Diagnosis of Dental Pulp and Periapical Area

Disorders

I- Diagnosis of Dental Pulp Disorders

Diagnosis of Dental Pulp Disorders

1-Tooth is sensitive to thermal changes especially the cold.

2-Pain disappears after removal of stimulus.3-Tooth is vital and responds well to electric pulp tester

( lower level of current.)4-Tooth is usually with deep carious lesion, or large metallic restoration without adequate isolation, or

restoration with defective margins.5-Recent restoration may be with poor lining, or cavity

preparation without cooling.6-Tooth return to a normal condition after removing

the cause.

*Diagnosis of focal reversible pulpitis (Pulp hyperemia):

1-Severe pain in thermal changes especially the cold.2-Pain persists even after removal of stimulus.

3-Tooth is vital and responds well to electric pulp tester ( very low level of current.)

4-Tooth is usually with large carious lesion, or defective restoration with recurrent caries.

5-General symptoms such as fatigue with delirium.6-Damage of pulp is irreversible and the tooth does not

return to normal after treatment.

*Diagnosis of acute pulpitis:

Diagnosis of Dental Pulp Disorders

1-Reaction to in thermal changes is dramatically reduced .2-Dull intermittent pain .

3-Tooth is necrosis and may respond to electric pulp tester ( high level of current.)

4-Tooth is usually with large carious lesion, or defective restoration with recurrent caries.

5-Probing of the pulp is painless in most cases.6-Damage of pulp is also irreversible.

*Diagnosis of chronic pulpitis:

Diagnosis of Dental Pulp Disorders

1-Tooth has a large, open carious lesion .2-It is usually found in children and young adult .

3-Most commonly teeth involved are deciduous molars and first permanent molars.

4-Pulp tissue appears asymptomatic pinkish red protruding from the pulp chamber and filling the entire cavity.

5-Probing may or may not cause bleeding depending upon vascularity of lesion .

6 -It must be differentiated from gingival polyp which is due to inflammation of the gingival near a broken tooth------it

proliferates to the broken area. To differentiate between them by probe where the gingival polyp is usually attached

to the gingival, while the pulp polyp coming from the pulp.

*Diagnosis of chronic hyperplastic pulpitis (Pulp polyp):

Diagnosis of Dental Pulp Disorders

Clinical features of pulp polyp.

1-It is the final stage of untreated pulpitis.2-It is asymptomatic condition.

3 -Tooth is usually with large carious lesion, or defective restoration with recurrent caries, or traumatic fracture.

4-Tooth is necrosis and does not respond to electric pulp tester.

5-Probing of the pulp is painless.6 -It may cause discolored tooth due to degeneration of

the dentinal tubules caused by death of the pulp.

*Diagnosis of Pulp necrosis (Pulp gangrene):

Diagnosis of Dental Pulp Disorders

Clinical feature of pulp necrosis

II- Diagnosis of Periapical Area Disorders

1 -It may be due to very mild and long standing irritation.

2-It is asymptomatic condition.3-Radiographically, it appears as a thin

well-defined radiopaque layer around the apical area.

*Diagnosis of periapical sclerosis:

Diagnosis of Periapical Area

Disorders

1-Tooth may be with penetrating carious lesion, or old defective restoration, or old

traumatic fracture.2-Gingival inflammation with infrabony pocket.

3-Tooth is tender to percussion.4-Painful in bitting or chewing a solid food.

5-Negative vitality test.6-Radiography reavels to widening of the

periodontal ligament at the apical area.

*Diagnosis of apical periodontitis:

Diagnosis of Periapical Area

Disorders

1-The involved tooth is extremely painful.2-The involved tooth is extremely sensitive to percussion .

3-The involved tooth is slightly extruded from its socket.4-Presence of systemic manifestations such as pain ,

swelling, fever and redness of overlying skin.5-The periapical abscess may be intraorlly )buccally or

lingually( or extraorally.6-Radiographically, it appears as an amorphous radiolucent

area with ill-defined irregular margin in the periapical area of the involved dental root.

7-Complications of untreated periapical abscess: a-Osteomyelitis. b-Cellulitis.

c-Bacteremia. d-Maxillary sinusitis.

Diagnosis of Periapical Area

Disorders*Diagnosis of periapical abscess:

Radiographical features of periapical abscess

*Diagnosis of periapical granuloma:

1-Mild pain when bitting or chewing on solid food.2-The involved tooth is mild sensitive to percussion .

3-The involved tooth is slightly extruded from its socket.4-No presence of systemic manifestations .

5-It could be discovered by routine radiographical examination.6-Radiographically, it appears as a rounded radiolucent area

with well-defined regular margin surrounding the apical foramen of the involved dental root and ranges from few

millimeters to 1 cm in diameter.7-Complications of untreated periapical granuloma:

a-Pain due to infected periapical granuloma. b-Periapical cyst develops due to proliferation of the

epithelial rests of Malassez presenting in the histological structure of periapical granuloma.

Diagnosis of Periapical Area

Disorders

Radiographical features of periapical granuloma

*Diagnosis of periapical cyst:1-It usually occurs in adult life.

2-It is more common in males than females.3-It is more frequently in the maxilla, specially the anterior region.

4-It is asymptomatic condition.5-There is usually a non-vital tooth from which the cyst

has developed.6-Radiographically, it appears as a round or ovoid well-defined

radiolucent area with narrow opaque margin that is continuous with the lamina dura of the involved tooth and ranges from

5 mms to several cms in diameter.7-Complications of untreated periapical cyst:

a-Increase in size. b-Residual cyst develops due to extraction of tooth without

enucleating or defective enucleating the periapical cyst.

Diagnosis of Periapical Area

Disorders

Radiographical features of periapical cyst