Post on 12-Nov-2014
Diagnosis of Dental Pulp and Periapical Area
Disorders
I- Diagnosis of Dental Pulp Disorders
Diagnosis of Dental Pulp Disorders
1-Tooth is sensitive to thermal changes especially the cold.
2-Pain disappears after removal of stimulus.3-Tooth is vital and responds well to electric pulp tester
( lower level of current.)4-Tooth is usually with deep carious lesion, or large metallic restoration without adequate isolation, or
restoration with defective margins.5-Recent restoration may be with poor lining, or cavity
preparation without cooling.6-Tooth return to a normal condition after removing
the cause.
*Diagnosis of focal reversible pulpitis (Pulp hyperemia):
1-Severe pain in thermal changes especially the cold.2-Pain persists even after removal of stimulus.
3-Tooth is vital and responds well to electric pulp tester ( very low level of current.)
4-Tooth is usually with large carious lesion, or defective restoration with recurrent caries.
5-General symptoms such as fatigue with delirium.6-Damage of pulp is irreversible and the tooth does not
return to normal after treatment.
*Diagnosis of acute pulpitis:
Diagnosis of Dental Pulp Disorders
1-Reaction to in thermal changes is dramatically reduced .2-Dull intermittent pain .
3-Tooth is necrosis and may respond to electric pulp tester ( high level of current.)
4-Tooth is usually with large carious lesion, or defective restoration with recurrent caries.
5-Probing of the pulp is painless in most cases.6-Damage of pulp is also irreversible.
*Diagnosis of chronic pulpitis:
Diagnosis of Dental Pulp Disorders
1-Tooth has a large, open carious lesion .2-It is usually found in children and young adult .
3-Most commonly teeth involved are deciduous molars and first permanent molars.
4-Pulp tissue appears asymptomatic pinkish red protruding from the pulp chamber and filling the entire cavity.
5-Probing may or may not cause bleeding depending upon vascularity of lesion .
6 -It must be differentiated from gingival polyp which is due to inflammation of the gingival near a broken tooth------it
proliferates to the broken area. To differentiate between them by probe where the gingival polyp is usually attached
to the gingival, while the pulp polyp coming from the pulp.
*Diagnosis of chronic hyperplastic pulpitis (Pulp polyp):
Diagnosis of Dental Pulp Disorders
Clinical features of pulp polyp.
1-It is the final stage of untreated pulpitis.2-It is asymptomatic condition.
3 -Tooth is usually with large carious lesion, or defective restoration with recurrent caries, or traumatic fracture.
4-Tooth is necrosis and does not respond to electric pulp tester.
5-Probing of the pulp is painless.6 -It may cause discolored tooth due to degeneration of
the dentinal tubules caused by death of the pulp.
*Diagnosis of Pulp necrosis (Pulp gangrene):
Diagnosis of Dental Pulp Disorders
Clinical feature of pulp necrosis
II- Diagnosis of Periapical Area Disorders
1 -It may be due to very mild and long standing irritation.
2-It is asymptomatic condition.3-Radiographically, it appears as a thin
well-defined radiopaque layer around the apical area.
*Diagnosis of periapical sclerosis:
Diagnosis of Periapical Area
Disorders
1-Tooth may be with penetrating carious lesion, or old defective restoration, or old
traumatic fracture.2-Gingival inflammation with infrabony pocket.
3-Tooth is tender to percussion.4-Painful in bitting or chewing a solid food.
5-Negative vitality test.6-Radiography reavels to widening of the
periodontal ligament at the apical area.
*Diagnosis of apical periodontitis:
Diagnosis of Periapical Area
Disorders
1-The involved tooth is extremely painful.2-The involved tooth is extremely sensitive to percussion .
3-The involved tooth is slightly extruded from its socket.4-Presence of systemic manifestations such as pain ,
swelling, fever and redness of overlying skin.5-The periapical abscess may be intraorlly )buccally or
lingually( or extraorally.6-Radiographically, it appears as an amorphous radiolucent
area with ill-defined irregular margin in the periapical area of the involved dental root.
7-Complications of untreated periapical abscess: a-Osteomyelitis. b-Cellulitis.
c-Bacteremia. d-Maxillary sinusitis.
Diagnosis of Periapical Area
Disorders*Diagnosis of periapical abscess:
Radiographical features of periapical abscess
*Diagnosis of periapical granuloma:
1-Mild pain when bitting or chewing on solid food.2-The involved tooth is mild sensitive to percussion .
3-The involved tooth is slightly extruded from its socket.4-No presence of systemic manifestations .
5-It could be discovered by routine radiographical examination.6-Radiographically, it appears as a rounded radiolucent area
with well-defined regular margin surrounding the apical foramen of the involved dental root and ranges from few
millimeters to 1 cm in diameter.7-Complications of untreated periapical granuloma:
a-Pain due to infected periapical granuloma. b-Periapical cyst develops due to proliferation of the
epithelial rests of Malassez presenting in the histological structure of periapical granuloma.
Diagnosis of Periapical Area
Disorders
Radiographical features of periapical granuloma
*Diagnosis of periapical cyst:1-It usually occurs in adult life.
2-It is more common in males than females.3-It is more frequently in the maxilla, specially the anterior region.
4-It is asymptomatic condition.5-There is usually a non-vital tooth from which the cyst
has developed.6-Radiographically, it appears as a round or ovoid well-defined
radiolucent area with narrow opaque margin that is continuous with the lamina dura of the involved tooth and ranges from
5 mms to several cms in diameter.7-Complications of untreated periapical cyst:
a-Increase in size. b-Residual cyst develops due to extraction of tooth without
enucleating or defective enucleating the periapical cyst.
Diagnosis of Periapical Area
Disorders
Radiographical features of periapical cyst