Dr Muath alsalek

1. Disorder of the dental pulp

2.  Inflammation is the most important disease process
affecting the dental pulp

3. pulpitis
 Clincal features:
a clinical diagnosis of acute pulpitis is usually made
when the patient complains of a severe throbbing
pain at times lacinating in type precipitated by hot
or cold stimuli or on lying down and which often
keeps the patient awake , the pain generally lasts for
about 10-15 mins but may be more or less
continuous.

4.  In contrast a clinical diagnosis of chronic pulpitis
is associated with spontaneous attacks of dull
aching pain which can last for an hour or more.

5. Pathway of Pulpitis

6. Etiology
 Dental caries is the most common cause of pulpitis.
 By other MO’s reaching the pulp via other routes.
 Traumatic injury.

7. Microbial
 Bacteria generally reach the pulp as a result of dental
caries.
 Inflammation of the pulp starts before the leading
organisms reach the pulp.
 Pulpitis is seen histologically when the leading
organisms in the dentine are within abuot 1mm of
the pulp in permanent or twice this distance in
deciduous teeth.

8. Chemical and thermal injury
Chemical and thermal injury to the pulp may occur
during restorative procedures.
 Irritant substances may be directly applied to an
exposed pulp or may diffuse through dentine after
insertion of a restorative material.

9. Pulp polyp
 Chronic hyperplastic pulpitis.
 In deciduous or recently erupted permanent
teeth with wide open carious cavities and a good
apical blood supply, pulpitis may be associated with
a hyperplastic response characterized by the
production of exuberant granulation tissue. The
polyp may become epithelialized by the spontaneous
grafting of oral epithelial cells present in the saliva.

11.  Clinically ,an ulcerated pulp polyp present as a dark
red yellow flecked (because of the fibrous
exudates) fleshy mass protruding from the pulp
chamber , which bleed readily on probing, in
contrast , an epithelialized polyp is firmer ,
pinkish white in color and does not bleed readily
 they both usually devoid of sensation on gentle
probing.

12. The effect of cavity preparation and restorative
material
 The speed, heat , pressure and coolants may all
irritate the pulp tissue.
 The main threat to the pulp is from frictional heat
generated during the cutting process.

13.  Histological changes in pulp reaction to restorative
techniques and materials are aspiration or
displacement of odontoblast or their nuclei into the
dentinal tubules and a reduction in the number of
odontoblasts.

14. Healing of pulp
 Animal experiments gave shown that it is possible
for pulpitis to heal if the irritant agent are removed
from the dentine.

15.  In some where the pulp is exposed during cavity
preparation , and following pulpotomy ,it is possible
to maintain pulp vitality by pulp-capping . Ideally
capping agent should be no irritant Should
stimulate the formation of a calcific barrier ,
and have and antibacterial action as most pulp
exposures are contaminated by saliva.

16. Pulp calcification
 Pulp stones are calcified bodies with an organic
matrix and occur most frequently in the coronal
pulp.
 True/false pulp stone.
 True pulp stones contain tubules and may have an
outer layer of predentine and adjacent odontoblasts.

17.  False pulp stones are composed of concentric layers
of calcified material with no tubular structure.
 According to their location in pulp , stones may be
described as free , adherent of interstitial when
they have become surrounded by reactionary or
secondary dentine.
 Pulp stones increase in size and number with
age and after tooth operative procedure.