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Diseases of the Pulp

Pulp Located in the central cavity of tooth. Supplies tooth with blood & nutrition Connective tissue w/c is highly vascular. One that causes pain to tooth. Infection of pulp would always go apically because this is where the apical foramen are. DENTAL PULP TISSUE This is neat image of a vital dental pulp. The tooth was diagnosed w/ irreversible pulpitis, acute apical periodontitis & cracked tooth. Once in a while, the pulp will come out in one piece. This actually shows the tissue from the pulp chamber all the way down to the apical portion. PULP DISEASE Are identified based on the signs & symptoms of the disease process. Provides general description that implies the fullest extent of pulpal disease. Clinical Classification I. Reversible Pulpitis No RCT required! II. Irreversible Pulpitis a) Symptomatic Irreversible Pulpitis b) Asymptomatic Irreversible Pulpitis III. Necrosis I. REVERSIBLE PULPITIS Also called Hyperemia. Doesnt last long & sever of short duration only. Inflammation of the pulp that is not severe. Causes: 1. Caries 2. Trauma 3. Thermal shock 4. Cervical Erosion/occlusal attrition 5. Deep Periodontal Scaling 6. Enamel Fractures resulting in exposure of dentinal tubules. Symptoms: 1. Pain of short duration lasting but a moment on as much as a minute. 2. Generally brought on by cold water or food, or cold air, sweet or sour foodstuffs. 3. Does not occur spontaneously & does not continue after cause is removed. Treatment - best treatment is Prevention. 1. Periodic care to prevent development of caries II. IRREVERSIBLE PULPITIS A. Symptomatic Irreversible Pulpitis Even without stimulus, pain is continuous. If left to run its course, acute pulpitis will ultimately terminate in death of pulp. The dilated & engorged capillaries surrounded by many Neutrophils (Predominant Cells). Theres excruciating feeling. Symptoms:

1. Early stages: A Paroxysm of pain maybe excited by sudden temperature change, particularly by cold 2. Pain often continuous after exciting cause has been removed & may come & go spontaneously without apparent cause. 3. Pain is sharp, throbbing, or shooting & generally severe. 4. Change of position (bending or lying down) causes exacerbation of pain due to changes *Intrapulpal Pressure is the more the patient lie down, the more painful will be felt because while patient lie down the blood will be more on the area of the oral side. 5. Referred pain 6. Later stage 7. Patient kept awake at night 8. Pain increased by heat & sometimes relieved by cold. Differential Diagnosis: Irreversible Pulpitis more severe, last longer Reversible Pulpitis transitory Diagnosis: Inspection discloses a deep cavity extending to the pulp/decay under a filling. Treatment: Pulp extirpation B. Asymptomatic Irreversible Pulpitis Conversion of symptomatic irreversible pulpitis into an inactive state resulting in a painless pulp exposure of long duration. Predominant cells, chronic inflammation, are Lymphocytes. CHRONIC HYPERPLASTIC PULPITIS Pulp Polyp seen on the mandibular molars Granulation Tissue response of pulp to injury. Test involve: Mobility Test (If theres no mobility present, then RCT can be done). Treatment: - Elimination of polypoid tissue followed by pulp extirpation NECROSIS - is the death of the pulp it devitalized pulp Cause: Results from untreated pulpitis Traumatic injury that disrups the blood to the pulp.

Symptoms: - Asymtomatic - Crown discoloration in anteriors Treatment: - RCT or extraction