpitis
Chronic granulating periodontitis
Chronic fibrous periodontitis
Hypertrophic papillitis

Solution algorithm:
1. Pay attention to complaints - blood is released from the cavity in the tooth on
the upper jaw when eating.
2. Pay attention to the age of the patient -21 years (hypertrophic changes in the
pulp are found in children and at a young age).
3. Pay attention to the localization of the carious process and the depth of the
lesion: in the 27th tooth, on the approximal chewing surface, there is a deep
carious cavity filled with the growth of soft tissues of a purple-red color,
bleeding easily when touched with the probe.
4. Note the color of the granulation tissue - soft, purplish red that bleeds easily
when touched (the pulp is usually young granulation tissue).
5. Pay attention to the diagnostic methods: probing is slightly painful, Reaction to
a cold stimulus is slightly painful. which is typical for hypertrophic papillitis
and chronic pulpitis. EDI - 60 mkA and X-ray (no pathological changes were
found on the Ro-gram), which excludes periodontal diseases, but is
characteristic of changes in all structural elements of the pulp in chronic
hypertrophic pulpitis.