DISEASES OF THE PULP AND PERIAPICAL TISSUES
DENTAL PULP
Delicate connective tissue with tiny blood vessels, lymphatics, myelinated and unmyelinated nerves and undifferentiated connective tissue cells. Reacts to noxious stimuli by an inflammatory response. ETIO O!I" #$"TOR% "$&%I'! (& ($ I'# $))$TIO' "aries Tooth fracture "hemical irritation %evere thermal chan*es
PULPAL PATHOLOGY
I. Focal Reversible Pulpitis or Pulp Hyperemia Clinical Features Exhibits sensitivity to thermal stimulus especially to cold $pplication of cold stimulus causes pain but disappears upon removal of stimulus Elicits positive response to lower currents of the E(T indicatin* a lower pain threshold (resence of + , deep caries , lar*e metallic restoration with inade-uate insulation , restoration with defective mar*ins
Histologic Features
)icroscopic study reveals dilation of pulp vessels with accumulation of edematous fluid due to dama*e to capillary walls allowin* extravasation of R." Treatment and Prognosis , condition is reversible
II.
Restoration of carious lesion $%$( is recommended.
Acute Pulpitis Extensive acute inflammation of the dental pulp is common se-uelae of focal reversible pulpitis . Clinical Features
lar*e caries or lar*e defective restorations
/ 0 1 response to cold stimulus which persists even after the stimulus has been removed lancinatin type of pain due to the pulpal tissue dama*e the tooth reacts to the E( tester at a lower level of current than a normal tooth indicatin* an increased sensitivity of the pulp. 2hen necrosis of the pulp tissue occurs, this sensitivity is lost Histologic Features
early acute pulpitis is characteri3ed by continued vascular dilatation alon* the walls of these vascular
pavementin* of ()' 4s becomes apparent channels odontoblasts in this area may be destroyed
a *reat collection of 2."4s may be seen beneath the carious lesion
if inflammatory process persists, the entire pulp may under*o necrosis. Treatment
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Root canal therapy or extraction of the tooth III. !"ronic Pulpitis
may arise from a previous acute episode or it may occur as a chronic episode from the onset si*ns and symptoms are milder than the acute form
Clinical Features pain is usually mild, dull, and 5or intermittent increased E(T current will illicit pulpal response as compared to acute pulpitis
Histologic Features characteri3ed by infiltration of mononuclear cells, chiefly lymphocytes and plasma cells Treatment
root canal therapy or extraction
IV. Chronic Hyperplastic Pulpitis / Pulp Polyp
defined as an excessive, exuberant proliferation of chronically inflamed dental pulp. It occurs almost exclusively amon* children and youn* adults. It involves teeth with lar*e, open carious lesions.
PERIAPICAL PATHOLO !
#$ PER#AP#!AL GRANULO%A
most common of all se-uela of pulpitis. It is essentially a locali3ed mass of chronic *ranulation tissue formed in response to an infection. Clinical Features
/ 0 1 response to percussion or pain associated with chewin* due to the spread of infection beyond the apex the tooth feels elon*ated 6 this is due to the edema and inflammation of the apical periodontal li*ament Radiographic Features
the earliest periapical chan*e appears as thic7enin* of the li*ament at the apex
the proliferation of the *ranulation tissues accompanied by bone resorption at the apical re*ion the periapical *ranuloma appears as a radiolucent area at the root apex
Histologic Features the *ranuloma is made up of or*ani3in* connective tissue with numerous capillaries, and a fibrous capsule that has colla*enous fibers. )acropha*es and other *ranulomatous inflammation. mononuclear pha*ocytes are the hallmar7 of
The proliferatin* epithelium ori*inates from the epithelial rests of )alasse3
Treatment root canal therapy or extraction of the involved tooth
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##$ AP#!AL PER#ODONTAL !Y&T This is considered as a true cyst since the lesion is consists of a patholo*ic cavity that is lined by epithelium and is often filled with fluid. Clinical Features
onset
asymptomatic, usually does not present any clinical evidence of its presence at the
it rarely produces expansion of the cortical plates and does not usually *row to a si3e that destroys overlyin* bone this type of lesion develops over a lon* period of time and may under*o an acute exacerbation of the inflammatory process and develop rapidly into an abscess Radiographic Features reveals a circumscribed radiolucent area at the apex of the tooth sometimes there may be a thin radiopa-ue line around the periphery of the radiolucent area as a reaction of the bone to the expandin* mass Histologic Features epithelial linin* is made up stratified s-uamous type the connective tissue that ma7es up the wall of the cyst is composed of parallel bundles of colla*en fibers the inflammatory infiltrate is mostly made up of lymphocytes and plasma cells
Treatment extraction of the tooth with curetta*e to remove the cyst or root canal therapy with apicoectomy
###$ Periapical Abcess
Clinical Features
Acute abcess 6 the tooth is extremely painful and is sli*htly extruded from the soc7et. %wellin* or expansion at the apical area of involved tooth !"ronic abcess 6 *enerally presents no clinical features since it is essentially a mild, well,circumscribed area of suppuration that shows little tendency to spread from the local area. %ometimes a fistula may be present where the pus drains. Radiographic Features
the acute periapical abcess is such a rapidly pro*ressive lesion that usually shows no radio*raphic evidence. The chronic abcess may present similar radio*raphic picture as in a *ranuloma or cyst Histologic Features
the area of suppuration is composed chiefly of a central area of disinte*ratin* ()' 4s surrounded by viable leu7ocytes and lymphocytes. There is dilatation of the blood vessels in the periodontal li*ament and ad8acent marrow spaces. These marrow spaces also show an inflammatory cell infiltrate. Treatment
(atient must be *iven antibiotic covera*e. Incision and draina*e is done for fluctuant swellin*. Tooth involved may be extracted or be treated by root canal therapy.
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!HRON#! AP#!AL PER#ODONT#T#& '!AP(
"hronic abcess (eriapical cyst (eriapical *ranuloma
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