1 Diseases of Pulp

DISEASES OF THE PULP
CONTENTS
INTRODUCTION
PULP
CLASSIFICATION OF PULPAL DISEASES
DIAGNOSIS
DISEASES OF PULP
INFLAMMATORY DISEASES OF PULP
PULP DEGENERATION
PULP NECROSIS
CONCLUSION
REFERENCES
INTRODUCTION
• Pulp is connective tissue consisting of nerves, blood vessels,
ground substance, interstitial fluid, odontoblasts, fibroblast
and other cellular elements
GROSSMAN’S ENDODONTIC PRACTICE 13TH EDITION

PULP
• Pulp is the formative organ of the tooth. It builds primary
dentin during the development of the tooth, secondary dentin
after tooth eruption and reparative dentin in response to
stimulation as long as the odontoblasts remain intact.

DIAGRAM OF ODONTOGENIC ZONE ILLUSTRATING ODONTOBLAST, CELL FREE ZONE, CELL RICH
ZONE WITH BLOOD VESSELS
NERVES IN
THE PULP
INGLES ENDODONTICS EDITION 6

PAIN PATHWAY
ACUTE:
sharp pain of short duration with
easily identified cause CHRONIC:
Intermittent
Often localized in small area Last for longer period
before spreading to neighbour
area
Usually treated with medication
COMPONENTS
Cohen S. Diagnostic procedures. In: Cohen S, Burns RC, eds. Pathways of the pulp. 7th
edn. St. Louis: Mosby 1998;17-19.
World Health Organization. Application of the International Classification of
Diseases to Dentistry and Stomatology. 3rd edn. Geneva: WHO, 1995
CLINICAL DIAGNOSTIC
METHODS

Listen to your patient……the patient will give
you diagnosis
-------Sir William Osler
1. HISTORY AND RECORDS
2. SYMPTOMS:
---subjective and objective symptoms.
SUBJECTIVE SYMPTOMS:
1) PAIN
Stephen Cohen: pathways of the pulp 9th edition

• DENTINAL HYPERSENSITIVITY:
Acc to Andreson et al and Brannstrom et al

suggest that neither odontoblastic process nor
excitable nerve with in dentin are responsible
This lead Brannstrom et al to propose the hydrodynamic

theory

A: CLASSICAL THERORY B: MODIFIED THEORY
C: HYDRODYNAMIC THEORY
PAIN:
1. KIND OF PAIN:
a) sharp, piercing and lancinating pain: excitaion of Adelta fibers.
b) dull,boring: C fibers
2 LOCATION:
a) Localized pain
b) diffuse pain
3 DURATION:
a) short and specific: response to cold
b) persistent and lingering: minute-hour
c) spontaneous pain
d) nocturnal pain.
DIAGNOSTIC TEST PERFORM TO GET
OBJECTIVE SYMPTOMS:
• .1)visual and tactile inspection.
• 3C’s
a) Hard Tissue:
life-like translucency and sparkle and life-
…..tooth that are discolored and life-less appearance

b) Soft Tissue
i) Gingiva
ii) periodontium
2) Percussion:
HORIZONTAL PERCUSSION VERTICAL PERCUSSION
3) palpation:
4) MOBILITY-DEPRESSIBILITY TESTING:
5) Bite test
6) Radiography

7) Assessment of pulp vitality:
a) neural sensibility test
i) thermal test
- heat test
-cold testing
• heat application for < 5 sec
• vasodilation
No response
• increased pulpal pressure
• reduced neural excitation threshold
Immediate painfull
response which Positive response
slightly differ from similar to
contralateral control Non vital tooth
contralateral
tooth\ that lingers control tooth
even after removal of
stimulus
Healthy state of
Irreversible pulpitis pulp
• Cold application for < 15 seconds
Painful response
Short sharp pain
A positive that linger even
disappear rapidly
response after removal of No response
once the stimulus
similar to that stimulus
is removed
of contralateral
control, tooth
Non vital tooth
Healthy pulp Irreversible
Reversible pulpitis
pulpitis

iv) EPT
Anterior tooth: incisal Posterior tooth: mid-third of

third Mb cusps of molars and
buccal cusps of pre-molars.
\
• NORMAL RESPONSE EARLY RESPONSE: diseased state of pulp..threshold
• NEGATIVE RESPONSE DELAYED RESPONSE: threshold more
• FALSE POSITIVE: gangrenous necrotic pulp. Multirooted teeth
• FALSE NEGATIVE: rec. traumatized tooth, immature tooth, extensive calcified tooth

v) ANESTHETIC TEST:
VI) TEST CAVITY:

• PULP VACULARITY TEST: true vitality can only be checked
when we are able to assess the vascular or blood supply.
• i) PULSE OXIMETRY:: non invasive method to measure the

oxygen saturation levels during the administration of anesthesia
or other medic ation
•

– Schnettler JM et pulse oximetry as a disagnostic toot of pulp
vitality Aj Endodon 17: 488.1991
Wallace JA et al :pulse oximetry as dianostic tool J

Endodon 88:343,2000
LASER DOPPLER FLOWMETRY
Laser light transmitted through a fiberoptic souce
placed on the tooth surface
Light enters tooth ..get absorbed by RBC – shift in

frequency of scattered light
Photodetector
Ascertain the presence of blood movement within

pulp space
DIAGNOSIS:

CONCLUSION
• The classification will help clinicians understand the
progressive nature of the pulp disease and will direct them to
the most appropriate and conservative treatment strategy for
each condition. With a comprehensive knowledge of the
pathophysiology of pain and inflammation in the pulp tissues,
clinicians may accomplish this task with confidence.
REFERENCES:
• GROSSMAN’S ENDODONTIC PRACTICE 13TH EDITION
• Stephen Cohen: pathways of the pulp 9th edition

• Seltzer S, Bender IB. The dental pulp. 3rd edn. Philadelphia : JB Lippincott, 1984:281
• World Health Organization. Application of the International Classification of Diseases to
Dentistry and Stomatology. 3rd edn. Geneva: WHO, 1995
• Abbott PV. Assessing restored teeth with pulp and periapical diseases for the presence of
cracks, caries and marginal breakdown. Aust Dent J 2004;49:33-39.
• Cohen S. Diagnostic procedures. In: Cohen S, Burns RC, eds. Pathways of the pulp. 7th
edn. St. Louis: Mosby 1998;17-19.
• Olgilvie AL. Pulpal pathosis. In: Ingle J, ed. Endodontics. London: Kimpton, 1965:295-345.

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DISEASES OF THE PULP

GROSSMAN’S ENDODONTIC PRACTICE 13TH EDITION

GROSSMAN’S ENDODONTIC PRACTICE 13TH EDITION

INGLES ENDODONTICS EDITION 6

GROSSMAN’S ENDODONTIC PRACTICE 13TH EDITION

---subjective and objective symptoms.

Stephen Cohen: pathways of the pulp 9th edition

Acc to Andreson et al and Brannstrom et al

This lead Brannstrom et al to propose the hydrodynamic

INGLES ENDODONTICS EDITION 6

Stephen Cohen: pathways of the pulp 9th edition

HORIZONTAL PERCUSSION VERTICAL PERCUSSION

Stephen Cohen: pathways of the pulp 9th edition

a) neural sensibility test

• reduced neural excitation threshold

GROSSMAN’S ENDODONTIC PRACTICE 13TH EDITION

Anterior tooth: incisal Posterior tooth: mid-third of

GROSSMAN’S ENDODONTIC PRACTICE 13TH EDITION

VI) TEST CAVITY:

• i) PULSE OXIMETRY:: non invasive method to measure the

Stephen Cohen: pathways of the pulp 9th edition

Wallace JA et al :pulse oximetry as dianostic tool J

Light enters tooth ..get absorbed by RBC – shift in

Ascertain the presence of blood movement within

Stephen Cohen: pathways of the pulp 9th edition

• Stephen Cohen: pathways of the pulp 9th edition

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