Pulp diseases

Dr. Győrfi Adrienne

Irritative factors

1. Microbial irritants: Streptococci,

Lactobacilli,

Actinomyces viscosus

2. Mechanical irritants: inadequate cooling during

cavity or crown preparation,

trauma or orthodontic

movement, deep scaling

and curettage

3. Chemical irritants: alcohol, chloroform,

hydrogen peroxide,

acid etching

Inflammatory mediators

histamine, prostaglandin, szerotonin,

substance P (P-anyag), kalcitonin-gén-

related peptide (CGRP), neurokinin A,

bradykinin, kallidin, nitrogénmonoxid

Classicifacion of pulpal diseases

1. Reversible pulpitis

2. Irreversible pulpitis

3. Hyperplastic pulpitis (Pulp polyp)

4. Pulpal necrosis

5. Pulp calcification

6. Internal resorption

1. Reversible pulpitis

Etiology: cervical erosion, occlusal

attrition, caries, operative procedures

Symptoms: asymptomatic or mild

symptoms

Vitality test: transient pain in response to cold, hot or

electrical stimuli

Radiograph: -

Treatment: removal of the irritative factors, pulp

capping

2. Irreversible pulpitis

Etiology: sequela to reversible pulpitis,

operative procedures, trauma

Symptoms: spontaneous pain

Vitality test: prolonged pain in response to cold,

hot or electrical stimuli

Radiograph: -

Treatment: root canal therapy

3. Hyperplastic pulpitis

(Pulp polyp)

Etiology: in childhood chronically inflammed young pulp is in occlusal surfaces of caries crowns,

a form of irreversible pulpitis

Symptoms: asymptomatic or symptoms of

irreversible pulpitis, in many cases are found during clinical examination as a raddish

cauli-flower-like tissue

Vitality test: similar to normal teeth

Radiograph: -

Hystology: granulomatous tissue

Treatment: pulpotomy or root canal therapy

Pulp polyp

3. Hyperplastic pulpitis

(Pulp polyp)

Etiology: in childhood, same as for irreversible pulpitis

Symptoms: asymptomatic or symptoms of

irreversible pulpitis, a raddish

cauli-flower-like tissue

Vitality test: similar to normal teeth

Radiograph: -

Hystology: granulomatous tissue

Treatment: pulpotomy or root canal therapy

4. Pulpal necrosis

Etyology: sequela to irreversible pulpitis,

traumatic injury

Symptoms: asymptomatic or pain in response

to heat and percussion,

discolouration

Vitality test: the patient doesn’t feel the cold

Radiograph: -

Treatment: root canal therapy

5. Pulp calcification

Etiology: permanent irritative factors: dental caries

Symptoms: yellowish discolouration of the crown

Vitality test: decreased reaction to stimuli

Radiograph: obliteration of pulp chamber and root

canal: pulp stone or calcific metamorphosis

Treatment: -

Pulp stone

Calcific

metamorphosis

5. Pulp calcification

Etiology: dental caries

Symptoms: yellowish discoloration of the crown

Vitality test: decreased reaction to stimuli

Radiograph: obliteration of pulp chamber and root

canal: pulp stone or calcific metamorphosis

Treatment: -

6. Internal resorption

Etiology: inflammation in the pulp

Symptoms: asymptomatic, pink spot in the crown

Vitality test: similar to normal teeth

Radiograph: radiolucent lesion with irregular

enlargement of the root canal

compartment

Treatment: root canal therapy

Internal resorption

6. Internal resorption

Etiology: inflammation in the pulp

Symptoms: asymptomatic, pink spots in the crown

Vitality test: similar to normal teeth

Radiograph: radiolucent lesion with irregular

enlargement of the root canal

compartment

Treatment: root canal therapy