Pathology of dental pulp

Dr. Kadija Bamashmoos

 introduction
:Dental pulpitis
.It means inflammation of dental pulp
 causes
The causes of pulpal diseases are:: physical, chemical
and bacterial
:Physical.1
:A.Mechanical
:I. Trauma
II. accidental (contact sports)
III. iatrogenic dental procedures
Pathologic wear .2
Cracked tooth syndrome .3
:B. Thermal
a. Heat from cavity preparation
b. Exothermic heat from the setting of cement
c. Conduction of heat and cold through deep fillings
without a protective base
.d. Frictional heat produced by polishing a restoration
C. Electrical
galvanic current from dissimilar metallic fillings
:II. Chemical
Phosphoric acid , acrylic monomer etc .1
Erosion (acids) .2
:III. Bacterial
.Direct invasion of dental caries to the pulp
 Physical causes
Mechanical injuries -
TRAUMA -
More in children -
Due to violent blow to the tooth during a fight , -
sports, accident , habits (opening bobby pins with
teeth and nail biting )
Pathologic wear -
The pulp may also be exposed or partially exposed by
pathologic wear of teeth from either abrasion or
attrition or compulsive bruxism
Cracked tooth syndrom
Incomplete fracture through the body of the tooth •
Patient complaints of pain ranging from mild to •
excruciating on biting
Close examination of the crown of the tooth may •
disclose an enamel crack, which maybe better
visualized using a dye or by transilluminating the
. tooth with a fiber optic light
.The pulp may become necrotic •
Thermal injuries
Heat from cavity preparation -
High speed engines and carbide burs reduce -
operating time, but they may also accelerate pulp
.necrosis if used without a coolant
The heat generated may be sufficient to cause -
.irreparable pulp damage
Heat conduction by fillings -
Metallic fillings close to the pulp without an -
intermediate cement base may conduct temperature
changes rapidly to the pulp and may cause
.irreversible changes
Remaining dentin thickness (RDT) under the -
restoration should be between 1.1 and 1.5 mm to
protect the pulp
Frictional force during polishing -
Enough heat may also be generated during .1
polishing of the filling or during setting of the
.cement to cause at least transient pulp injury
.These injuries are usually reversible in nature .2
 Chemical causes
Earlier , the presence of arsenic in silicate cement -
powder and the use of a desensitizing paste
containing paraformaldehyde accounted for many
pulp deaths
To protect the pulp : use calcium hydroxide bases in -
deep cavities and calcium hydroxide liners in
.shallow cavities
 Bacterial causes
MILLER in 1894 suggested that bacteria were the -
most common cause of inflammation in the pulp
 classification
Diseases of the pulp by grossman
Reversible pulpitis pulpitis
Irreversible pulpitis
a) acute
Abnormally responsive to cold)1
2)Abnormally responsive to heat
b) Chronic
Asymptomatic with pulp exposure)1
2)Hyper plastic pulpitis

pulp necrosis
 Reversible pulpitis
: DEFINITION -
Reversible pulpitis denotes a level of pulpal
inflammation in which the tissue is capable of
returning to a normal state of health if the noxious
.stimuli are removed
:Clinical features -
.Sharp pain lasting from 5- 15 minutes •
Brought on by cold stimuli •
Does not occur when stimuli is removed •
.It does not occur spontaneously •
 :HISTOPATHOLOGY -
Dilated blood vessels •
.odontoblasts layer is an intact•
:TREATMENT -
.It require either direct or indirect pulp capping
 Irreversible pulpitis
:DEFINITION -
The pulp has damaged beyond repair and even with
removal of irritant it will not be healed. It is a
.persistent inflammatory condition of the pulp
: Divided into -
ACUTE )1
CHRONIC )2
:Acute pulpitis )1

It is that form of pulpitis which rapidly develops

from reversible pulpitis if the invading
. microorganisms are sufficiently virulent
:Clinical features -
.Pain continues after removal of the cause -
.Sharp, piercing ,or shooting -
Change of position ;bending over or lying down -
exacerbates the pain
History of night pain -
Pain referred to adjacent teeth ; to the sinuses when an -
upper posterior tooth is involved and to the ear when a
lower posterior tooth is affected
:HISTOPATHOLOGY -
.a. Degeneration of odontoblasts nuclei
.b. Dilatation and congestion of blood vessels
c. Infiltration of large numbers of neutrophils into
.the surrounding tissue
:TREATMENT -
.RCT (root canal treatment) •
:Chronic pulpitis .2
It is that form of pulpitis which develops from acute
.pulpitis if the irritant of low virulence
:Clinical features
.a. Dull intermittent pain
.b. The pain decreases with temperature changes
:Histopathological features
.a. Fibroblastic activity
.b. Formation of small abscesses
c. Infiltration of large numbers of chronic
inflammatory cells such as lymphocytes and
.plasma cells into the surrounding tissue
: Treatment
Root canal treatment
Chronic hyper plastic pulpitis – pulp polyp
It is that form of chronic pulpitis in which the pulp -
tissue is opening to the oral cavity associated with
.polyp
:Clinical features
a. It appears as a pinkish globlar mass protruding from
.the pulp champer and often filling he entire cavity
.b. It is usually seen in children and young adult
c. It is usually effects deciduous molars and the first
.permanent molars
.d. It is usually painless
.e. It may bleed easily
-

:HISTOPATHOLOGY -
It appears as a granulation tissue consists of collagen
fibers, fibroblasts, chronic inflammatory cell
.infiltration and blood vessels
:TREATMENT -
Removal of the pulp polyp with root canal
.treatment
 Necrosis of the pulp
Necrosis is the death of the pulp due to untreated -
.pulpitis
.It can be partial or total -
:Clinical features
.a. It is asymptomatic
b. It may cause discolored tooth due to degeneration
.of dentinal tubules caused by death of the pulp
:Histopathological features
It shows either an empty pulp champers and canal or an
.isolated empty areas
:Treatment
.Root canal treatment