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Diseases of the Dental Pulp

1-21. GENERAL

Pulp is an extremely sensitive tissue that can only elicit pain. It can be subjected to many irritations resulting from dental caries, exposure to excessive heat or cold, and mechanical, chemical, or electrical stimulation. In a healthy tooth, the enamel and periodontal tissues act as mechanical and insulating coverings. If the enamel or cemental tissues covering the root are damaged or removed, the underlying dentin is exposed. The dentin then becomes sensitive to external irritants because of the movement of fluid in and out of the dentinal tubules. This fluid movement causes stimulation of the sensitive pain receptors inside the dentin pulp. Injuries such as dental caries, trauma, developmental defects and/or diseases, or dentistogenic (dentist-caused) injuries can have a negative effect on the pulp. Among the diseases that occur in the pulp are acute pulpitis, chronic pulpitis, pulp abscesses, hyperplastic pulpitis, and a number of degenerative changes (diseases) that take place. Acute and chronic pulpitis and pulp abscesses are commonly encountered in clinical dental practice.

1-22. ACUTE PULPITIS

Acute inflammatory changes in the pulp are often caused by bacteria that have gained access to the exposed pulp. These changes may cause an initial inflammation or a flare-up of a chronic inflammation. The active growth of the organisms in the environment of the pulp produces rapid destructive changes. These changes are accompanied by symptoms which can be correspondingly severe. Clinically, severe pulsating pain is caused by the rapid buildup of pressure within the tooth. Release of pressure by opening into the pulp chamber brings almost immediate relief. If the condition is severe enough, it may be accompanied by fever, headache, and malaise. As the inflammation progresses, it gradually may involve the entire pulp. Inflammation can spread to the periapical tissues and cause the tooth to loosen and be sensitive to externally applied pressure. It may pass beyond the periapical tissues to involve the surrounding bone and perforate the periosteum and overlying tissues to drain either into the mouth or through the skin.

1-23. CHRONIC PULPITIS

Chronic pulpitis may be the result of persistent mild to moderate irritation of the pulp or it may follow a period of acute pulpitis. Chronic pulpitis may either resolve itself or continue with slow destruction of the entire pulp, involving also the periapical tissues. Chronic pulpitis may also develop into an acute infection in the presence of virulent organisms that have reached the pulp from the mouth. Chronic pulpitis is usually characterized by intermittent periods of mild to moderate pain or no pain at all. These intermittent periods are associated with periods of increased activity and buildup of pressure in the pulp chamber and root canals.

1-24. PULP ABSCESS

Localized areas of infection, such as an abscess with pus, may develop within the pulp tissue. Abscesses may be found in teeth in which restorations have been placed or in teeth having no detectable lesion. They can produce severe, intermittent pain that may increase when the patient lies down. This sharp pain may respond to the application of cold, tapering off to a dull pulsation. The affected tooth is sometimes difficult to identify because of the occasional absence of caries or other identifiable causes. Lack of involvement of the periapical tissues also makes it difficult to identify the affected tooth. The tooth may not differ from the other teeth in its sensitivity to percussion or other externally applied pressure.

1-25. HYPERPLASTIC PULPITIS

Hyperplastic pulpitis is occasionally encountered in deciduous teeth as an enlargement of the pulp following carious destruction of the tooth crown. It is an unusually excessive reaction to inflammation. The exposed pulpal tissues extrude through a communication to the oral cavity and an excessive inflammatory reaction results. It is seen as a soft palpable mass (pulp polyp) overlying the pulp chamber, exposed within the crown portion of the tooth. There is usually no pain associated with this condition.

1-26. DEGENERATIVE CHANGES OF THE PULP

Since the pulp of the tooth is subjected to a variety of bacterial, mechanical, or chemical irritations, degenerative changes often occur within the pulp. Types of degenerative changes include calcific degeneration, pulp stones, and fibrosis. Degenerative changes seldom have any clinical significance. To a certain extent, they are normal physiological processes. They do, however, make any future endodontic treatment more difficult for the dental officer.

David L. Heiserman, Editor

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Revised: June 06, 2015