An inflammatory response of pulpal CT. to an

irritant that stimulate granulation tissue

formation

( tendency for healing )

4) Chronic pulpitis:

A) Chronic pulpitis is asymptomatic, as there is

outlet for exudate through:

- Carious cavity

- Venous or lymphatic circulation.

So the pressure did not reach the pain threshold.

B) The low grade irritation stimulates formation

of granulation tissue:

- Young fibroblasts

- Young blood vessels.

- Young nerve endings.

N.B.. Granulomatous tissue (fibrous tissue + chronic

inflammatory cells).

It is a chronic

inflammation of a

cariously exposed pulp.

by the formation of an

abscess at a point of

leading to ulceration.

A) Chronic ulcerative pulpitis:

The pulp is formed of 3 zoncs:

1) Zone of necrosis: Inner most zone formed of necrotic tissue

releasing exudate and necrotic by-products.

2) Zone of contamination: Middle zone. that consists of exudate

+ chronic inflammatory cells.

3) Zone III: Outermost zone. that consists of granulation tissue.

- This chronic inflammation of cariously exposed

pulp is

characterized by overgrowth of granulomatous

tissue into the carious cavity.

forming a polyp which is usually lined by stratified

squamous epithelium of mucosa.

- It occurs in young patients or adolescents.

B) Chronic hyperplastic pulpitis

(pulp polyp):

Polyp is

- pinkish in

colour

- easily

bleeding

- not sensitive

Visual

examination:

History of a long standing carious cavity.

Visually: ulcerated

lesion and large carious cavity in chronic

ulcerative cases. Pinkish polyp which bleeds

easily in chronic hyperplastic.

Signs and

Symptoms:

No or slight pain so called asymptomatic

because produet of

exudative zones is drained away through:

1) Carious cavity.

2) Venous or lymphatic circulation.

Percussion: -ve

Radiographically:

normal

Vitality tests:

Themal test no response or may be delayed

response with heat.

Electric pulp test responds at high current -

Treatment:

Cauterization of the

polyp.

followed by root canal treatment.

Additional Pulp Diseases

Def.:

Death of pulp tissue in

sequel of :

a) Acute and chronic

inflammation.

b) Immediate arrest of

circulation due to

traumatic injury.

1) Necrosis:

Necrosis

Liquifactive

Coagulative

*Occurs when there is good blood supply i.e. acute

or chronic inflammation.

**Characterized by the presence of pus.

***Proteolytic enzymes -> proteolysis.

Cells die and autolytic enzymes produce autolysis.

Anaerobic bacteria -> putrifiying enzymes -

>putrifaction pus.

I) Liquifactive necrosis

*Occurs, when there is poor blood supply e.g.

trauma.

**Characterized by a soft solid cheesy-like

mass (caseation)

*** this mass is formed of coagulated protein,

fat and little amount of water.

II) Coagulative necrosis

visual examination: 1)carious tooth

2)trauma.

The tooth is dark in color (due to affection

of dentin by necrotic tissue or extravasated

R.B.Cs).

Signs and Symptoms: painless

Percussion: -ve

Radiographically: normal or slight widening of the lamina

dura.

Vitality tests: -ve, except for

a) Partial necrosis (if only one root is

totally necrotic and other roots are not ).

b) Liquifactive necrosis ( fluild will

transmit current to P.L ) FALSE POSITIVE

Treatment:

Root canal treatment must not be done in

one visit,

the clinician cleans and shapes the canal

using crown down technique.

2) Retrogressive pulp changes

( Irritation of tooth induce aging of pulp )

Def.:

decrease in the size of an organ due to faulty

nutrition.

( 1 ) fibrosis:

Histopathology and pathogenesis:

a. Decreased no. of cells.

b. Decreased ground substance.

c. Increase mature collagen fibers

these bundles cause anoxia or hypoxia of

cells

The cells shrink and their nuclei become

pyknotic

visual examination: caries,attrition,erosion or trauma.

Signs and symptoms: painless

Percussion: -ve

Radiographically: normal

Vitality tests: -ve or shows a slight response to a

very high current.

Treatment:

May be left untreated.

unless the patient

complains.

Def.:

Calcium deposits in the pulp Chamber or

root canal.

II) Calcification (Chalky Tooth):

A) Pulp stone (denticles):

More common in the pulp

Chamber.

a) According to location:

Free (lying free in the pulp

Chamber)

Attached (due to further

calcium deposition)

Embedded (more dentin laid

around them)

b) According to structure:

1) True denticles:

composed of dentin formed by:

Detached odontoblasts

Proliferation of fragment of

epithelial sheath of Hertwig.

2) False denticles:

deposition of calcium salts in dead or

degenerated tissue occurs, due to the

alkalinity of the destroyed tissue,

which acts as central nidus for

deposition of concentric layers of

calcified tissues .

More common in the

root canal alongside

walls of blood vessels

and nerves.

B) Diffuse calcification:

visual examination: history of trauma, or caries.

The tooth looks lifeless,(chalky tooth)

Signs and symptoms: Painless

Percussion: -ve

Radiographically: Calcific changes

Vitality tests: Response at a very high current or no

response, depending on the degree of

calcification.

Treatment:

No need for treatment unless

patient is complaining

III) Internal resorption (pink

spot):

Etiology:

-Trauma

-Inflammation

-Idiopathic

Trauma

Intra-pulpal hemorrhage.

Extravasation of blood, which changes into granulation

tissue.

When in contact with dentin Stimulation of

dentino-clasts.

*This process can go on until:

1- (pink spot)

2- (pathologic perforation)

Pathogenesis:

Pinkish discoloration of right deciduous mandibular molar

visual

examination:

History of chronic inflammation or

trauma.

Pink spot can be seen.

Signs and

Symptoms:

No pain

Percussion: -ve

Radiographically Area of internal resorption .

Vitality tests: Response at low current , when dentin

removed from resorbed area .

Root canal treatment done

immediately

Treatment: