ENDODONTICS

• Causes of Pulp Disease


  • Physical
  • Chemical
  • Bacterial
• Physical causes


  • Mechanical
  • Thermal
  • Electrical
• Mechanical causes


  1. Trauma

  2. Pathologic wear

  3. Crack through body of tooth

  4. Barodontalgia
• Trauma


  Violent blow of the tooth during fight, sports, automobile accident, household accident
• Pathologic wear


  • Attrition
  • Abrasion
  • Bruxism
  • Abfraction
• Crack through body of tooth

  Incomplete fractures through the body of the tooth
• Barodontalgia


  Toothache during low atmospheric pressure (during flight, during a test run in a decompression chamber)
• Thermal causes


  1. Heat from tooth preparation

  2. Heat conduction by fillings

  3. Conduction of heat and cold through deep fillings

  4. Frictional heat cause by polishing
• Electrical causes are the least common cause of pulp injury
• Bacterial causes


  • Streptococci
  • Staphylococci
  • Porphyromonas gingivalis
  • Porphyromonas endodontalis
  • Fusobacterium nucleatum
• Reversible pulpitis


  Mild to moderate inflammatory condition of the pulp cause by noxious stimuli in which a pulp is capable of returning to its uninflamed state from removal of stimuli
• Types of reversible pulpitis

  • Acute reversible pulpitis
  • Chronic reversible pulpitis
• Acute reversible pulpitis


  Pain is present for short time (hours, days), no pain after removal of stimuli
• Chronic reversible pulpitis


  Pain is present for longer time (months), no pain after removal of stimuli
• Causes of reversible pulpitis


  • Trauma
  • Thermal shock
  • Excessive dehydration of a cavity
  • Placement of fresh filling
  • Chemical stimulus
• Symptoms of reversible pulpitis

  Characterized by short, sharp pain lasting for a moment, pain is specific to stimulus, pain is relieved upon removal of stimuli, brought by cold, hot beverages, cold air
• The clinical difference between reversible and irreversible pulpitis is traceable to a stimulus, such as cold water, or cold air, while irreversible pulpitis pain is severe, longer, and pain come without stimulus
• Diagnosis of reversible pulpitis


  Pain is sharp, last a few seconds, disappears upon removal of stimulus, causes by cold, sweet, sour foods, may become chronic, paroxysm may be of short duration, but may continue for weeks or months
• Irreversible pulpitis


  Persistent inflammation of the pulp, symptomatic or asymptomatic with the pulp incapable of healing
• Types of irreversible pulpitis

  • Asymptomatic irreversible pulpitis
  • Symptomatic irreversible pulpitis
• Asymptomatic irreversible pulpitis


  Pulp is already exposed, little to no pain except when food is packed into the cavity
• Early symptomatic stage of irreversible pulpitis

  Less current is needed, pulp is abnormally responsive to cold, sharp, piercing pain is readily identified in specific tooth
• Later stage of irreversible pulpitis

  Symptoms may develop: diffuse, dull, constant pain, characterized by throbbing, gnawing, respond abnormally and severely to heat
• Chronic hyperplastic pulpitis


  Also known as "pulpal hyperplasia, pulp polyp", productive pulpal inflammation due to an extensive carious exposure of a young pulp, development of granulation tissue, resulting from long-standing, low-grade inflammation
• Internal resorption


  Slow or fast progressive resorptive process occurring in the dentin of the pulp chamber or in the root canals of the teeth
• Pulp degeneration


  It is present in older people, result of persistent, mild irritation in young people; calcific degeneration of the pulp
• Calcific degeneration


  Part of the pulp tissue is replaced with pulp stones or denticles, occur within the pulp chamber or within root canal, like a skin of an onion, "Calcific metamorphosis" type of a pulpal response to trauma characterized by rapid deposition of hard tissue within the canal space
• Fibrous degeneration


  Characterized by replacement of the cellular elements by fibrous connective tissue, when root canal is removed, leathery fiber appearance is evident
• Types of pulp necrosis

  • Pulp necrosis
  • Pulp necrosis with no signs of infection
  • Necrotic and infected pulp
• Pulp necrosis


  A tooth with necrobiosis has both inflamed (acute irreversible pulpitis) and necrotic pulp tissue, mixed symptoms
• Pulp necrosis with no signs of infection

  No periapical tissue response, no apical periodontitis, no symptoms, no response to pulp sensibility test, no other abnormal findings
• Necrotic and infected pulp

  Bacterial invasion, no symptoms at all, any symptoms will be from periapical tissues, also depends from periapical status, no response to pulp sensibility test, periapical radiolucency is evident
• ved


  leathery
• ͽber


  appearance is evident
• Necrosis of the pulp

  Death of the pulp
• Causes of pulp necrosis

  • Trauma
  • Ischemic infarction can develop
  • May cause a dry gangrene necrotic pulp
• Types of pulp necrosis

  • Pulp necrosis
  • Pulp necrosis with no signs of infection
  • Necrotic and infected pulp
• Pulp necrosis


  A tooth with necrobiosis has both inflamed (acute irreversible pulpitis) and necrotic pulp tissue
• Pulp necrosis with no signs of infection

  • No periapical tissue response
  • No apical periodontitis
  • No symptoms
  • No response to pulp sensibility test
  • No other abnormal findings
• Necrotic and infected pulp

  • Bacterial invasion
  • No symptoms at all
  • Any symptoms will be from periapical tissues, also depends from periapical status
  • No response to pulp sensibility test
  • Periapical radiolucency is evident