presentation about diseases of dental pulp

1. Vivek Narayan
Oral Medicine and Radiology

2. 
It is a microbial disease of the calcified tissues
of the tooth (enamel & dentin), characterized
by the demineralization of the inorganic
components and the dissolution of the organic
components of the tooth.
Dental caries

4. 
Pulpitis is defined as the inflammation of the dental pulp
Pulpitis ???
PULPITIS
ACUTE
REVERSIBLE
IRREVERSIBLE
CHRONIC
CHRONIC
HYPERPLASTIC
PULPITIS

5. PULPITIS
Mechanical
Thermal
Chemical
Microbial
Etiology

6. 
Clinical features
 Shorter duration.
 Sensitivity to cold temperatures.
 Mild or moderate pain.
 Pain is relieved on removal of the stimulus.
 Tests positive for EPT at low current.
 Minimal inflammation.
Treatment
 Removal of the irritant.
 Removal of caries and restoration of the tooth.
 Replacement of any defective fillings.
 Analgesics and anti-inflammatories for the pain.
Acute pulpitis – Reversible pulpitis

7. 
Clinical features
 Shorter duration.
 Pain is severe & spontaneous sometimes.
 Pain aggravated by extremes of temperature.
 Pain is not relieved even after removal of the stimulus.
 Radiating pain.
 Pain is also aggravated in supine position – ‘nocturnal pain’.
 Severe inflammation.
Treatment
 Same as reversible pulpitis.
Acute pulpitis – Irreversible
pulpitis

8. 
Clinical features
 Symptoms are milder than the acute form.
 Pain is dull & continuous in nature.
 EPT threshold is increased.
 Presence of a large carious lesion majority of the
time.
Treatment
 Root canal therapy.
 Extraction.
Chronic pulpitis

10. 
Excessive & exuberant
proliferation of the dental pulp as
a result of chronic inflammation.
Clinical features
 Occurs mostly in children &
young adults.
 Large carious lesions.
 Appears as pinkish red mass
protruding out of the carious
tooth.
 May or may not bleed when
probed.
 Deciduous & first permanent
molars are frequently affected.
Treatment
 Extraction of the affected teeth.
Chronic hyperplastic pulpitis
(pulp polyp)

12. 
Spread of infection to the apical
periodontal ligament region.
Clinical features
 Acute or chronic.
 Mild pain while chewing.
 Pain on percussion and on periapical
palpation.
 Tooth feels slightly elevated due to
inflammation & edema in the apical
region.
Radiographic features
 Loss of lamina dura in the periapical
region.
 Widened periodontal ligament space.
Treatment
 Endodontic treatment.
Periapical periodontitis

13. It is a localized mass of granulation
tissue formed at the apex.
Clinical features
 Asymptomatic.
 Mild pain present.
 Pain present while chewing.
 Tooth is elevated from the socket.
Radiographic features
 Radiolucent area present attached
to the tooth apex.
 Well circumscribed & demarcated
from the surrounding bone.
Treatment
 Extraction of the affected tooth.
 Apicectomy in some cases.
Periapical granuloma

14. Acute or chronic suppurative process of the periapical
region of the tooth.
Clinical features
 Carious or a discolored tooth.
 Tooth is very painful & is extruded from the socket.
 Regional lymphadenitis & fever.
 Chronic form generally presents with no features.
 Sinus tract openings.
Radiographic features
 Ill defined periapical radiolucency.
Treatment
 Drainage of pus.
 Extraction of the affected tooth.
 Endodontic treatment done sometimes.
Periapical abscess

15. ABSCESS
Organism - staphylococcus
Coagulase secretion
Fibrinogen (from exudate) Fibrin
Fibrin barrier
Localization of pus
SPREADING INFECTION
Organism - streptococcus
Streptokinase & hyaluronidase
secretion
Breakdown of hyaluronic acid
(cement substance)
Streptococci consumes local O₂
creates anaerobic environment
Growth of anaerobes -
collagenase
Perforation of bone
Spread of infection

16.  Infection gone beyond the alveolar
bone & involves the neighbouring
soft tissues as a localized form.
 Pain is continuous and may be
described as extreme, growing,
sharp, shooting, or throbbing in
nature.
 Acute onset.
 Localized intraoral & extraoral
swelling.
 Trismus.
 Lymphadenitis.
 Pyrexia.
Dentoalveolar abscess

17. 
Cellulitis
Spread of infection diffusely into fascial planes of soft
tissues.
Cellulitis
Ludwig’s angina
Cavernous sinus
thrombosis

18. 
Clinical features
 Edematous periorbital
enlargement.
 Canine space is infected.
 Ptosis.
 Induration of the swelling.
 Fever, headache, nausea.
 CNS spread leads to meningitis.
Treatment
 Surgical drainage.
 High dose antibiotics.
 Extraction of affected tooth.
 Anticoagulants.
Continued…

19. Clinical features
 Chronic in nature & asymptomatic.
 Mostly associated with a non vital tooth.
 Swelling is present if the cyst expands by destroying bone.
 Initially swelling is bony hard but later exhibits ‘egg shell’ crackling.
 Due to acute exacerbation, the cyst can turn into an abscess.
Radiographic features
 Well circumscribed radiolucency in the periapical region.
 Radiolucency surrounded by sclerotic border.
 Radiolucency is bigger than that of a periapical granuloma.
 Root resorption.
Treatment
 Extraction of the affected tooth.
 Endodontic therapy.
 Marsupialization.
Periapical cyst (radicular cyst)

20. Caries in enamel
Caries in dentin
Caries in pulp - pulpitis
Acute pulpitis Chronic pulpitis
Acute periapical
periodontitis
Chronic periapical
periodontitis
Chronic periapical
abscess
Acute periapical
abscess
Dentoalveolar abscess
Periapical granuloma
Radicular cystCellulitis
Sequel
Of
Pulpitis