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Pulpitis: etiology, pathogenesis, classification. Pathomorphology of acute
and chronic forms of pulpitis. Clinic, diagnostics of acute
forms of pulpitis.
IntroductionIntroduction
Endodontics is the specialty of dentistry that manages the prevention, diagnosis, and treatment of the dental pulp and the periradicular tissues that surround the root of the tooth
formative organ of tooth
builds primary dentin during development of tooth
secondary dentin after tooth eruption
reparative dentin in response to stimulation as long as odontoblast remain vital
Pulp
Pulpitis
UNTREATED
Death of pulp
Spread of Infection throughapical foramina into periapical
tissues
Causes Periapical Periodontitis
Causes of PulpitisCauses of Pulpitis
1.1. Physical irritationPhysical irritation – Most generally brought on by Most generally brought on by
extensive decay.extensive decay.
2.2. TraumaTrauma – Blow to a tooth or the jawBlow to a tooth or the jaw
3.3. AnachoresisAnachoresis
- retrograde infections- retrograde infections
Signs and SymptomsSigns and Symptoms
Pain when biting downPain when chewing
Sensitivity with hot or cold beverages
Facial swelling
Discolouration of the tooth
Endodontic DiagnosisEndodontic Diagnosis Subjective examinationSubjective examination
Chief complaint
Painful stimuli
Sensitivity to biting and pressure
Discolouration of tooth
Character and
duration of pain
Important questions?Important questions?
How bad is the pain?
When does it start
hurting?
Does it hurt to hot or
cold?
Does it hurt when
you’re chewing?
What type of pain is it?
How long does the pain last?
Does anything relieve it?
Objective examinationObjective examination
Extent of decay
Periodontal conditions
surrounding the tooth in question
Tooth mobility
Presence of an extensive
restoration
Swelling or discolorationPulp exposure
Diagnostic TestsDiagnostic Tests
Thermal
Palpation
Percussion
Electrical
Radiographs
1. Percussion tests1. Percussion tests Completed by the Completed by the
dentist tapping dentist tapping on the incisal or on the incisal or occlusal surface occlusal surface of the tooth in of the tooth in question with the question with the end of the mouth end of the mouth mirror handle mirror handle held parallel to held parallel to the long axis of the long axis of the tooththe tooth
– The dentist The dentist applies firm applies firm pressure to pressure to the mucosa the mucosa above the above the apex of the apex of the root root
2. Palpation tests2. Palpation tests2. Palpation tests2. Palpation tests
3. Thermal sensitivity3. Thermal sensitivityNecrotic pulp will Necrotic pulp will notnot respond to respond to cold or hotcold or hot
1.1. Cold testCold test2.2. Heat testHeat test
Placement of a pulp tester.Placement of a pulp tester.
4. Electric pulp testing
5. Radiographs5. Radiographs
1. Pre-operative radiograph
Invaluable diagnostic tool
Periapical radiolucency
Widening of PDLDeep cariesResorptionPulp stonesLarge restorationsRoot fractures
Pulpitis Pulpitis The pulp tissues have The pulp tissues have
become inflamedbecome inflamed
Can be either:Can be either:
Acute Acute
– – inflammation of the inflammation of the periapical area periapical area
– – usually quite painfulusually quite painful
Chronic Chronic – Continuation of acute Continuation of acute
stage orstage or– low grade infectionlow grade infection
Acute PulpitisAcute Pulpitis
mainly occurs in mainly occurs in children teeth and children teeth and adolescentadolescent
pain is more pain is more pronounced than pronounced than in chronicin chronic
Symptoms and SignsSymptoms and Signs of acute of acute pulpitispulpitis
The pain not localized in the affected tooth The pain not localized in the affected tooth is constant and throbbing worse by is constant and throbbing worse by reclining or lying downreclining or lying down
The tooth becomes painful The tooth becomes painful with hot or cold stimuliwith hot or cold stimuli The pain may be sharp and stabbingThe pain may be sharp and stabbing Change of color is obvious in the affected Change of color is obvious in the affected
toothtooth swelling of the gum or face in theswelling of the gum or face in the area of the affected tooth area of the affected tooth
Forms of acute pulpitisForms of acute pulpitis 1. Form of 1. Form of purulent purulent
acuteacute where the pulp is where the pulp is totally inflammedtotally inflammed
2. Form of 2. Form of gangrenous gangrenous chronicchronic where the pulp where the pulp begins to die in a less begins to die in a less painful manner that painful manner that can lead into the can lead into the formation of an formation of an abscessabscess
Chronic PulpitisChronic Pulpitis
Reversible
Irreversible
Clinical Features
polypoid tissue appears
• tissue easily bleeds because of rich network of blood vessels
• tooth may respond or not at all to thermal test
Chronic Hyperplastic Pulpitis
Management
elimination of polypoid tissue
followed by extirpation of pulp
hyperplastic tissue bleeeding can be controlled by pressure
extraction of tooth can also be done
Chronic Hyperplastic Pulpitis
Periradicular abscessPeriradicular abscess An inflammatory An inflammatory
reaction to pulpal reaction to pulpal infection that can be infection that can be chronic or have rapid chronic or have rapid onset with onset with painpain, , tenderness of the tenderness of the tooth to tooth to palpationpalpation and and percussionpercussion, pus , pus formation, and formation, and swellingswelling of the of the tissues. tissues.
An inflammatory reaction An inflammatory reaction frequently caused by bacteria frequently caused by bacteria entrapped in the periodontal entrapped in the periodontal sulcus for a long time. A patient sulcus for a long time. A patient will experience rapid onset, will experience rapid onset, painpain, , tenderness to tenderness to palpationpalpation and and percussionpercussion, pus formation, and , pus formation, and swellingswelling..
Periodontal Periodontal abscessabscess
Periodontal Periodontal abscessabscess
Periradicular cystPeriradicular cyst
A cyst that develops at or A cyst that develops at or near the root of a necrotic near the root of a necrotic pulp. These types of cysts pulp. These types of cysts develop as an develop as an inflammatory response to inflammatory response to pulpal infection and pulpal infection and necrosis of the pulpnecrosis of the pulp
Necrotic toothNecrotic tooth
Plan of TreatmentPlan of Treatment
Depends widely on the diagnosisDepends widely on the diagnosis
Simple plan of treatmentSimple plan of treatment
Visit 1:Visit 1: Medical historyMedical history History of the toothHistory of the tooth Access cavityAccess cavity Place rubberdamPlace rubberdam Extirpation + irrigation with sodium hypochloriteExtirpation + irrigation with sodium hypochlorite Placed intra-canal medication (calcium hydroxide)Placed intra-canal medication (calcium hydroxide) Place cotton pelletPlace cotton pellet Placed temporary restoration (IRM/Kalzinol)Placed temporary restoration (IRM/Kalzinol)
Visit 2:Visit 2: Working length determinationWorking length determination Debridement using the hybrid Debridement using the hybrid
techniquetechnique IrrigationIrrigation Placed intra-canal medication Placed intra-canal medication
(calcium hydroxide)(calcium hydroxide) Place cotton pelletPlace cotton pellet Placed temporary restoration Placed temporary restoration
(IRM/Kalzinol)(IRM/Kalzinol)
Visit 3:Visit 3: Obturation with GP using lateral Obturation with GP using lateral
condensationcondensation
Placed temporary/permanent Placed temporary/permanent restoration (IRM/Kalzinol) restoration (IRM/Kalzinol)
Questions????Questions????