M06

Changes in the Pulp Definition (Description Symptomatology Histopathological Change Treatment

and Etiology)
Types of Pulpitis According to Duration
a. Acute Pulpitis - Extensive acute - Relatively severe - Continued - Can’t save the
inflammation of pain is elicited by vascular dilatation pulp
the dental pulp is thermal changes - Accumulation of - Pulpotomy
frequent (especially cold) edema fluid - Placement of
- Immediate sequela - Pain persists even - Pavementing of CaOH over apical
of focal reversible after thermal polymorphonuclea foramen.
pulpitis, although stimulus r leukocytes - Filling the root
it may also occur disappears or been - CD 44 expression canal with inert
as an acute removed is higher during material
exacerbation of a - Pain can be initiation and
chronic described as maintenance
inflammatory lancinating or phase of pulp
process throbbing type inflammation
- Recurrent caries - Tooth reacts to - Odontoblasts in
- Pulp exposure due electric pulp test this area are
to faulty cavity - Pain is increased usually destroyed
preparation when lying down
- When necrosis of
the pulp occurs,
sensitivity is lost
b. Chronic Pulpitis - Chronic pulpitis - Pain is not a - Characterized by - The treatment of
may arise on prominent feature infiltration of the chronic pulpitis
occasion through of chronic pulpitis pulp tissue by does not differ
quiescence of a - Sometimes the varying numbers dramatically from
previous acute patient complains of mononuclear that of acute
pulpitis of a mild, dull cells, chiefly pulpitis
- More frequently ache, which is lymphocytes and - The integrity of
occurs as the more often plasma cells the pulp tissue is
chronic type of intermittent than - More vigorous lost sooner or
disease from the continuous connective tissue later, necessitating
onset - Reaction to reaction either root canal
- Signs and thermal change is therapy or
symptoms are dramatically extraction of the
 considerably reduced in tooth
milder than those comparison to that
in the acute form in acute pulpitis
Types of Pulpitis According to Extent
1. Reversible Pulpitis - Mild to moderate - Short, sharp pain, - May range from - Removal of the
- Symptomatic inflammatory lasting for a hyperaemia to mild noxious stimuli
- Asymptomatic condition of the moment to moderate - Periodic care: Early
pulp where pulp is - Does not occur inflammatory insertion of a filling
capable of returning spontaneously and changes limited to and use of cavity
to uninflamed state. does not continue the area of the varnish
- Causes: trauma, when the cause has involved dentinal
thermal shock, been removed tubules
disturbed occlusal - No pain in - Reparative dentin
relationship asymptomatic but present
can be brought back
to uninflamed state.
2. Irreversible - Persistent - Exhibit intermittent - Disruption of - Complete removal
Pulpitis inflammatory or spontaneous pain odontoblasts of pulp
condition of pulp - Rapid exposure to - Dilated blood - Placement of
- Causes: bacteria dramatic vessels intracanal
involvement of temperature - Extravasation of medicament
pulp through caries, changes will elicit edema fluid to act as
chemical, thermal, heightened and - Chronic disinfectant or
mechanical injury prolonged episodes inflammatory cells obtundent
to the pulp of pain even after - Cresatin, Eugenol,
stimulus is removed Formocresol
2.1. Triggered by change in - Lingering thermal - Thickening of - Endodontic
Symptomatic posture pain, spontaneous periodontal Treatment Removal
- Pulp is still vital pain, referred pain ligament may of pulp tissue
and inflamed pain - Continuous become apparent
transmission still paroxysms of pain - Irritation due to
going on. - Triggered by extensive pulp
change in posture\ chamber or root
canal space
calcification
2.2. Asymptom - Indicates that the - No clinical - Disruption of - Endodontic
atic vital pulp is symptoms odontoblasts Treatment
 incapable of - Inflammation - Dilated blood
healing produced by caries, vessels
caries excavation - Chronic
and trauma inflammatory cells
a. Chronic - Also called pulp - Asymptomatic - Granulation tissue - Elimination of
Hyperplastic polyp or pulpitis - Seen only in teeth made up of polypoid tissue
Pulpitis aperta of children and delicate connective followed by
- Essentially an young adults tissue fibers extirpation of pulp
excessive - Polypoid tissue - Hyperplastic
exuberant appears fleshy and bleeding can be
proliferation of reddish with controlled by
chronically pulpal mass filling pressure
inflamed dental most of pulp - Extraction of
pulp tissue chamber or cavity tooth can also be
- Slow progressive done
exposure of pulp
- Bacterial infection
b. Internal - May be seen as - Appearance of a - Variable degree of - Treatment of
Resorption part of an pink – hued area resorption of the choice is root
inflammatory on the crown of inner or pulpal canal therapy with
response to pulpal the tooth, which surface of the the expectation of
injury represent dentin and a fairly high
- Result of hyperplastic, proliferation of degree of success
activation of vascular pulp the pulp tissue
osteoclasts or filling the defect
dentinoclasts on
internal surfaces
of the root or
crown
c. Pulp Degeneration - Generally present - Empty spaces
in the teeth of occupied by
older people odontoblasts
- Calcific - Part of the pulp - The calcified
Degeneration tissue is replaced by - No signs and material has a
calcific material symptoms in the laminated structure, - Endodontic
- May occur either early stages and lies unattached Therapy
within the pulp - As degeneration within the body of
 chamber or root progresses, tooth pulp
canal may discolor and
- Fibrous - Characterized by the pulp will not - Cellular elements
Degeneration replacement of the respond to replaced by
cellular elements stimulation fibrous connective
by fibrous tissue
connective tissue
- Appearance of a
leathery fiber
- Pulp Artifacts - Vacuolization of - Causes no - Vacuolization of - Root Canal
odontoblasts was distinguishing odontoblasts Therapy
thought to be a symptoms to aid in - Empty spaces
type of pulp clinical diagnosis occupied by
degeneration odontoblasts
characterized by
empty spaces
occupied by
odontoblasts
- Caused by poor
fixation of the
tissue specimen Causes no distinguishing
symptoms to aid in clinical
diagnosis
- Tumor Metastasis - Tumors in the - Pain may come - Depending on the - Extraction of
dental pulp which from impingement tumor that has affected tooth and
is not exposed to of nerves metastasized to the removal of tumor
the oral cavity - May be pulp, it will be the located outside of
- May originate asymptomatic same histologically the pulp
from the pulp
itself or from
tissue outside of
the tooth
3. Pulp Necrosis - Death of pulp - - Necrotic Pulp
- Maybe partial or - Tissue
total depending on - - Cellular debris
whether part or if - No painful and
the entire pulp is symptoms microorganisms
 involved - Tooth may be seen in the
- Sequelae of discoloration pulp cavity
inflammation - History of pain
- Can also occur lasting from a few
following trauma minutes to a few
- Coagulation - Soluble portion of hours followed by - Tissue is Proper treatment
tissue is complete and converted into of necrosis is
precipitated or sudden cessation tissue mass through canal
converted into a of pain consisting chiefly debridement
solid material - Tooth lacks of coagulated - Obturation of the
brilliance, luster proteins, fats and root canal(RCT)
and translucency water
- Liquefaction - Results when - Results when
proteolytic proteolytic
enzymes convert enzymes convert
the tissue into the tissue into
softened mass, softened mass
liquid, or liquid or
amorphous debris amorphous debris
4. Previously - Clinical diagnostic - Depending on the - Continuation of
Initiated Tooth category level of therapy, Root Canal
indicating that the the tooth may or Therapy
tooth has been may not respond
previously treated to pulp testing
by partial modalities - There is no pulpal
endodontic cells,, so tooth is
therapy such as clinically dead
pulpectomy without its blood
supply
5. Previously - Clinical diagnostic - The tooth typically - The amount of vital - Retreatment of
Treated Tooth category does not respond pulp cells depends failed Root Canal
indicating that the to pulp testing on the previous Therapy
tooth has been modalities treatment. Extraction
endodontically
treated and the
canals are
obturated with
 various filling
materials other
than intracanal
medicaments

References:
Cawson’s Essentials of Oral Pathology and Oral Medicine 8th Edition
Ghom ali & Mhaske, Shubhangi: Textbook of Oral Pathology
https://www.dentalcare.com/en-us/professional-education/ce-courses/ce562/pulpal-diagnosis