Pulpal disease l Oral pathology MCQ

 Pulpal disease pathology ; reversible and irreversible pulpitis , chronic hyperplastic pulp inflammation , pulp necrosis and internal resorption l Oral pathology MCQs for dental students

Pulpal pathology :

• The bacterial or traumatic exposure of the pulp can cause inflammatory or degenerative pathologies of pulp which may range in severity from pulpal hyperemia, to varying degree of pulpal inflammation or to pulpal degeneration or to pulpal necrosis and to any subsequent sequel to periradicular tissue.

Classification of Pulpal Pathosis

1. Reversible pulpitis-Acute and chronic
2. Irreversible pulpitis, -Acute and chronic
3. Chronic hyperplastic pulpitis
4. Necrosis
5. Calcification
6. Internal resorption

Reversible pulpitis

• Is very mild inflammatory pulpal reaction to incipient caries, mechanical wear, operative trauma, and enamel fractures.

• The reversible pulpitis can be better described as pulpal hyperemia. It causes hypersensitivity to thermal and electric stimuli. The pain is mild to moderate and is typically intermittent. Microscopically,

• The prominent features are dilation and engorgement of pulpal blood vessels, edema and extravasation of red blood cells.

• Reversible pulpits may be acute and chronic.

Chronic reversible pulpitis

• Is usually asymptomatic. Acute form is associated with sharp transient pain evoked by extermal stimuli. Removal of these stimuli, result in immediate relief from the pain.

• The condition is treated through the removal of irritant and the restoration of exposed tooth surface. If left untreated the condition may progress to pulpal necrosis.

• Acute irreversible pulpitis is a severe inflammatory pulpal reaction which occurs as sequel to reversible pulpitis.

• Pulpal damage may range in severity from simple acute inflammation to focal liquefaction necrosis to total pulpal suppurative necrosis.

• Spontaneous consistent, severe, tooth-associated pain is the presenting symptom.

• Pain is intensified with the application of heat or cold, although in cases in which liquefaction of the pulp has occurred, cold may in fact alleviate the symptoms.

• This is due to the fact that cold causes vasoconstriction with a drop in pulpal pressure and subsequent pain relief.

• Early in the acute pulpitis the tooth may be hyper reactive to electric stimulation, but as pulp damage increases, sensitivity is reduced until there is no response.

• The treatment of acute irreversible pulpitis is pulpectomy.

Chronic irreversible pulpitis

• Is an inflammatory reaction that results from long-term, low-grade infection or occasionally from quiescence of an acute process.

• Chronic pulpitis is usually asymptomatic or may present with milder symptom. A dull ache may be the presenting symptom.

• Microscopically, lymphocytes, plasma cells, and fibrosis appear in the chronically inflamed pulp.

• Extension of inflammation to the periodontal ligament will leads to tenderness of the tooth, percussion sensitivity and better localization of pain.

• Treatment is pulpectomy or extraction of the involved tooth, depending on the severity of sign and symptom, restorability of the tooth and on the periodontal status of the tooth.

Chronic Hyperplastic pulpitis (pulp polyp)

• Is a form of chronic irreversible pulpitis, characterized by excessive or exuberant proliferation of the chronically inflamed young pulp.

• The pulp reacts in a hyperplastic manner to produce reddish cauliflower like mass of reparative granulation tissue that extrudes through the pulp exposure.

• The tissue is sensitive to manipulation. The condition is usually seen in larger carious lesions of both primary and permanent molar teeth in children and young patients.

• High vascularity of young pulp, large root opening, high tissue resistance and reactivity in young persons are the reason of unusual tissue proliferation.

• Hyperplastic pulpitis is usually asymptomatic.

• It is sometime associated with clinical signs of irreversible pulpitis such as spontaneous pain as well as lingering pain to cold and heat stimuli.

• Treatment is the endodontic treatment or extraction of the given tooth

Pulpal necrosis

• The human pulp is encased in rigid walls of enamel, dentin and cementum and has no collateral blood circulation.

• The pulpal venules and lymphatics collapse under increased tissue pressure. The disruption of the vasculature due to severe inflammation of the pulp following physical, bacterial or traumatic insult, results in liquefaction necrosis or ischemic necrosis of the pulpal tissue.

• The pulpal necrosis is usually asymptomatic but may be associated with spontaneous pain and tenderness of the tooth. Root canal treatment or extraction is the indicated treatment.

Pulpal Calcification

• Usually in the form of pulp stones or diffuse calcification may occurs in response to pulpal irritation or to persistent trauma, chronic caries, or other irritants.

• Thrombi in blood vessels and collagen sheaths around vessel walls are possible nidi for these calcifications. This process is known as calcific metamorphosis.

• As irritation increases, the amount of calcification may also increase, leading to partial or complete obliteration of the pulp chamber and root canals: A yellowish discoloration of the crown is often a manifestation of calcific metamorphosis.

• The pain threshold to thermal and electrical stimuli usually increases, or often the teeth are unresponsive.

• In contrast to soft tissue diseases of the pulp, which have no radiographic signs and symptoms, calcification of pulp tissue is associated with various degrees of pulp space obliteration.

• This condition in and of itself is not a pathosis and does not require treatment.

Internal resorption

• Is an unusual condition wherein the inflammatory condition within the pulpal tissue may initiate the resorption of adjacent hard tissues due to the dentinoclastic activity of the vascularized inflammatory tissue.

• The resorption begins from within the pulpal chamber towards the periphery. The condition is either idiopathic or secondary to trauma.

• The first clinical sign may be the appearance of pink-hued area on the crown of the tooth. The internal resorption can be managed with conventional non-surgical root canal treatment.

• In cases of perforation of the root to the periodontal ligament, calcium hydro-oxide preparation can be tried to repair the perforation.