The document discusses diseases of the dental pulp, including pulpitis, pulp degeneration, and necrosis. It defines reversible and irreversible pulpitis, and describes their causes, signs, and treatments. Reversible pulpitis can be treated by removing irritants, while irreversible pulpitis may require root canal treatment or extraction. Pulp degeneration includes calcific, atrophic, and fibrous changes. Necrosis is the death of pulp tissue from issues like trauma, infection, or treatment. Necrotic pulp is typically treated with root canal therapy.

1. DISEASES OF PULP
Prepared by :- Shagun Kumar (BDS, 2015-19)
Guided by :- Dr. Sachin Mittal
Dr. Shubhankar Dasgupta
Dr. Zeba Rao

2. CONTENTS
•Introduction
•Etiology
•Classification
•Bibliography

3. INTRODUCTION
The pulp or pulp chamber is the soft area
within the centre of the tooth and contains
nerve, blood vessels, and connective
tissue.
Dental pulp is the formative organ of the
tooth and responds to hot and cold
stimulus, that are perceived as pain.
The pulp’s sensory role is important, but it
has other roles as well. The pulp functions
to form dentin, among other things. It
supplies nutrients and moisture the
surrounding areas of the tooth. The pulp
also helps protect the tooth.
Pulpitis refers to the inflammation of pulp. It
is mainly caused by an opportunistic
infection of the pulp space with
commensal oral microorganisms.
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4. NORMAL PULP

5. ETIOLOGY OF PULPAL DISEASES
According to Grossman,
1. Physical
Mechanical Trauma : - Accidental (E.g. - Contact
sports)
- Iatrogenic dental procedure.
Pathological wear
Cracked tooth syndrome
Barometric changes

6. • Mechanical Trauma
May be caused by a violent blow
to the tooth during sports,
accidents, fights etc.
• Pathologic wear of teeth
leading to pulp exposure
due to attrition and
abrasion, or compulsive
bruxism.

7. Cracked tooth syndrome
• Incomplete fracture through body of the tooth,
including cracked enamel that can be appreciated
with the help of dye or by trans illumination.
• Diagnosed by reproducing the pain by asking
patient to bite on rubber wheel. Mild to
excruciating pain can be experienced on biting.

8. • Barodontalgia or Aerodontalgia is observed in altitudes above
50,000 ft. Usually occurs in patients with chronic pulpitis but
not on ground level.
• During ascend, trapped gases expand and move into the
dentinal tubules. Movement of contents from the pulp
chamber to the apex causes pain.

9. • Thermal
Heat from cavity preparation and Exothermic reactions from
setting of cements. ( 20° and 30° rise in temperature at 1mm
and 0.5mm from the pulp chamber, respectively.)
Frictional heat from polishing a restoration.

10. 2. Electrical
Galvanic current due to interaction
dissimilar metals
3. Chemical
Erosion
Dental materials, acrylic Monomer.
4. Bacterial
Direct microbial invasion into the
pulp.
Microbial colonization by blood-
borne microorganisms(anachoresis).
Increased capillary permeability.

11. PULPAL PATHOSIS
1. Deep invasion by microbes and their
byproducts into the dentin.
2. The pulp is affected by byproducts first,
before actual bacterial invasion. (Via
exposed dentinal tubules)
3. Local cellular invasion.
4. When bacterial invasion occurs,
Polymorphonuclear neutrophils are
infiltrated in the pulp. (first line
defense)
5. This is followed by liquefaction necrosis
of exposed site.
6. Eventually, necrosis spreads through
the pulp and if not treated, periapical
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12. CLASSIFICATION

13. WHO CLASSIFICATION
• K04.0 : Pulpitis/pulpal hyperaemia/pulpal
abscess/pulp polyp, acute/ chronic hyperplastic/
ulcerative pulpitis
• K04.1 : Necrosed pulp/pulp gangrene
• K04.2 : Pulp degeneration, denticles/ pulp
calcification
• K04.3 : Abnormal hard tissue formation in pulp
secondary or irregular dentin.

14. DISEASES OF THE PULP
Accordingto Grossman:-
• PULPITIS
1. Reversible Pulpitis (Symptomatic, Asymptotic)
2. Irreversible Pulpitis [ Acute—(a) Abnormally responsive to cold,
(b) Abnormally responsive to heat.
Chronic —–(a) Asymptotic with pulp exposure
(b) Hyper-plastic pulpitis
(c) Internal resorption. ]
• PULP DEGENERATION
1. Calcific (Pulp stones or Denticles)
2. Atrophic
3. Fibrous
• NECROSIS OF PULP

15. A. PULPITIS

16. DEFINITION :
• Reversible Pulpitis denotes a level of pulpal
inflammation in which the tissue is capable of
returning to the normal state if the noxious
stimuli are removed. Also referred to as “PULP
HYPERAEMIA”.
• Irreversible pulpitis is a persistent
Inflammatory condition of the pulp,
symptomatic or asymptomatic caused by a
noxious stimulus.
• It may be acute or chronic.
REVERSIBLE PULPITIS IRREVERSIBLE PULPITIS

17. REVERSIBLE PULPITIS
• Trauma, disturbed occlusal
relationship.
• Thermal shock
• Excessive dehydration of
cavity.
• Irritation of exposed dentin.
• Chemical stimulus.
• Divided into
1. ACUTE – Occurs as a
sequelae of reversible
Pulpitis. Presents as an
acute condition. An acute
exacerbation of chronic
pulpitis.
2. CHRONIC – Inflammation
due to long term low grade
injury. Large cavity,
Asymptomatic with pulp
exposure.
IRREVERSIBLE PULPITIS
ETIOLOGY
Irreversible pulpitis

18. SIGNS AND SYMPTOMS
lead

20. • Prevention
• Periodic care
• Carious lesion should be
excised and restored or
defective filling is replaced.
• Removal of noxious stimuli.
• If primary cause is not
corrected, extensive pulpitis
may result in the death of
pulp.
Chronic :
1. Extraction of
tooth
2. And RCT
TREATMENT
REVERSIBLE PULPITIS IRREVERSIBLE PULPITIS
Acute :
1. Drainage of exudates
from pulp chamber.
2. Pulpotomy & placing
calcium hydroxide over
the entrance of the root
canal.
3. Root canal treatment.
4. Extraction of tooth.

21. • Cap. Amoxicillin 500mg + clavulanic acid 125mg
administered TDS for 5 days
(Maximum dose : 40 mg/kg/day or 2-3 g/25hr)
• Tab. Diclofenac sod. 50mg + Paracetamol 500mg
administered BD x 3 days
• Tab. Pantoprazol 40mg OD x 3 days

22. CHRONIC HYPERPLASTIC
PULPITIS
• Also known as pulp polyp or
pulpitis aperta
Overgrowth of pulp tissue outside
the boundary of pulp chamber as
protruding mass.
A form chronic pulpitis.
Occurs either as a chronic lesion
from onset or as chronic stage of a
previously ACUTE PULPITIS.
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23. CLINICAL FEATURES :
Children and young adults with
high degree of tissue resistance and
reactivity and responds to
proliferative lesions.
Pulp – pinkish red globule of tissue
protruding from chamber and
extend beyond caries.
Most commonly affected are
deciduous molars and 1st
permanent molars.
Lesion bleeds profusely on
provocation.

24. Pulp
polyp

25. TREATMENT
1)Elimination of polypoid tissue followed by
extirpation of pulp, provided the tooth can be
restored.
2)After the removal of the hyperplastic pulp mass
with a curette or spoon excavator, bleeding is
controlled with pressure.
3)The pulp tissue of chamber is completely
removed and a temporary dressing is sealed in
contact with radicular pulp tissue.

26. INTERNAL RESORPTION
• Idiopathic slow or fast progressive resorptive process
occurring in the dentin of pulp chamber or root canals
of teeth.
• When there is insult leading to inflammation (trauma,
bacteria, tooth whitening, orthodontic movement,
periodontal treatment) in the root canal/s or beside
the external surface of the root, cytokines are
produced, and osteoclasts are activated and resorb
the root surface
• Such patients often have a history of trauma.
SYMPTOMS :
1. The root of the tooth is asymptomatic.
2. In crown, it is manifested as a reddish area
called as “Pink tooth of mummery”
3. The reddish area represents the
granulation tissue showing through the
resorbed area of crown.

27. TREATMENT
A. Extirpation of pulp stops
internal resorption.

28. B. PULP DEGENERATION
oPulp degeneration is usually present in teeth of old
people.
oIt may also result in persistent, mild irritation in teeth of
young patients.

29. TYPES OF PULPAL DEGENERATION
1.Calcific degeneration :-
• In this, part of pulp is replaced by calcific
material i.e., pulp stone or denticle.
• It may occur in the root canal or pulp
chamber.
1. :
2. Atrophic/Resorptive
degeneration :
• In atrophic degeneration fewer stellate
cells are present in pulp and intercellular
fluid is increased.
1.
2.
3. Fibrous degeneration :
• In this type of degeneration, pulp is characterised by replacement of
cellular elements fibrous connective tissue.

31. C. NECROSIS OF PULP
 It is the death of pulp
 It may be partial or total, depending on whether part, or the entire
pulp is involved.

32. Types :
Coagulation Caseation Liquefaction
Death of pulp tissue may be with or without bacterial
invasion. When the necrosis is due to ischemia with
superimposed bacterial infection, it is referred to as pulp
gangrene. When the necrosis is non-bacterial in origin, it
is called pulp mummification.

34. Causes : It can be due to any noxious insult
injurious to the pulp, such as bacteria, trauma
and chemical irritation.
Dental caries
Trauma
Treatment
Pulpitis
Infection

35. Pulp necrosis may or may not arise with symptoms.
Signs and symptoms of pulpal necrosis include;
.
Pain
Crown
discolourat
ion
Abscess an
d/or fistula
Internal
root
resorption
Increased
tooth
mobility
There are additional signs of pulp necrosis which may be
detected during radiographic assessment:-;
Untreated
caries
Extensive/
deep
restoration
Previous
pulp capping
However, in some cases there may be no radiographic signs. For
example, pulp necrosis caused by dental trauma which may only
manifest/present itself with time, resulting in clinical changes.

36. . Pulp necrosis
following trauma
Unrestored anterior teeth may
require endodontic treatment
because of pulp
necrosis caused by traumatic
injury

37. Discoloration of tooth, tooth is greyish or brownish in
colour.
Pulp is dead.
Management : Root canal treatment.
Prognosis : Favourable.

38. BIBLIOGRAPHY
• Grossman’s endodontic practice 12th edition
• Review article by Dan- Krister Rechenberg,
Jonah C. Galacia, and Ove A. Peters.
• Burket’s Oral medicine