Pulpitis An inflammation of the pulpal tissue that may be acute or chronic with or without symptoms, and reversible or irreversible.

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Peregrine Rice
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1 Pulpitis An inflammation of the pulpal tissue that may be acute or chronic with or without symptoms, and reversible or irreversible. Acute pulpitis - severe dental pain abrupt in onset short duration keeps patient awake at night Chronic pulpitis - milder, duller pain longer duration varying intensity hard to localize periodic Reversible pulpitis - mild, diffuse pain short duration - hours elicited by heat or cold Irreversible pulpitis - severe, radiating pain long duration varying intensity of pain spontaneous pain hyperreactive response to vitality testing Septic pulpitis - bacteria enter through: -carious exposure -mechanical exposure during dental treatment -coronal fracture following trauma Aseptic pulpitis - trauma in the absence of infectious MOs -following placement of restorations -following direct physical trauma Chronic hyperplastic pulpitis - A reaction to deep caries in a young tooth in which an inflamed pulp extends through a large carious lesion. Bacterial, chemical, or physical irritation Main Pathologic Process: Inflammation LMDC Page 1 of 10

2 Acute Pulpitis An inflammation of the pulp caused by injury to the pulp, usually from dental caries or trauma. Usually occurs in a tooth with a large carious lesion or a defective restoration Usually found in the teeth of children and adolescents Constant, severe tooth-associated pain, intensified with the application of heat or cold Bacterial, Chemical, or Physical Irritation Histological Features: Acute inflammation (PNM s) Dystrophic calcification LMDC Page 2 of 10

3 Reversible Pulpitis Mild inflammation of the tooth pulp caused by caries encroaching on the pulp. Hypersensitive to thermal (hot or cold) or sweet stimulus which rapidly disappears when stimulus is removed Localized increase in intrapulpal pressure Threshold stimulation for A-delta nerve fibers is lowered Bacterial, chemical, or physical irritation pulp tissue Histologic Features: Inflammatory cells Disruption of the odontoblastic layer Dilated blood vessels Main Pathologic Process: LMDC Page 3 of 10

4 Inflammation Treatment: No treatment other than time for the tooth pulp to heal Prognosis: Good Irreversible Pulpitis Progresses from reversible pulpitis, a severe inflammation of the pulp. Hypersensitive to thermal stimulus (hot or cold) which produces a pain which lingers for minutes when stimulus is removed Pain is severe, persistent and poorly localized Pain may radiate to ear, temple, eye or neck Bacterial, chemical, or physical irritation Histological Features: LMDC Page 4 of 10

5 Dilated blood vessels and inflammatory cells Inflammation in adjacent areas Localized area of necrosis Main Pathologic Process: Inflammation Treatment: Root canal treatment or extraction Prognosis: Good Chronic Pulpitis with Pulp Stone An inflammation of the pulp caused by injury to the pulp, usually from dental caries or trauma. Symptoms, mild and intermittent over an extended period of time Responses to thermal and electric stimulation are reduced over a period of time LMDC Page 5 of 10

6 Radiographic Features: Radiopaque pulp stones Bacterial, chemical, or physical irritation Histological Features: LMDC Page 6 of 10

7 Chronic inflammation (lymphocytes, plasma cells [Russell Bodies], macrophages) Presence of dystrophic calcification Loose, delicate connective tissue Possible presence of pulp stones Main Pathologic Process: Inflammation Treatment: Eliminate the cause of inflammation Endodontic therapy or extraction is typically required Prognosis: Pulpal death is the characteristic end result Pulpal Necrosis A term applied to pulp tissue that is no longer living, may be partial or complete. LMDC Page 7 of 10

8 Discolored tooth Teeth do not respond to either cold or electric pulp tests May range from being a symptomatic to being very sensitive to percussion Radiographic Features: Radiolucent pulp chamber Bacterial, chemical, or physical irritation Histological Features: Abscence of normal pulp tissue Necrotic cells and fluid Inflammation with both vascular and cellular phases LMDC Page 8 of 10

9 Main Pathologic Process: Inflammation Pulpal Abscess An inflammation of the dental pulp, associated with a circumscribed collection of necrotic tissue and pus arising from breakdown of leukocytes and bacteria, sometimes walled off with connective tissue. Severe painful toothache Hypersensitive to thermal (hot or cold) stimulus Possible fever General discomfort Swollen jaw and glands possible Bacteria Histological Features: Area of necrosis with purulent exudates LMDC Page 9 of 10

10 Granulation tissue Inflammatory cells Main Pathologic Process: Inflammation Treatment: Root canal therapy or extraction Prognosis: Good May lead to serious medical problems if left untreated LMDC Page 10 of 10

Communication Task - Scenario 1 CANDIDATE COPY

Communication Task - Scenario 1 Your patient is 30 years old, and has presented today complaining of pain from the lower right posterior side. The tooth had been cold sensitive for several weeks, but the