DISEASES OF PULP

CONTENTS
• INTRODUCTION

• CAUSES

• FIBERS ASSOCIATED WITH DENTAL PAIN.

• CLASSIFICATION.

• REVERSIBLE PULPITIS.

• IRREVERSIBLE PULPITIS.

. ACUTE PULPALGIA.(ACUTE PULPITIS)

. CHRONIC PULPALGIA.(SUBACUTE PULPITIS)

 CONTENTS

. CHRONIC PULPITIS

. CHRONIC HYPERPLASTIC PULPITIS.

. PULP NECROSIS.

. ATROPHY.

. DISTROPHIC CALCIFICATION.

. REFERENCES

. CONCLUSION.
 CAUSES OF PULP DISEASE

• PHYSICAL
A. MECHANICAL
1. TRAUMA
a. ACCIDENTAL(CONTACT

SPORTS)
b. IATROGENIC DENTAL
PROCEDURES

2. PATHOLOGIC WEAR
(ATTRITION, ABRASSION
etc).
3. CRACKED TOOTH
SYNDROME.
4. BARODONTALGIA.
 CAUSES OF PULP DISEASE

B. THERMAL

1. HEAT FROM CAVITY

PREPRATION.

2. EXOTHERMIC HEAT FROM

SETTING OF CEMENTS.

3. CONDUCTION OF HEAT OR
COLD THROUGH DEEP
FILLINGS WITHOUT ANY
PROTECTIVE BASE.

4. FRICTIONAL HEAT CAUSED BY

POLISHING A RESTORATION.
 CAUSES OF PULP DISEASE

• CHEMICAL

A. PHOSPHORIC ACID ACRYLIC

MONOMER.
B. EROSION ACIDS.

• BACTERIAL

A. TOXINS SSOCIATED WITH

CARIES.
B. DIRECT INVASION OF PULP
FROM CARIES AND
TRAUMA.
C. ANACHORESIS.
 FIBERS ASSOCITAED WITH
DENTAL PAIN
A DELTA FIBERS C FIBERS
DIA 2-5 0.3-1.2

DIA OF PARENT FIBER SAME DIAMETER

SMALLER BRANCHES EMERGE THROUGHOUT THEIR
FROM PARENT FIBER KNOWN LENGTH.
AS TELODENDRITE.

CONDUCTION
VELOCITY 5-30 0.4-2

MYELINAIED YES, NO NO
 FIBERS ASSOCITAED WITH
DENTAL PAIN
A$ FIBERS C FIBERS

LOCATION IN THE TERMINALS

TERMINALS IN
SUBODODNTOBLASTIC NEAR BLOOD
ZONES VESSELS ALSO
THROUGHOUT
THE PULP

PAIN CHARACTERSTICS

LINGERING
SHAR,PRICKING THROBBING
UNPLEASENT ACHING
BEARABLE LESS BEARABLE
Responses of pulpal A- δ and C nerve fibers to special stimuli
Stimulus A- δ C
(Low threshold) (High threshold )
Intrapulpal pressure change
Sudden nerve compression Increased response Increased response
Prolonged nerve compression Decreased response Resistant to pressure
(may block pain impulses) increased

( impulses will continue)

Vitality tests
Electric Positive (immediate) Negative(except at high
levels of stimulation )
Cold (ice) Positive (immediate) Negative
(no apparent effect)
Rapid heat Immediate:first response Delayed: second (two
—phase response) (sharp, localized) (dull, radiating)

Slow and sustained heat Negative Positive ( after 45 to 47 c)

 CLASSIFICATION
ACCORDING TO WEINE

A. INFLAMMATORY CHANGES

1. HYPERPLASTIC (REVERSIBLE PULPITIS).

a. HYPERSENSTIVE DENTIN.
b. HYPEREMIA.

2. ACUTE PULPALGIA.(ACUTE PULPITIS)

3. CHRONIC PULPALGIA.(SUBACUTE PULPITIS)

4. CHRONIC PULPITIS

5. CHRONIC HYPERPLASTIC PULPITIS.

6. PULP NECROSIS.
 CLASSIFICATION

B. RETROGRESSIVE CHANGES

1. ATROPHY.
2. DISTROPIC CALCIFICATIONS.
 CLASSIFICATION
ACCORDING TO INGLE
1. HYPERREACTIVE PULPALGIA.
A. DENTINAL HYPERSENSTIVITY.
B. HYPEREMIA.

2. ACUTE PULPALGIA.
A. INCEPIENT.
B. MODERATE.
C. ADVANCED.

3. CHRONIC PILPALGIA.
A. BARODONTALGIA.

4. HYPERPLASTIC PULPITIS.
 CLASSIFICATION

ACCORDING TO INGLE
5. NECROTIC PULP.

6. INTERNAL RESORPTION.

7. TRAUMATIC OCCLUSION.

8. INCOMPLETE FRACTURE.
 CLASSIFICATION

ACCORDING TO GROSSMAN
1. PULPITIDES (INFLAMMATION).
A. REVERSIBLE.
a. SYMPTOMATIC.
b. ASYMPTOMATIC.

B. IRREVERSIBLE PULPITIS.
a. ACUTE
- ABNORMALLY RESPONSIVE TO COLD.
- ABNORMALLY RESPONSIVE TO HEAT.
b. CHRONIC
- ASYMPTOMATIC WITH PULPAL EXPOSURE.
- HYPERPLASTIC PULPITIS.
- INTERNAL RESORPTION.
 CLASSIFICATION

2. PULP DEGENERATION.

A. CALCIFIC (RADIOGRAPHIC DIAGNOSIS).

B. OTHERS (HISTOPATHOLOGIC)

3. NECROSIS.
 DISEASES OF PULP

REVERSIBLE PULPITIS

DEFINITION

Reversible pulpitis is a mild-to moderate inflammatory

condition of the pulp caused by noxious stimuli in which the
pulp is capable of returning to the uninflamed state following
removal of the stimuli.

Pain of brief duration may be produced by thermal stimuli.

• Histopathology.
MILD -TO-MODERATE INFLAMMATORY CHANGES LIMITED TO
THE AREA OF THE DENTINAL TUBULES.

MICROSCOPICALLY

• REPARATIVE DENTIN.
• DISRUPTION OF THE ODONTOBLAST LAYER.
• DILATED BLOOD VESSELS.
• EXTRAVASATION OF EDEMA FLUID.
• IMMUNOLOGICALLY COMPETENT CHRONIC
INFLAMMATORY CELLS.
 CAUSES
TRAUMA:
BLOW
DISTURBED OCCLUSAL RELATIONSHIP.

THERMAL SHOCK:

A. PREPARING A CAVITY WITHT A DULL BUR .

B. KEEPING THE BUR IN CONTACT WITH THE TOOTH FOR TOO
LONG,
C. OVERHEATING DURING POLISHING A FILLING.

EXCESSIVE DEHYDRATION

A. ALCOHOL OR CHLOROFORM
B. IRRITATION WITH OF EXPOSED DENTIN AT THE NECK OF
TOOTH.
C. PLACEMENT OF A FRESH AMALGAM FILLING.
 CAUSES
• CHEMICAL STIMULUS :
SWEET OR SOUR FOODS.
SETTING OF SELF CURING
ACRYLIC FILLING.

• BACTERIAL :
FROM CARIES.

• CIRCULATORY
DISTURBANCES :
PREGNANCY.
MENSTURATION.

• COMMON COLD OR SINUS

PROBLEMS
 SYMPTOMS

• SHARP PAIN LASTING FOR A

MOMENT.

• DISCONTINUES WHEN THE

CAUSE IS REMOVED.

• CAUSE OF PAIN IS
TRACABLE e.g.
COLD WATER.
DRAFT OF AIR.
 DIAGNOSIS
• PATIENT’S SYMPTOMS
SHARP PAIN.
LASTS FOR FEW SECONDS.
DISAPPEARS WHEN STIMULUS
IS REMOVED.

• CLINICAL TESTS
COLD TEST IS EXCELLENT
WAY TO LOCATE.
NORMAL PERCUSSION,
PALPATION AND MOBILITY.

• RADIOGRAPHICALLY
NORMAL FINDINGS.
 DIFFERENTIAL DIAGNOSIS

• REVERSIBLE PULPITIS • IRREVERSIBLE PULPITIS

PAIN LASTS FOR FEW PAIN LASTS FOR SEVERAL

SECONDS.(A$ FIBERS) MINUTES OR LONGER(C
FIBERS)
SHARP PAIN.
SHARP SHOOTING AND
PAIN SUBSIDES WHEN PIERCING PAIN
STIMULUS IS REMOVED.
LATER PAIN IS BORING OR
GNAWING

SEvERE PAIN

PAIN ON BENDING OR
LYING.
 PERIODIC CARE

REMOVAL OF
PREVENTION TREATMENT
STIMULI

IF PAIN THEN
GO FOR R.C.T
 PROGNOSIS

• GOOD IF IRRITANT IS
REMOVED EARLIER

• ELSE CONDITION WILL

DEVELOP TO
IRREVERSIBLE PULPITIS
 IRREVERSIBLE PULPITIS
• DEINITION :

IT IS A PERSISTANT INFLAMATORY
CONDITION OF THE PULP, SYMPTOMATIC OR
ASYMPTOMATIC, CAUSED BY NOXIOUS STIMULI.

IT EXHIBITS PAIN BY HOT OR COLD STIMULI, OR

PAIN THAT OCCURS SPONTANEOUSLY.

PAIN PERSISTS FOR SEVERAL MINUTES TO

HOURS , LINGERING AFTER REMOVAL OF
STIMULUS.
 HISTOPATHOLOGY
• AS DECAY REACHES PULP FOLLOWING CHANGES ARE
SEEN

VENULES BECOME CONGESTED CAUSING NECROSIS.

CHEMOTAXIS

NECROTIC AREA
ATTRACT PMNL’S

ACUTE INFLAMMATION

RELEASE LYSOZYMES PMNL’S DIES PHAGOCYTOSIS

 PURULANT EXHUDATE MICROABSCESSES

PULP PROTECTS ITSELF

WITH FIBROUS CONNECTIVE
TISSUE

MICROSCOPICALLY

 AREA OF ABSCESS
 ZONE OF NECROTIS TISSUE
 LYMPHOCYTES
 PLASMA CELLS
 MACROPHAGES
 REDUCES
AREAS OF
INTRA PULPAL
PRESSURE ULCERATIONS

IF CARIES PENETRATES
THE PULP

DRAINS THROUGH
THE PULP
 CAUSE

CHEMICAL

MECHANICAL
THERMAL

BACTERIAL INVOLVEMENT
OF PULP

REVERSIBLE PULPITIS DETERIORATE

TO IRREVERSIBLE
 SYMPTOMS

• EARLY STAGES :
PAIN IS CAUSED BY THE FOLLOWING:
 SUDDEN TEPERATURE CHANGES .
 SWEET.
 PRESSURE FROM PACKING OF FOOD INTO THE CAVITY .
 SUCTION EXERTED BY THE TONGUE OR CHEEK.

EARLY LATE
 NATURE OF PAIN

SHARP,SHOOTING
PIERCING

ADJACENT TEETH
TEMPLE LYING

CONTINOUS
INTRMITTENT
 NATURE OF PAIN
• IN LATER STAGES:
PAIN IS MORE SEWERE .

PAIN IS BORING GNAWING

OR THROBBING.

SLIGHT EXPOSURE IS USUALLY

PRESENT.
LATE STAGES
LEATHERY SLOUGH IS SEEN .

PATIENT IS KEPT AWAKE AT

NIGHT.

PAIN IS RELIEVED BY COLD

IT MAY INTENSIFY BY
CONTINOUS COLD APPLICATION.
 NATURE OF PAIN

• PAIN INCREASES BY HOT

APPLICATION.

• APICAL PERIODONTITIS IS
ABSENT BUT IN LATER
STAGES IT MAY OCCUR.
 DIAGNOSIS

• DEEP CAVITY EXTENDING TO THE PULP.

• DECAY UNDER FILLING.

• GREYISH SCUM LIKE LAYER.

• AN ODOR OF DECOMPOSITION.

• PROBING INTO THE AREA IS NOT PAINFUL.

• DEEP PROBING WILL RESULT IN HAEMORRHAGE.

RADIOGRAPHIC EXAMINATION

• CARIOUS LESION.

• INTERPEOXIMAL CAVITY NOT SEEN VISUALLY.

• CARIOUS EXPOSURE UNDER THE FILLING.

• DEEP CAVITY.
 THERMAL TESTS
• STAGES IN EARLY
• ELICTS PAIN THAT PERSISTS AFTER REMOVAL OF
STIMULI.

• IN LATER STAGES
• FEEBLY REACTION TO COLD OR HOT.

ELECTRIC PULP TEST

• MORE CURRENT IS REQUIRED TO ELICT THE RESPONSE.

 TREATMENT

• PULPECTOMY OR COMPLETE
REMOVAL OF PULP
 PAINFUL PULPITIS

DEFINITION:
IT IS A CLINICALLY DETECTABLE INFLAMMATORY
RESPONSE OF PULPAL CONNECTIVE TISSUE TO AN
IRRITANT.

INCREASED INTRA PULPAL PRESSURE

SURPASSES THE PAIN THRESHOLD

ACUTE PAIN
 CLASSIFIACTION

PAINFUL PULPITIS

ACUTE PULPALGIA CHRONIC PULPALGIA

(ACUTE PULPITIS) (SUBACUTE PULPITIS)
 PAINFUL PULPITIS

ACUTE PULPALGIA (ACUTE PULPITIS):

SEWERELY PAINFUL AND IRREVERSIBLE ACUTE
INFLAMMATORY RESPONSE CHARACTERIZED
BY EXHUDATIVE HYPERACTIVITY.

CHRONIC PULPALGIA (SUBACUTE PULPITIS) :

THIS IS MILD EXACERBATION OF CHRONIC
PULPITIS.
THE EXHUDATE RESPONSE BECOMES HYPERACTIVE TO A
SLIGHT OR MODERATE DEGREE.
CHARACTERIZED BY INTERMITTENT EPISODES OF MILD TO
MODERATE PAIN DUE TO PRESSURE FROM EXHUDATE ZONE.
WHY TO USE THE TERM SUB
ACUTE

• THIS IS USED IN THE CASES

WHERE ONE CANNOT
CLEARLY CLASSIFY ACUTE
OR CHRONIC PULPITIS.

• IT SHOWS SMOULDERING
INFLAMMATORY RESPONSE.

• ACCORDING TO INGLE
WORD GRUMBLE IS GIVEN.
 FOOD IMPACTION
PAIN
IN THE CAVITY

ETIOLOGY

PRESSURE BLOCKAGE OF
BUILD UP THE DRAINAGE
 INCREASED CHRONICALLY
INTRAPULPAL INFLAMMED
PRESSURE TOOTH

ETIOLOGY

ACTIVATION
STIMULUS
OF
BY
EXHUDATIVE
OPERATIVE
RESPONSE
PROCEDURES
 HISTOPATHOLOGY AND CLIICAL SYMPTOMS

PROLONGED DILATION AND ENGORGEMENT OF BLOOD

VESSELS.

FLUID EXHUDATION ,LEUKOCYTE INFILTERATION

ABCESS FORMATION

INCREASED VASCULAR PERMIABILITY

AND CAPILLARY PRESSURE
• EARLIER, INTRAPULPAL PRESSURE WILL CAUSE A
THROBBING PAIN .

• THROBBING PAIN IS DUE TO PULSATION OF

INTRAPULPAL PRESSURE

• AS THE INTRAPULPAL PRESSURE INCREASES THE PAIN

BECOMES SPONTANEOUS.
 DIAGNOSIS
• IN ACUTE PULPALGIA PAIN:

PAIN VARIES WITH THE INFLAMMATION.

DEPENDS UPON THE INTRAPULPAL PRESSSURE.

MILD

SLIGHT
DISCOMFORT

SEVERE
THROBBING
• PAIN IS CONTINOUS OR HAS PERIOD OF CESSATION.
• IT IS SPONTANEOUS BECAUSE OF PRESENCE OF
NECROTIC TISSUE WHICH WILL FURTHER PROVOKES
AND INFLAMMATION INCREASES.

INCREASE INTRAPULPAL PRESSURE

THIS IS WHY PAIN LINGERS AFTER THE REMOVAL

OF PRIMARY IRRITANT
• PATIENT CANNOT LOCATE THE PAIN i.e. PIN POINT
AREA.
LYING DOWN ALSO INCREASES THE PAIN .

CHRONIC PULPALGIA
CLINICAL MANIFESTATIONS ARE SIMILAR TO ACUTE
PULPITIS.

PAIN IS MORE MODERATE

PATIENT TOLERATES THE DISCOMFORT FOR THE
MONTHS
MOSTLY ASSOCIATED WITH THE SECONDARY CARIES .
 PAIN REFERRAL

• PAIN CAN BE REFERED TO SAME AND OPPOSING

ARCHES
PAIN

MAXILLARY
MANDIBULAR MOLARS
PREMOLARS
MAXILLARY MOLARS
: MAXILLARY MOLARS
: BODY OF THE MANDIBLE
: MANDIBULAR MOLARS
: ANGLE OF THE MANDIBLE
: MENTAL AREA
EAR
: MIDRAMAL AREA
 PAIN REFERRAL

• PAIN IS REFERED TO
OPPOSITE ARCH ON THE
SAME SIDE BY POSTERIOR
TEETH ONLY.

• REFERENCE FROM INCISOR

TO POSTERIOR TEETH IS
NEVER RECORDED.

• REFERAL OF PAIN ACROSS

MIDLINE IS NEVER
RECORDED.
 RADIOGRAPHY AND PERCUSSION

RADIOGRAPHIC EVALUATION PERCUSSION

DEPTH AND EXTENT OF TENDERNESS TO

PERCUSSION.
CARIES.

EXTENT OF
RESTORATION.

SLIGHT WIDENING OF
PERIODONTAL LIGAMENT
SPACE IN ADVANCED
STAGES.
 THERMAL TESTS

HEAT APPLICATION COLD APPLICATION

EXPANSION CONTRACTION

MORE PRESSURE LESS PRESSURE

MORE PAIN LESS PAIN

 ELECTRIC TEST

EARLY STAGES LATE STAGES

LESS CURRENT IS REQUIRED NO RESPONSE AS RESULT

OF DESTRUCTION OF A$
AS RESULT OF MORE A$
FIBERS. FIBERS.

AS PULP TESTING WILL ACTIVATE A$ FIBERS ONLY.

WHAT IF MULTI ROOTED TEETH ?

 NON PAINFUL PULPITIS

DEFINITION:

IS AN INFLAMMATORY RESPONSE OF THE

PULPAL CONNECTIVE TISSUE TO AN IRRITANT.

PAIN IS ABSENT BECAUSE OF DIMINISHED EXHUDATIVE

INFLAMMATORY ACTIVITY AND DECREASE IN
INTRAPULPAL PRESSURE TO A POINT BELOW PATIENT’S
THRESHOLD.
 CLASSIFICATION

NON PAINFIL
PULPITIS

CHRONIC PULPITIS CHRONIC CHRONC PULPITIS

ULCERATIVE / OPEN FORM HYPERPLASTIC FORM CLOSED FORM
 CHRONIC ULCERATIVE PULPITIS

• CHRONIC INFLAMMATION
OF CARIOUSLY EXPOSED
PULP CHARACTERIZED BY
FORMATION OF ABCESS
AT THE POINT OF
EXPOSURE.

• IFLAMMATION MAY BE
PARTIAL OR TOTAL.

• PULPAL CHRONIC
ABSCESS.
• PULPAL GRANULOMA.
 CHRONIC HYPERPLASTIC PULPITIS

• CHRONIC INFLAMMATION
OF CARIOUSLY EXPOSED
PULP IS CHARACTERIZED
BY AN OVERGROWTH OF
TISSUE IN THE ORAL
CAVITY.

POLYP IS LINED BY
STRATIFIED SQUAMOUS
EPITHELIUM.
 WHY THIS IS NON PAINFUL PULPITIUS ?

• PRODUCTS OF EXHUDATE ARE

DRAINING INTO THE CARIOUS LESION.

ABSORBED INTO THE VENOUS OR LYMPHATIC

CIRCULATION.

MOVING INTO AN ADJACENT CONNECTIVE TISSUE.

UTILIZING ANY COMBINATION OF THESE.

HISTOPATHLOGY AND CLINICAL FEATURES

CHRONIC PULPITIS:(ULCERATIVE)

CARIES SCLEROTIC FURTHER

IRRITATION DENTIN DESTRUCTION

PULPAL EXPOSURE

ZONE I
EXHUDATE
ZONE II
INFLAMMATION
ZONEIII
CELLULAR INFILTERATION
 CLINICAL SYMPTOMS

• THERE IS NO PAIN
• DRAINAGE IS PRESENT THEREFORE NO PAIN.
• PAIN OCCURS IF THERE IS BLOCKAGE OF DRAINAGE.
CHRONIC PULPITIS (HYPERPLASTIC)

TISSUE MAY PROLIFERATE

FROM A LARGE CARIOUS
EXPOSURE.

FOUND IN TEETH OF YOUNG

CHILDREN.

AS TISSUE HAS A HIGH

RESISTANCE AND LARGE
CARIOUS LESION IT PERMITS
FREE PROLIFERATION OF
HYPERPLASTIC TISSUE.
 CHRONIC PULPITIS (HYPERPLASTIC)

• POLYP IS PINK IN
COLOR.

• FILLS THE ENTIRE

CARIOUS CAVITY.
• SURFACE BLEEDS EASILY
WHEN TOUCHED OR
PROBED.
• LESS SENSTIVE THAN
NORMAL PULPAL TISSUE.
• MORE SENSTIVE THAN
NORMAL GINGIVAL
TISSUE.
 DIAGNOSIS

• PAIN IS ABSENT.
• PERIAPICALLY RADIOGRAPHIC EVIDENCE IS LACKING.
• IN YOUNG CHILDREN LOW GRADE IRRITATION
STIMULATES PERIAPICAL BONE DEPOSTION.(CONDENSING
OSTITIS)
• DENSE BONE DEVELOPS AROUND APICES OF THE
TEETH.

• THERMAL AND ELECTRICAL TESTS ELICT NORMAL

RESPONSES.

• VISUAL EXAMINATION SHOWS PULP POLYP.

 TREATMENT

• REMOVAL OF POLYP PROGNOSIS

WITH SHARP CURRETTE. IS POOR FOR THE PULP
• ROOT CANAL THERAPY. TISSUE.
PROGNOSIS OF TOOTH
IS GOOD AFTER
ENDODONTIC THERAPY
 PULP NECROSIS

• DEIFNITION :

NECROSIS OR DEATH OF A PULP TISSUE

IS A SEQUEL OF ACUTE AND CHRONIC INFLAMMATION
OF THE PULP OR AN IMMEDIATE ARREST OF
CIRCULATION BY TRAUMATIC INJURY.IT MAY BE
PARTIAL OR TOTAL DEPENDING ON EXTENT OF PULP
TISSUE INVOLVEMENT.
HISTOPATHLOGY AND CLINICAL FEATURES

PULP NECROSIS

LIQUEFACTION NECROSIS COAGULATION NECROSIS

FLOW OF PUS FROM LESS BLOOD SUPPLY TO THE AREA

ACCESS CAVITY. TISSUE APPEARANCE OF SOLID MASS.
GOOD BLOOD SUPPLY. CHEESY CONSISTENCY.
INFLAMMATORY EXHUDATE.
 POISINOUS END PRODUCTS FOUND IN
NECROSIS

I. INTERMEDIATE PROTIOLYTIC PRODUCTS THAT EMIT

FOUL ODOUR.
a. INDOLE AND SKATOLE.
b. PUTRISCINE AND CADAVARINE.
c. INDICAN.
2. HYDROGN SULPHIDE, AMMONIA, WATER, CARBON
DIOXIDE AND FATTY ACIDS.
3. EXOTOXINS.
4. ENDOTOXINS.
5. FORIGEN BACTERIAL PROTIEN.
 DIAGNOSIS

• PAIN IS ABSENT WITH TOTAL NECROSIS.

• SWELLING - ive.
• MOBILITY - ive.
• TENDERNESS TO PERCUSION - ive.

• RADIOGRAPHIC FINDINGS ARE NORMAL EXCEPT IF

THERE IS APICAL PERIODONTITIS.

• NO RESPONSE TO VITALITY TESTS.

• SOME POSITIVE ELECTRIC TEST AS RESULT OF

LIQUEFACTION NECROSIS.
• COLOR CHANGE AS RESULT OF HAEMOLYSIS.(GREY OR
BROWN)
 TREATMENT

• PREPRATION AND OBTURATION OF ROOT

CANALS.

PROGNOSIS
GOOD IF PROPER ENDODONTIC THERAPY IS
DONE.
 RETROGRESSIVE PULP CHANGES

ATTRITION, ABRASSION, TRAUMA, OPERATIVE PROCEDURES,

CARIES, PULP CAPPING AND REVERSIBLE PULPITIS ALL
INCLUDES CHANGES IN THE PULP TISSUE THAT
CANNNOT BE CLASSIFIED AS INFLAMMATORY.

OTHER NAMES:
RETROGRESSIVE
DEGENERATIVE
AGING
DYSTROPIC
CATABOLIC
PULPOSIS ARE USED.
 RETROGRESSIVE PULP CHANGES

ATROPHY AND FIBROSIS CACLIFICATIONS

 ATROPHY AND FIBROSIS

• ATROPHY OCCURS SLOWLY AS THE TOOTH GROWS

OLDER.
• COLLAGEN FIBER INCREASES AND THE PULPAL CELLS
DECREASES.
• THIS INCREASE IN COLLAGEN FIBERS IS CALLED
FIBROSIS.

FOLLOWING THINGS ARE SEEN IN FIBROSED PULP :

REDUCTION IN SIZE OF PULP CHAMBER.

DEPOSITION OF CALCIUM MASSES. ORIGINATES IN ROOT
PULP AND THEN CORONAL PULP.
DECREASE IN NERVE SUPPLY OR BLOOD SUPPLY.
 CALCIFICATIONS

LARGER MINERALIZATIONS ARE CALLED DENTICLES.

THESE ARE LARGER MINERALIZED BODIES SOMETIMES

RESULTING FROM FUSION OF SEVERAL SMALLER ONES.

CLASSIFICATION

STRUCTURE SIZE LOCATION

 DENTICLES

DENTICLES

STRUCTURE SIZE LOCATION

TRUE FALSE
FINE DIFFUSED EMBEDED ADHERENT FREE
DENTICLE DENTICLES
 REFERENCES

• ENDODONTIC THERAPY BY FRANKLIN

S.WEINE

• ENDODONTIC PRACTICE BY GROSSMAN

• ENDODONTICS BY JHON
INGLE

• THE DENTAL PULP BY S. SELTZER

THERE ARE VARIOUS DISEASES OF PULP WHICH ARE
CONFUSING AND LOOK SIMILAR, THEREFORE ONE SHOULD
HAVE PROPER KNOWLEDGE AND ABILITY TO DIAGNOSE
THEM AND TREAT THE PULPAL DISEASES ACCORDINGLY.