Pulpal diseas

• What is the dental pulp composed of?

  Tiny blood vessels, lymphatics, nerves, and undifferentiated connective tissue cells
• What factors modify the inflammatory process in the dental pulp?

  • Pulp is enclosed in a rigid chamber of dentine
  • Absence of collateral circulation
  • Constricted periapical foramen
  • Pulp withstands sudden temperature changes from 20 °C to 45 °C
  • Pulps of individual teeth are not precisely represented on the sensory cortex
  • Pulp lacks the power of regeneration

  
• How does the rigid chamber of dentine affect pulp inflammation?

  It prevents pulp tissue from swelling, leading to necrosis due to pressure on blood vessels
• What is the effect of the absence of collateral circulation on the pulp?

  It weakens the defensive mechanism of the pulp and accelerates degeneration of pulp tissue
• What happens when there is a constricted periapical foramen?

  It limits blood supply and venous return, leading to congestion, degeneration, and necrosis of the pulp
• What temperature range can the pulp withstand?

  From 20 °C to 45 °C
• Why do pulps of individual teeth lead to unlocalized pain?

  Because they are not precisely represented on the sensory cortex
• What are the two main groups of irritants to the pulp?

  Living irritants (microbial) and non-living irritants
• What are the types of non-living irritants to the pulp?

  • Chemical
  • Physical (Thermal/Electrical)
  • Mechanical
• What is "Odonto-iatrogenic Pulpitis"?

  Pulp inflammation caused by dentist’s procedures
• What is the most common cause of pulpitis?

  Dental caries
• How can bacteria gain access to the pulp?

  1. Through an open cavity
  2. Deep periodontal pocket via an accessory root canal
  3. Extension of periapical infection from adjacent teeth
  4. Anachoresis (hematogenous infection)

  
• What is anachoresis?

  A phenomenon where bacteria circulating in the blood localize in inflamed areas
• What are some chemical irritants that can affect the pulp?

  Free phosphoric acid, arsenic in silicate cement, acrylic resin monomer, and sterilizing agents
• What are the physical irritants to the pulp?

  • Thermal: Large metallic restorations without base, heat during cavity preparation, heat during setting of cements
  • Electrical: Presence of two dissimilar metals (galvanism)

  
• What is aerodontalgia or barodontalgia?

  Tooth pain resulting from extremes of pressure, often occurring during flying or diving
• What factors affect the pulp's response to irritants?

  1. Nature, severity, and duration of the irritant
  2. Pre-existing state of the pulp
  3. Apical blood flow
  4. Local anatomy of the pulp chamber
  5. Host defense

  
• What are the classifications of pulpitis?

  1. According to severity:

  • Reversible Pulpitis
  • Irreversible Pulpitis (Acute and Chronic)

  
  

  1. According to extent:

  • Focal or Subtotal or Partial Pulpitis
  • Total or Generalized Pulpitis

  
  

  1. According to communication:

  • Open Pulpitis
  • Closed Pulpitis

  
• What is reversible pulpitis?

  A mild to moderate inflammatory condition of pulp that can return to normal after removal of stimuli
• What are the clinical features of reversible pulpitis?

  Sharp shooting pain, sensitivity to thermal changes, and pain disappears after removal of the cause
• What are the radiographic features of reversible pulpitis?

  No radiographic changes in periapical tissue, normal PDL space, and lamina dura
• What are the histopathological features of reversible pulpitis?

  • Dilated blood vessels
  • Intact odontoblastic layer
  • Increased permeability of capillary walls
  • Fluid exudates in pulp tissue
  • Increased viscosity of blood
  • Reparative dentin in adjacent dentinal wall

  
• What is the best treatment for reversible pulpitis?

  Removal of the cause and restoration of the tooth
• What are the sequelae of untreated reversible pulpitis?

  • Regression if treated before pulp damage
  • Irreversible pulpitis (acute or chronic)
  • Death of the pulp
• What is irreversible pulpitis?


  A severe inflammatory condition of pulp that cannot recover from the insult and damage
• What are the clinical features of acute pulpitis?

  Severe, continuous pain that can be spontaneous and is increased by thermal changes
• What are the histopathological features of acute pulpitis?

  Vasodilation, extravasation of RBCs, and acute inflammatory cellular exudate
• What is the treatment for acute pulpitis?

  Extraction or endodontic treatment
• What is chronic pulpitis?

  A chronic inflammation of pulp tissue characterized by specific clinical features and attempts at repair
• What are the clinical features of chronic pulpitis?

  Milder symptoms than acute pulpitis, with intermittent dull pain
• What are the types of chronic pulpitis?

  • Closed or Open
  • Ulcerative or Hyperplastic
• What are the histopathological features of chronic pulpitis?

  The pulp is infiltrated with chronic inflammatory cells and attempts at repair
• What is the etiology of chronic pulpitis?

  Long-term, low-grade injury or sequelae to acute pulpitis
• What are the sequelae of chronic pulpitis?

  • Pulp necrosis
  • Chronic pain
  • Potential for abscess formation
• What are the common causes of pulp diseases?

  • Dental caries
  • Trauma
  • Chemical irritants
  • Thermal irritants
  • Electrical irritants
• What is the role of the odontoblastic layer in pulp health?

  • Provides a barrier to bacteria
  • Involved in the formation of reparative dentin
  • Plays a role in the sensitivity of the pulp
• What is the significance of the periapical foramen in pulp health?

  • It allows for blood supply and venous return
  • Its constriction can lead to pulp necrosis
  • It is a pathway for infection spread

  
• How does the pulp respond to thermal stimuli?

  • Can cause hyperemia and inflammatory changes
  • Sensitivity varies based on the health of the pulp
  • Extreme temperatures can exacerbate pain

  
• What is the impact of dental procedures on pulp health?

  • Can lead to odonto-iatrogenic pulpitis
  • May cause trauma to the pulp
  • Can introduce irritants that affect pulp health
• What is the relationship between pulpitis and dental caries?

  • Dental caries is the most common cause of pulpitis
  • Caries can introduce bacteria to the pulp
  • Untreated caries can lead to irreversible pulpitis