pulpitis: etiology, pathogenesis, classification. pathomorphology of acute and chronic forms of...

Pulpitis: etiology, pathogenesis, classification. Pathomorphology of acute

and chronic forms of pulpitis. Clinic, diagnostics of acute

forms of pulpitis.

IntroductionIntroduction

Endodontics is the specialty of dentistry that manages the prevention, diagnosis, and treatment of the dental pulp and the periradicular tissues that surround the root of the tooth

formative organ of tooth

builds primary dentin during development of tooth

secondary dentin after tooth eruption

reparative dentin in response to stimulation as long as odontoblast remain vital

Pulp

Pulpitis

UNTREATED

Death of pulp

Spread of Infection throughapical foramina into periapical

tissues

Causes Periapical Periodontitis

Causes of PulpitisCauses of Pulpitis

1.1. Physical irritationPhysical irritation – Most generally brought on by Most generally brought on by

extensive decay.extensive decay.

2.2. TraumaTrauma – Blow to a tooth or the jawBlow to a tooth or the jaw

3.3. AnachoresisAnachoresis

- retrograde infections- retrograde infections

Signs and SymptomsSigns and Symptoms

Pain when biting downPain when chewing

Sensitivity with hot or cold beverages

Facial swelling

Discolouration of the tooth

Endodontic DiagnosisEndodontic Diagnosis Subjective examinationSubjective examination

Chief complaint

Painful stimuli

Sensitivity to biting and pressure

Discolouration of tooth

Character and

duration of pain

Important questions?Important questions?

How bad is the pain?

When does it start

hurting?

Does it hurt to hot or

cold? 

Does it hurt when

you’re chewing?

What type of pain is it?

How long does the pain last?

Does anything relieve it?

Objective examinationObjective examination

Extent of decay

Periodontal conditions

surrounding the tooth in question

Tooth mobility

Presence of an extensive

restoration

Swelling or discolorationPulp exposure

Diagnostic TestsDiagnostic Tests

Thermal

Palpation

Percussion

Electrical

Radiographs

1. Percussion tests1. Percussion tests Completed by the Completed by the

dentist tapping dentist tapping on the incisal or on the incisal or occlusal surface occlusal surface of the tooth in of the tooth in question with the question with the end of the mouth end of the mouth mirror handle mirror handle held parallel to held parallel to the long axis of the long axis of the tooththe tooth

– The dentist The dentist applies firm applies firm pressure to pressure to the mucosa the mucosa above the above the apex of the apex of the root root

2. Palpation tests2. Palpation tests2. Palpation tests2. Palpation tests

3. Thermal sensitivity3. Thermal sensitivityNecrotic pulp will Necrotic pulp will notnot respond to respond to cold or hotcold or hot

1.1. Cold testCold test2.2. Heat testHeat test

Placement of a pulp tester.Placement of a pulp tester.

4. Electric pulp testing

5. Radiographs5. Radiographs

1. Pre-operative radiograph

Invaluable diagnostic tool

Periapical radiolucency

Widening of PDLDeep cariesResorptionPulp stonesLarge restorationsRoot fractures

Pulpitis Pulpitis The pulp tissues have The pulp tissues have

become inflamedbecome inflamed

Can be either:Can be either:

Acute Acute

– – inflammation of the inflammation of the periapical area periapical area

– – usually quite painfulusually quite painful

Chronic Chronic – Continuation of acute Continuation of acute

stage orstage or– low grade infectionlow grade infection

Acute PulpitisAcute Pulpitis

mainly occurs in mainly occurs in children teeth and children teeth and adolescentadolescent

pain is more pain is more pronounced than pronounced than in chronicin chronic

Symptoms and SignsSymptoms and Signs of acute of acute pulpitispulpitis

The pain not localized in the affected tooth The pain not localized in the affected tooth is constant and throbbing worse by is constant and throbbing worse by reclining or lying downreclining or lying down

The tooth becomes painful The tooth becomes painful with hot or cold stimuliwith hot or cold stimuli The pain may be sharp and stabbingThe pain may be sharp and stabbing Change of color is obvious in the affected Change of color is obvious in the affected

toothtooth swelling of the gum or face in theswelling of the gum or face in the area of the affected tooth area of the affected tooth

Forms of acute pulpitisForms of acute pulpitis 1. Form of 1. Form of purulent purulent

acuteacute where the pulp is where the pulp is totally inflammedtotally inflammed

2. Form of 2. Form of gangrenous gangrenous chronicchronic where the pulp where the pulp begins to die in a less begins to die in a less painful manner that painful manner that can lead into the can lead into the formation of an formation of an abscessabscess

Chronic PulpitisChronic Pulpitis

Reversible

Irreversible

Clinical Features

polypoid tissue appears

• tissue easily bleeds because of rich network of blood vessels

• tooth may respond or not at all to thermal test

Chronic Hyperplastic Pulpitis

Management

elimination of polypoid tissue

followed by extirpation of pulp

hyperplastic tissue bleeeding can be controlled by pressure

extraction of tooth can also be done

Chronic Hyperplastic Pulpitis

Periradicular abscessPeriradicular abscess An inflammatory An inflammatory

reaction to pulpal reaction to pulpal infection that can be infection that can be chronic or have rapid chronic or have rapid onset with onset with painpain, , tenderness of the tenderness of the tooth to tooth to palpationpalpation and and percussionpercussion, pus , pus formation, and formation, and swellingswelling of the of the tissues. tissues.

An inflammatory reaction An inflammatory reaction frequently caused by bacteria frequently caused by bacteria entrapped in the periodontal entrapped in the periodontal sulcus for a long time. A patient sulcus for a long time. A patient will experience rapid onset, will experience rapid onset, painpain, , tenderness to tenderness to palpationpalpation and and percussionpercussion, pus formation, and , pus formation, and swellingswelling..

Periodontal Periodontal abscessabscess

Periodontal Periodontal abscessabscess

Periradicular cystPeriradicular cyst

A cyst that develops at or A cyst that develops at or near the root of a necrotic near the root of a necrotic pulp. These types of cysts pulp. These types of cysts develop as an develop as an inflammatory response to inflammatory response to pulpal infection and pulpal infection and necrosis of the pulpnecrosis of the pulp

Necrotic toothNecrotic tooth

Plan of TreatmentPlan of Treatment

Depends widely on the diagnosisDepends widely on the diagnosis

Simple plan of treatmentSimple plan of treatment

Visit 1:Visit 1: Medical historyMedical history History of the toothHistory of the tooth Access cavityAccess cavity Place rubberdamPlace rubberdam Extirpation + irrigation with sodium hypochloriteExtirpation + irrigation with sodium hypochlorite Placed intra-canal medication (calcium hydroxide)Placed intra-canal medication (calcium hydroxide) Place cotton pelletPlace cotton pellet Placed temporary restoration (IRM/Kalzinol)Placed temporary restoration (IRM/Kalzinol)

Visit 2:Visit 2: Working length determinationWorking length determination Debridement using the hybrid Debridement using the hybrid

techniquetechnique IrrigationIrrigation Placed intra-canal medication Placed intra-canal medication

(calcium hydroxide)(calcium hydroxide) Place cotton pelletPlace cotton pellet Placed temporary restoration Placed temporary restoration

(IRM/Kalzinol)(IRM/Kalzinol)

Visit 3:Visit 3: Obturation with GP using lateral Obturation with GP using lateral

condensationcondensation

Placed temporary/permanent Placed temporary/permanent restoration (IRM/Kalzinol) restoration (IRM/Kalzinol)

Questions????Questions????