SIGNS AND SYMPTOMS OF PULPAL DISEASES

Dr.Amithbabu.c.b.

M.Sc.D-ENDO

INTRODUCTION

The pulp is a connective tissue that is almost totally surrounded by hard tissue i.e. the dentine walls.

The inflammatory process in the pulp is basically the same as elsewhere in the body connective tissue.

There are a few major vessels that supply the pulp through the apical foramen and small vessels that enter through lateral or accessory canals.

• The pulp is the only organ that can produce reparative dentine to keep a wall of dentine between the irritant and itself as a mean of protecting itself from injury.

During inflammation, exudates leaves the vessels and rise the interstitial pressure.

Since the fluid is not compressible and there is little room for oedema, this may cause local tissue hypoxia leading to localized necrosis.

Total pulp necrosis may result from the continued spread of local inflammation

Formerly, it was thought that the pulp responded initially by acute inflammation, followed by chronic inflammation, regardless of the etiologic factor.

However, it was recently shown that the initial response might be chronic inflammation because of the relatively slow progression of the irritant.

Operative procedures, because of their rapid effect, probably result in a transient acute inflammation

CLASSIFICATION Duration and severity

Acute

Chronic

Sub acute Presence or absence of symptoms

Symptomatic

Asymptomatic Ability or inability to heal

Reversible

Irreversible

Pulpal conditions can be classified as

reversible and irreversible pulpitis

hyperplastic pulpitis

necrosis.

Hard tissue responses include

calcifications and resorption.

REVERSIBLE PULPITIS

reversible pulpitis is inflammation of the pulp that is not severe ( Local vasodilatation leading to slight edema ).

If the cause is eliminated, inflammation will resolve and the pulp will return to normal.

CAUSES Mild or short-acting stimuli such as incipient caries, cervical erosion, occlusal attrition, most operative procedures, a recent deep filling without a protective base, deep periodontal curettage enamel fractures

SIGNS AND SYMPTOMS

• Reversible pulpitis is usually asymptomatic (No spontaneous pain ).

• Application of stimuli such as cold or hot liquids or even air, may

• produce sharp transient pain.• Hypersensitive dentin.• Removal of these stimuli, which do not normally

produce pain or discomfort, results in immediate relief

Distinguished from irreversible pulpitis

--- thermal test reversible pulpitis

momentary, painful response

subsides as soon as the stimulus removed

irreversible pulpitis

painful, linger after the stimulus removed

Reversible pulpitis

SYMPTOMATIC IRREVERSIBLE PULPITIS

The pulp has been damaged beyond repair, and even with removal of the irritant it will not heal.

The pulp will progressively degenerate, causing necrosis and reactive destruction

SIGNS AND SYMPTOMS

A rapid onset of pain when any stimulus like cold foods, or sweet food, pressure from packing of food into cavity, or pressure exerted by tongue, that results in congestion of the blood vessels of the pulp.

The pain may be caused by sudden temperature changes, which is prolonged. prolonged episodes of pain even after the source of the pain is removed

The pain may be sharp, shooting or piercing in nature.

The pain may be referred to adjacent teeth sometimes, and also to ear if lower teeth are involved, and to temple region if the upper teeth are involved.

The pain caused by cold stimulation can be relieved by heat, and similarly, the pain caused by heat can be relieved by cold

Chronic Hyperplastic Pulpitis(PULP POLYP)

• It is a productive pulpal inflammation due to extensive carious exposure of any young pulpal tissue.

• This is a type of irrversible pulpitis, which is chronic and usually asymptomatic in nature.

SIGNS AND SYMPTOMS

Hyperplastic pulpitis is usually asymptomatic. It appears as a reddish cauliflower-like

outgrowth of connective tissue into caries that has resulted in a large occlusal exposure.

It is occasionally associated with clinical signs of irreversible pulpitis such as spontaneous pain as well as lingering pain to cold and heat stimuli.

The teeth respond within normal limits when palpated or percussed.

PULP POLYP

PULP CALCIFICATION

• Extensive calcification (usually in the form of pulp stones or diffuse calcification) occurs as a response to trauma, caries, periodontal disease, or other irritants

SIGNS AND SYMPTOMS

• Yellowish discoloration of the crown

• Pain threshold to thermal and electrical stimuli usually increases; teeth are nonresponsive, palpation and percussion

PULP CALCIFICATION

INTERNAL RESORPTION

• Internal resorption is a pathological process initiated within the pulp space with the loss of dentin

• Asymptomatic and detectable by routine radiographs

• Oval-shaped enlargement of the root canal space

• Advanced internal resorption involving the pulp chamber is often associated with pink spots in the crown.

• Teeth with intracanal resorptive lesions usually respond within normal limits to pulpal and periapical tests.

INTERNAL RESORPTION (clinical view)

PULPAL NECROSIS WITH ACUTE APICAL PERIODONTITIS• Extension of pulp inflammation, bacteria,

and chemicals into the periradicular tissue.

Signs and symptoms

Usually Asymptomatic

Pain on biting or percussion, moderate to severe spontaneous discomfort

NECROSIS WITH ACUTE APICAL ABSCESS

• It is an acute condition characterized by the formation and retention of pus in the alveolar bone around the root apex of a tooth with a necrotic pulp along with the extension of infection through the apical foramen into the periapical tissues.

SIGNS & SYMPTOMS

Pain-severe intensity, constant and spontaneous, throbbing.

Slight to severe swellingPain on bitingTooth may be mobileFever Regional lymph node may be involved

NECROSIS WITH CHRONIC APICAL ABSCESS

• Chronic periradicular abscess is similar to chronic apical periodontitis except that it is characterized by the presence of a draining sinus tract.

SIGNS & SYMPTOMS

• A tooth with a chronic periradicular abscess (suppurative periradicular periodontitis) will not generally present with clinical symptoms.

• This tooth will not respond to pulp vitality tests and the radiograph or image will exhibit a periradicular radiolucency.

• The tooth is generally not sensitive to biting pressure but can “feel different” to the patient upon percussion

PHOENIX ABSCESS

• A phoenix abscess is a chronic apical periodontitis that suddenly becomes symptomatic.

• A phoenix abscess may develop spontaneously, almost immediately after endodontic treatment has been initiated on a tooth diagnosed as having chronic apical periodontitis without a sinus tract.

SIGNS AND SYMPTOMS

• pain• fever and malaise• Swelling• Halitosis

PERIAPICAL GRANULOMA

• Bone destruction around apex of tooth, mostly secondary to pulp exposure due to caries or trauma.

• Bacterial invasion of pulp produces toxic metabolites which escape to the periapical bone through apical foramen and cause inflammation.

• • Periapical granuloma: Localized mass of

chronic granulation tissue containing PMN’s, lymphocytes, plasma cells.

PERIAPICAL GRANULOMA

CONDENSING OSTEITIS

• Condensing Osteitis is defined as pathologic growth of maxillomandibular bones characterized by mild clinical symptoms.

SIGNS & SYMPTOMS

• Could be symptomatic or asymptomatic depending on the condition of the pulp and periradicular tissues

• Pathways of pulp ,stephen cohen .9 edition

• Endodontic john i.ingle• Torebinejad Principles and Practice

of endodontics

REFERENCES