ORAL PATHOLOGY

• Pulp


  Soft tissue of mesenchymal origin residing within pulp chamber and root canals
• Parts of the pulp

  • Coronal pulp (pulp chamber)
  • Radicular pulp (root canal)
• Orifice


  Opening of a canal
• Tooth types


  • Monorooted (one root)
  • Multirooted (two or more roots)
• Functions of the pulp

  • Formative (produce primary and secondary dentin)
  • Protective (produce secondary dentin)
  • Nutritive (blood supply)
  • Sensory (nerves)
• Unique features of the pulp

  • Encased by hard tissue that will not allow for the usual swelling to occur
  • Has no collateral circulation to maintain vitality when primary blood supply is compromised
  • Biopsy and direct application of medicine are impossible without injuring or causing death of the pulp
• Pulp Capping


  • Direct Pulp Capping (pulp exposure, Calcium Hydroxide applied)
  • Indirect Pulp Capping (thin dentin, no pulp exposure)
• Pain is the only sign that can be used to determine the severity of inflammation
• Inflammation


  Local physiologic reaction of the body to noxious stimuli or irritant
• Cardinal signs of inflammation

  • Pain/Dolor
  • Swelling/Tumor
  • Redness/Rubor
  • Heat/Calor
  • Loss of Function/Functiolaesa
• In an inflamed pulp, the 5 cardinal signs are observed but since the pulp is encased by dentin, pain and loss of function are recognized clinically

  
• Examination procedures required to make an endodontic diagnosis

  • Medical/Dental History
  • Clinical Exam
  • Clinical Testing: Pulp Tests
  • Periapical Tests
  • Radiographic Analysis
  • Additional Tests
• Vitality testing (pulp test)

  • Vital (Cold test +, Heat test +, Electric Pulp Test +)
  • Non-vital (Cold test -, Heat test -, Electric Pulp Test -)
• Periapical testing


  • Inflammation/Infection (Percussion +)
  • Normal (Percussion -)
• Pulpitis


  Inflammation of the pulp tissue
• Causes of pulpitis


  • Bacteria (dental caries, sulcus, general circulation)
  • Trauma (accident, fights, iatrogenic)
  • Thermal (rotary equipment)
  • Chemicals (restorative materials, liners)
  • Galvanic current
  • Septicemia (blood poisoning)
• Classification of pulpitis (by extent)


  • Partial/Subtotal Pulpitis (coronal pulp only)
  • Generalized/Total Pulpitis (entire pulp tissue)

  
• Classification of pulpitis (by relationship to external environment)

  • Pulpitis aperta/open (exposed to oral cavity)
  • Pulpitis clausa/closed (not exposed to oral cavity)
• Classification of pulpitis (by symptoms)

  • Reversible Pulpitis (normal -> inflamed -> normal)
  • Irreversible Pulpitis (normal -> inflamed -> not normal)

  Acute Pulpitis/Symptomatic Irreversible Pulpitis (+pain)

  Chronic Pulpitis/Asymptomatic Irreversible Pulpitis (-pain)

  
• Reversible Pulpitis


  Mild to moderate inflammatory condition of the pulp caused by noxious stimuli in which the pulp is capable of returning to the uninflamed state after the removal of the stimuli
• Histopathological features of Reversible Pulpitis

  • Shows pulpal congestions (hyperemia)

  Engorged capillaries and apparent increase in their number

  Odontoblastic layer is intact

  Cell-free zone is obliterated with capillaries and cells that is not normal
• Acute Pulpitis/Symptomatic Irreversible Pulpitis


  Occurs as an immediate sequelae of hyperemia or acute exacerbation of chronic pulpitis

  Presence of tooth-associated pain which is intensified with application of heat and cold

  Persists even after the thermal stimulus has disappeared or been removed
• Types of Acute Pulpitis


  • Serous Type (Acute Serous Pulpitis)

  Suppurative Type (Acute Suppurative Pulpitis)
• Serous Type (Acute Serous Pulpitis)


  • Mild form usually involving a portion of unexposed pulp

  Pain is more severe than in hyperemia

  Medicament: analgesics, anti-inflammatory
• Suppurative Type (Acute Suppurative Pulpitis)


  • Progressive type

  Accumulation of pus and exudates in an exposed pulp

  Open type allows sufficient drainage for the escape of exudate and pus

  Pain is intense, pulsating type which later become intermittent throbbing

  Referred pain present

  May be (+) to percussion

  Severe – swollen lymph node, fever, headache, general malaise

  Medicament: antibacterial/antibiotics
• Chronic Pulpitis/Asymptomatic Irreversible Pulpitis

  A dull ache may be the presenting complaint, or the patient may have no symptoms at all

  Results from long-term, low-grade injury or quiescence of an acute process
• Types of Chronic Pulpitis

  • Closed Chronic Pulpitis

  Open Chronic Pulpitis (Ulcerative Chronic Pulpitis, Hyperplastic Chronic Pulpitis)
• Hyperplastic Chronic Pulpitis (Pulp polyp)


  • Excessive exuberant proliferation of chronically inflamed pulp tissue

  Bleeds easily
• Differential diagnosis for Hyperplastic Chronic Pulpitis

  • Hyperplastic Gingiva

  Pulp Polyp
• Terminal stages of inflammatory process

  • Necrosis (death of the pulp without bacterial infection/invasion)

  Gangrene (organic decomposition from bacterial infection)

  Putrefaction (organic decomposition from bacteria and fungi with formation of foul-smelling products)
• Pulp


  Soft tissue of mesenchymal origin residing within pulp chamber and root canals
• Parts of the pulp

  • Coronal pulp (pulp chamber)
  • Radicular pulp (root canal)
• Orifice


  Opening of a canal
• Tooth types


  • Monorooted (one root)
  • Multirooted (two or more roots)
• Functions of the pulp

  • Formative (produce primary and secondary dentin)
  • Protective (produce secondary dentin)
  • Nutritive (blood supply)
  • Sensory (nerves)
• Unique features of the pulp

  • Encased by hard tissue that will not allow for the usual swelling to occur
  • Has no collateral circulation to maintain vitality when primary blood supply is compromised
  • Biopsy and direct application of medicine are impossible without injuring or causing death of the pulp
• Pulp Capping (Calcium Hydroxide)

  1. Direct Pulp Capping (pulp exposure, Calcium Hydroxide applied)

  2. Indirect Pulp Capping (thin dentin, no pulp exposure)
• Pain is the only sign that can be used to determine the severity of inflammation
• Inflammation


  Local physiologic reaction of the body to noxious stimuli or irritant
• Cardinal signs of inflammation

  • Pain/Dolor
  • Swelling/Tumor
  • Redness/Rubor
  • Heat/Calor
  • Loss of Function/Functiolaesa