Pulpal Disorders

Heidi Emmerling, RDH, PhD DHYG 138 Oral Pathology Fall 2007

PULPITIS

Inflammation of the pulp a general term, describing all pulpal inflammation

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

General Information

Pulp is unique in that it is surrounded by rigid dentin and has no collateral circulation because the arteries are end arteries. Pulp is connective tissue and the inflammation here is similar to inflammation of C.T. elsewhere in the body.
DHYG 138 Oral Path Fall 2007

Heidi Emmerling, RDH, PhD

Pulpitis

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

General Information

The effects of an irritant on the pulp and how the tooth reacts has a lot to do with the resistance of the host.

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

General Information

Irritants:

Microorganisms:

One of the most common forms of irritation. Trauma, Blows to tooth, Bruxism

Decay, fractures, etc.

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

General Information
Irritants (Cont) Iatrogenic: A condition produced by improper dentistry

Drilling, polishing (heat), others

Eugenol, restorative materials, cements.

Chemical

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

General Information

Irritants (Cont)

Systemic disorders:

Diabetic

infections and pulp disease Lack of oxygen to the pulp.

Sickle cell anemia

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

General Information

Pain with pulpitis is due to pressure from inflammation within a confined chamber. Progressive inflammatory changes in the pulp are:

Hyperemia Acute Suppurative Pulpitis Acute Serous Pulpitis Chronic Pulpitis

DHYG 138 Oral Path Fall 2007

Heidi Emmerling, RDH, PhD

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

HYPEREMIA

An increase in the amount of blood in the vessels of the pulp.

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

Etiology

Caries: most common cause Lost temporary or permanent restoration. Heat: High speed drill; polishing cup. Traumatic injury: Mild blow to tooth Occlusal trauma Chemical irritants: Bases, liners. Galvanic shock: An electrical current caused from saliva and two different metals.
DHYG 138 Oral Path Fall 2007

Heidi Emmerling, RDH, PhD

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

Symptoms

Pain during eating due to ordinary temperature changes.

Sharp pain that lasts for a short period of time.

Pain from sweet and sour food that last for a short period of time. X-rays

normal; hyperemia is confined to the pulp PDL is normal; may show caries electric pulp tester: readings are lower than normal

Vitality Test:

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

Treatment:

Remove the irritant. Pain should go away. If pain persists, then it's Acute Serous Pulpitis.

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

ACUTE SEROUS PULPITIS

Etiology: Same as Hyperemia Symptoms: Similar to Hyperemia, but more:

Severe Prolonged Pain may come and go without an apparent cause. EPT: Very sensitive and lower-than-normal readings. Ice: A quick response of pain. Heat: No noticeable response. Everything appears normal. Remove the irritant

Vitality Test:

X-rays

Treatment:

If pain persists, do a RCT.

DHYG 138 Oral Path Fall 2007

Heidi Emmerling, RDH, PhD

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

ACUTE SUPPURATIVE PULPITIS

Etiology: Usually caries in close proximity to the pulp. Symptoms:

Pain that is excruciating, throbbing, continuing, especially at night. Very tender to percussion.

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

ACUTE SUPPURATIVE PULPITIS

X-rays: everything appears normal Vitality Test:

Percussion: very tender EPT: confusing; may be low or negative depending on stage of pulpitis

early=low; late=dead

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

ACUTE SUPPURATIVE PULPITIS

Ice:

relief of pain (reduces pressure caused by gas from necrotic tissue

Heat: pain Treatment: Open tooth; let drain Medication for a few days. Do a RCT

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

CHRONIC PULPITIS

Etiology

A low grade infection. Pulp dies slowly with NO ACUTE PAIN. Patient may experience pain off-and-on, but ignores this pain.
usually asymptomatic occasional sharp pain may be negative or may have a radiolucency at the apex

Symptoms:

X-rays:

depending on stage of pulpitis Vitality Test:

EPT: high readings or no response at all Hot/cold: no response rct

DHYG 138 Oral Path Fall 2007

Treatment:

Heidi Emmerling, RDH, PhD

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

PULP STONES

Large calcification in the pulp. Of no significance unless a RCT is needed.

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

CHRONIC HYPERPLASTIC PULPITIS (Pulp Polyp)

An excessive proliferation of chronically inflamed dental pulp tissue. Occurs in teeth with large, open carious lesions in children. Primary and permanent teeth A red or pink nodule of tissue, filling the entire cavity of the tooth and protrudes from the pulp chamber. The tissue is granulation tissue. Treat by extraction or RCT.
DHYG 138 Oral Path Fall 2007

Heidi Emmerling, RDH, PhD

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

SEQUELEA TO PULPITIS

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

PERIAPICAL ABSCESS

This abscess is composed of purulent exudate or pus. The patient will be in pain due to the pressure of the exudate. The pus will seek a path of escape by going toward the pathof-least resistance, and forming a fistula, or spreading to other tissues. The tooth is quite painful and extruded slightly from its socket. It will be in hyperocclusion. Treatment is to establish drainage if possible, by opening the tooth through the pulp chamber, or extraction. If the abscess invades other tissue, an incision may be necessary. Antibiotics are also indicated in many cases.

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

PERIAPICAL GRANULOMA

A localized mass of chronic granulation tissue at the apex of the tooth due to a chronic stimulus. The tooth is usually asymptomatic for the most part. (Some slight discomfort at times; may be slightly extruded.) Treatment is to extract or do a RCT. X-rays will show a slight thickening of the periodontal ligament space and/or a diffuse radiolucent area at the apex.
DHYG 138 Oral Path Fall 2007

Heidi Emmerling, RDH, PhD

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

RADICULAR CYST (PERIAPICAL CYST)

A true cyst, a pathological cavity lined by epithelium. The cyst develops from a granuloma when the granuloma proliferates epithelial rest of Malassez. As the cells in the center of the granuloma become more distant from the lining, they die and liquify, forming a liquid center. A granuloma and a cyst are identical except for the epithelial lining of the cyst.
DHYG 138 Oral Path Fall 2007

Heidi Emmerling, RDH, PhD

RADICULAR CYST (PERIAPICAL CYST)

No symptoms are apparent. X-rays show a radiolucent area with a well circumscribed, not diffuse margin. It is difficult to determine a granuloma from a cyst. The radiopaque lining of the cyst may be the determining factor in diagnosis. Treatment is to extract the tooth or perform a RCT. Then the cyst must be curetted from the apical area.
DHYG 138 Oral Path Fall 2007

Heidi Emmerling, RDH, PhD

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

TOOTH RESORPTION

Roots are resorbed in the same manner as bone. If it resorbs from the outside, it is called external root resorption

This occurs during eruption of permanent teeth on the roots of the deciduous teeth. It also occurs to 2nd molars during eruption of third molars. Can occur with improper forces during orthodontic treatment. Can occur in response to pressure from granulomas and cysts.

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

Tooth Resorption

If the root resorbs from the inside, it is called internal root resorption

Causes cannot always be seen. It has something to do with the inflammatory process. If internal resorption occurs in the crown, it can often be seen during the oral exam. The tooth looks pink. If in the root, it can only be seen on x-rays. The pulp canals will be unequally larger in certain areas.

Treatment: If treated earlyRCT; if late: the tooth will be lost

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007

CONDENSING OSTEITIS

A change in bone, near the apices of the teeth due to a low-grade infection. Radiopaque area extending beyond the apex of the tooth. Most common tooth effected is the mandibular first molar. Treatment is not necessary. Biopsy may be needed to rule out other pathology.
DHYG 138 Oral Path Fall 2007

Heidi Emmerling, RDH, PhD

Heidi Emmerling, RDH, PhD

DHYG 138 Oral Path Fall 2007