Pulpal Pathologies

03/20/2024 Dr. Meti

 Diseases Of Dental Pulp

03/20/2024 Dr. Meti

 ANATOMY OF DENTAL PULP
• Pulp lies in the center of tooth and shapes itself to
miniature form of tooth.
• This space is called pulp cavity which is divided into pulp
chamber and root canal.
1. PULP CHAMBER
• It reflects the external form of enamel at the time of
eruption .A)
Pulp Horn - is an accentuation of the roof of the pulp
chamber directly under a cusp or a developmental lobe.
Canal Orifice – are openings in the floor of the pulp chamber
leading into the root canals

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03/20/2024 Dr. Meti
2.ROOT CANAL
• Is that portion of pulp cavity which extends from canal
orifice to the apical foramen.
• Accessory or Lateral Canals – are lateral branching of the
main root canal generally occurring in the apical third or
furcation area.
• Apical Foramen – an aperture at or near the apex of a root
through which the blood vessels and nerves of the pulp
enter or leaves the pulp cavity.

03/20/2024 Dr. Meti

Dental Pulp

03/20/2024 Dr. Meti

FUNCTION OF PULP

• The pulp lives for Dentin and the Dentin lives by the grace of the
pulp.

1. Formation of Dentin
• The most important function of the pulp is the production of dentin.
• Various cells are present, which not only help lay down tooth
structure, but nourish the cells.

2. Nutrition of Dentin
The high vascularity of the pulp ensures that dentin is nourished via the
odontoblasts and processes.

03/20/2024 Dr. Meti

3. Innervation of Tooth
• Through the nervous system, pulp transmits sensations
mediated through enamel or dentin to the higher nerve
centers.
• Pulp transmits pain, also senses temperature and touch.

4. Defense of Tooth
• The pulp contains defensive cells (i.e. histiocytes) and has
the ability to respond to injury by an inflammatory process
and form reparative dentin.

03/20/2024 Dr. Meti

DIAGNOSTIC AIDS FOR PULPAL PATHOLOGY
• Subjective symptoms—most common being pain
• Objective symptoms
1. Visual and tactile inspection — 3Cs –i. Color ii. Contour iii. Consistency
2. Thermal tests
i. Heat tests — isolation of tooth — use of:
– Warm air, Hot water,Hot burnisher, Hot gutta-percha stick
ii. Cold tests:
– Ethyl chloride spray, Ice pencils, CO2 snow — temperature 18ºC
3. Electrical pulp testing
4. Radiographs
5. Anesthetic tests
6. Test cavity

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NORMAL PULP
• Asymptomatic
• Produces a mild to moderate transient response to thermal and
electrical stimuli.
• The response subsides almost immediately when the stimulus is
removed.
• The tooth and its attachment apparatus do not cause a painful
response when percussed or palpated.
• Radiograph shows an intact lamina dura, absence of any pulpal
abnormality, calcifications, and resorption

03/20/2024 Dr. Meti

 PULPITIS
Pulpitis is inflammation of the dental pulp resulting from
untreated caries, trauma, or multiple restorations.
Its principal symptom is pain.

1.REVERSIBLE PULPITIS
• This is the first stage where the pulp is symptomatic.
• There is a sharp hypersensitive response to cold, but the pain
subsides when stimulus is removed.
• The patient may describe symptoms of momentary pain and is
unable to locate the source of pain.
• This stage can last for month or years.

03/20/2024 Dr. Meti

Diagnosis
1. Pain: It is sharp but of brief duration, ceasing when irritant is
removed.
2. Visual examination and history: It may reveal caries,traumatic
occlusion and undetected fracture.
3. Radiographs: These show normal PDL and lamina dura.
– Depth of caries or restoration may be evident .
4. Percussion test: It shows negative responses, i.e. tooth is not
tender to percussion.
5. Vitality test: Pulp responds readily to cold stimuli. Electric pulp
tester requires less current to cause pain.

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Treatment
• Restoration
• Reversible pulpitis when left untreated deteriorates into
irreversible pulpitis.

03/20/2024 Dr. Meti

2. IRREVERSIBLE PULPITIS
Definition
• “It is a persistent inflammatory condition of the pulp,
symptomatic or asymptomatic, caused by a noxious
stimulus.”
• It has both acute and chronic stages in pulp.

03/20/2024 Dr. Meti

Symptoms
o A rapid onset of pain, which can be caused by sudden
temperature change, sweet or acidic food.
o Pain remains even after removal of stimulus.
o Pain can be spontaneous in nature which is
sharp,piercing,intermittent or continuous in nature.
o Pain exacerbated on bending down or lying down due to
change in intrapulpal pressure.
o Presence of referred pain.
o Pain is so severe that it keeps the patient awake in night.
o The relief of pain can be simply done by use of cold water.

03/20/2024 Dr. Meti

Diagnosis
1. Visual examination and history: Examination of involved
tooth may reveal previous symptoms.
On inspection, one may see deep cavity involving pulp or
secondary caries under restorations.
2. Radiographic findings:
 May show depth and extent of caries.
3. Percussion: Tooth is tender on percussion

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4. Vitality tests:,
pain may persist even after removal of irritant.
• heat intensifies the response because it has expansible
effect on blood vessels.
• Cold tends to relieve pain because of its contractile effect
on vessels, reducing the intrapulpal pressure

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Treatment
• Pulpectomy, i.e. root canal treatment
• Extraction

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3.Hyperplastic Pulpitis
• Also known as “pulp polyp”
• A reddish, cauliflower-like growth of pulp tissue through
and around a carious exposure.
• Has a generous vascularity characteristically found in
young people.
• Most commonly affected are deciduous molar & 1st
permanent molars.

• May occasionally cause mild, transient pain during

mastication.

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Hyperplastic form of pulpitis showing fleshy reddish
pulpal mass filling the pulp chamber

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Treatment
• RCT
• If tooth is in non-restorable stage, it should be extracted.

03/20/2024 Dr. Meti

 4.PULP NECROSIS
• Pulp necrosis or death is a condition following untreated
pulpitis.
Etiology
• Necrosis is caused by noxious insult and injuries to pulp by
bacteria, trauma, and chemical irritation.
Symptoms
• Discoloration of tooth—First indication of pulp death
• History from patient
• Tooth might be asymptomatic.

03/20/2024 Dr. Meti

Pulpal necrosis of 21 resulting in discoloration

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Diagnosis
1. Pain: It is absent in complete necrosis.
2. History of patient reveals past trauma or past history of severe
pain
3. Radiographic changes: Radiograph shows a large cavity or
restoration or normal appearance .
4. Vitality test: Tooth is non responding to vitality tests.

Treatment
• Complete removal of pulp followed by restoration
• extraction of non restorable tooth.

03/20/2024 Dr. Meti

 Thank you

03/20/2024 Dr. Meti