Inflammatory pulp conditions DR.AHMED IBRAHIM AL-JOBORY B.D.S. M.SC. CONSERVATIVE DEPARTMENT/ BAGHDAD UNIVERSITY

Inflammatory pulp conditions DR.AHMED IBRAHIM AL-JOBORY B.D.S. M.SC. CONSERVATIVE DEPARTMENT/ BAGHDAD UNIVERSITY

Inflammation is the single most important disease process affecting the dental pulp. Pulpitis classified in the past on either clinical or pathological basis into a number of different types such as (acute or chronic), (reversible or irreversible), (partial or total) and (open or closed). These divisions are somewhat artificial and confusing since inflammation of pulp presents a continuous spectrum of changes.

CLINICAL FEATURE Pulpitis presents clinically as pain which the patient may have difficulty in localizing the tooth. The pain often radiating to the adjacent jaw and sometimes into the face, ear and neck. The pain may continuous for several days or may be occur intermitting over a long period. A sever throbbing pain at times lancinating in type, precipitated by hot or cold stimuli and commonly keeping the patient a wake which is often described as (A cute pulpitis) the pain generally lasting for 10-15 min, but may be more or less continuous, spontaneous attacks of dull aching pain lasting for an hour or two hours are often described as (chronic pulpitis).

The critical decision which has to be made clinically is whether pulpitis is reversible or irreversible, as this will determine the management of the affected tooth; this is based on factors such as: 1. The age of patient 2. Size of caries lesion 3. Present or absence of symptoms 4. Pulp vitality test 5. Radiograph evidence 6. Direct observation during operative procedure

CHRONIC INFLAMMATION The first response to carious or micro leakage within pulp tissue will be a lowgrade. chronic inflammation characterized by the presence of greatly increased numbers of T-lymphocyte in extra-vascular space, which is symptom less, because lymphocyte do not cause release of factors that change the sensitivity of pulps sensory nerves. An infiltrate will form with varying numbers of lymphocytes, monocytes, macrophages and plasma cells, capillaries may become engorged and increased in number as inflammation progress there may be hemorrhagic changes related to extensive leukocyte, infiltration, there may be extra vascular hemorrhage complete loss of C.T. and scattered chronic inflammatory infiltrate.

ACUTE INFLAMMATION Foci of acute inflammation can develop within chronically inflamed tissue if toxin damage pulpal cells bringing about the synthesis of histamine, bradykinin and prostaglandins. The pulpal nerves may become sensitized to normal stimuli of short duration to hot and cold food and drink. Acute reaction was characterized by the presence of polymorphs, macrophages, dilated B.V., odema and erythrocyte outside B.V.

REVERSIBLE PULPITIS The diagnosis of reversible pulpitis implies that the pulp is capable of full recovery if the irritant factors subsided or removed. The symptoms reflect an irritated pulp tissue that react with the earliest form of inflammatory response consisting of vasodilation, slight infiltrate of lymphocytes and disruption of odontoblast layer. The pain or reversible pulpitis is sharp, intense and responded to a sudden change in temp., the pain remain for 5-10 min and no longer than 20min. the tooth remain without symptoms until it is stimulated again. The treatment consist of protecting the pulp from further thermal stimulation and placing sedative dressing for several weeks. The pulp will be less vascular, less cellular and more fibrous than before.

IRREVERSIBLE PULPITIS The pulp tissue will exhibit a wide spectrum of acute and chronic inflammatory changes, the pulp may die painlessly overtime and total necrosis may take place. The pain of irreversible pulpitis is less intense, last for prolong period more than 20 min and maybe referred to another location. The boundary between reversible and irreversible pulpitis is impossible to define. Clinically characterized by severe pain of long duration in response to hot and cold or to spontaneous unstimulated pain particularly at night; the patient cannot identify which tooth is causing the pain. Histological examination reveal at last one pulpal micro abscess often in the area of pulp horn, which is an accumulation of PMNL and chronic inflammatory cells.

PULPAL NECROSIS Is a term applied to pulp tissue that is no longer living which is result of: 1. Sudden traumatic event in which blood supply has been served. 2. Because of untreated irreversible pulpitis, in which the patient may gradually lose the acute and chronic symptoms because the nerve fiber in the pulp degenerate. In general a symptomatic state is usually temporary because of pulp tissue undergoes autolysis and irritant the periodontal membrane tissue adjacent to the apical area, which produce a great deal of pain and other systemic reactions. In non-infected pulpal necrosis, the first sign is the change in coloration of the tooth, which result from decomposing tissue debris and breakdown products of R.B.Cs. in the empty dentinal tubules.

COMMON DIAGNOSTIC TECHNIQUE: 1. History & nature of pain 2. Reaction to thermal change 3. Reaction to mild electric stimulation 4. Reaction to percussion of the tooth 5. Radiographic examination 6. Visual clinical examination 7. Palpation of surrounding tissue

PULP CALCIFICATION Pulp stones are calcified bodies with an organic matrix and occur mostly in coronal pulp. Pulp stones increased in number and size with age and after operative procedure on tooth, it may be recognized radiograph and cause no symptoms

PULP OBLITERATION It may be follow traumatic injury to the apical B.Vs, which is not sufficient to cause pulp necrosis; it is compose of large quantities of irregular dentine form in the pulp chamber.

PULP POLYP In young people with untreated carious lesions that exposed the body of the pulp. Chronic ulcerative pulpitis may lead to proliferation of hyperplastic granulation tissue into carious cavity, which is known as pulp polyp, which may become epithelialized by oral epithelial cells present in saliva. Clinically ulcerated pulp polyp appear as dark red which blood readily on probing, while epithelialized is firmer-pinkish-white in color and does not bleed readily on probing. Both type have no sensation on gentle probing.

PULP ABSCESS Similar but not identical to an abscess in any other parts of the body. The core composed of exudate consisting of PMNLs, fibrin, necrotic tissue debris and extra-vacated RBCs. This core surrounded by zone of granulation tissue consist of newly forming capillary B.Vs, fibroblasts, plasma cells and lymphocytes.