L8 Pulpitis Flashcards
(27 cards)
What is pulpitis?
The inflammatory response to tissue damage of pulp.
How is the pulp affected in caries?
- Tooth surface cavitates
- Bacteria enters cavity and dentinal tubules
- Products of bacterial metabolism penetrate along tubules to reach pulp
- These products damage cells of the pulp including odontoblasts
Pulp can be classified according to what 2 factors?
Clinical classification:
- Acute
- Chronic
Pathological classification:
- Parital or total
- Open or closed (open = coronal pulp is open to oral cavity)
- Exudative (serum based) or suppurative (pus based)
Describe the clinical presentation of pulptitis.
- Predominantly pain but some patients will present without pain
- Pain will be difficult to localise to a specific tooth, pain may radiate to adjacent jaw and sometimes to the face, ear and neck
- Pain may be continuous or intermittent
What are the clinical signs of acute pulptitis?
Severe, throbbing pain.
Made worse by hot or cold, and lying down.
May keep patient awake.
What are the clinical signs of chronic pulpitis?
Spontaneous attacks of dull, aching pain.
Lasts 1-2 hours.
What is the difference between reversible and irreversible pulpitis?
- Reversible pulptitis: restorative treatment will cause pulpitis to resolve
- Irreversible pulpitis: no matter what intervention, pulpal inflammation is likely to persist and ultimately cause total pulp necrosis
What does pulp management depend on?
- Patient age
- Size of carious lesion
- Presence of symptoms
- Vitality testing
- Radiographic changes
Describe physical causes of pulpitis.
Physical trauma:
- Tooth fracture
- Cracked tooth
- Iatrogenic (e.g. during cavity preparation)
Describe microbial causes of pulpitis.
Microbial:
- Bacteria and bacterial products reach the plup as a result of caries
- Pulp changes seen when bacteria are 1mm from pulp in adult teeth, 2mm from pulp in deciduous teeth
Describe chemical causes of pulpitis.
Chemical:
- Irritant chemicals reach pulp by diffusing through dentinal tubules e.g. during restorative treatment
- Iatrogenic: applied directly to exposed pulp during restorative treatment
Describe thermal causes of pulpitis.
Thermal:
- Heat generated by friction in cavity preparation
- Unlined large metallic fillings may transmit thermal changes to the pulp (e.g amalgam in contact with gold)
What factors may modify the inflammatory process?
- Local anatomy of the pulp chamber
- Nature of the damaging agent
- Duration and severity of tissue damage
- Pre-existing state of the pulp
- Host defences
- Apical blood flow: whether the apical foramen is already closed, or if tooth is still developing and apex still open
How can pulpitis lead to total pulp necrosis?
- Increased vascular permeability causes inflammatory exudate to enter pulp chamber
- Local rise in tissue pressure could cause local collapse of venous part of microcirculation
- Local tissue hypoxia and anoxia produces further tissue damage, and further inflammation causes increase in pressure
- Can lead to total pulp necrosis
What is the main host defence against pulpitis?
Reparative dentine formation:
- Begins 20 days after initial damage
- Produced at rate of 0.1mm over next 100 days
What tissue type may be seen in pulpitis?
Granulation tissue
What immune cells may be present in pulpitis?
Lymphocytes (large dark nucleus), plasma cells (odd positioned nucleus) and macrophages (pale nucleus).
NB: loss of odontoblasts
Pulpitis progression depends on what?
- Severity and duration of tissue damage
- Properties of the bacteria
- Host resistance
How do neutrophils reach the pulp tissue and what can neutrophil accumulation cause?
- When bacteria reach the pulp there is vascular dilation
- Neutrophils migrate from vessels
- Majority of pulp entering the pulp is destroyed by neutrophils and other defence mechanisms
- Local tissue necrosis and neutrophil accumulation leads to suppuration (pulp abscess)
Describe the cellular composition of a pulp abscess.
- Necrotic tissue with many neutrophils (multi-lobed nucleus)
- Almost no viable tissue remaining
What membrane may form around a pulp abscess?
A pyogenic membrane (made of granulation tissue)
How can a pulp abscess cause pulp necrosis?
Abscess may extend through the pulp, causing necrosis.
What is pulp necrosis?
Inflammation of the entire pulp, reaches the root apices. Pulp completely dead.
What is a pulp polyp?
- A pink soft tissue swelling attached to the dental pulp
- Seen as bright red or pink soft tissue mass within large carious caivty
- Seen in primary teeth or
permanent teeth with wide
open root apices thus pulp
has good blood supply - Core of dense fibrous tissue, oftem with squamous epithelium on surface to protect from bacteria
- Called chronic hyperplastic pulpitis
