--Pulp and Periodontal Pathoses Cuwik

8/9/2019 --Pulp and Periodontal Pathoses Cuwik

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Classification of pulpal diseases

The diagnosis are based on clinicalsigns and symptoms rather than onhistopathologic findings.


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Reversible pulpits

Reversible pulpitis is inflammation of thepulp is not severe.

If the cause is eliminated , inflammation

will resolve.


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Symptoms

Reversible pulpitis is usually asymptomatic. Application of stimuli may produce sharp

transient pain.


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Treatment

Removal of irritants and sealing aswell as insulating exposed dentin orvital pulp usually result in diminished

symptoms .


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Irreversible pulpitis

Irreversible pulpitis is often a sequel to and aprogression from reversible pulpitis.

Irreversible pulpitis is a severe inflammationthat will not resolve even if the cause isremoved.


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Symptoms

Irreversible pulpitis is usually asymptomatic ,may also be associated with intermittent orcontinuous episodes of spontaneous pain.

Localization of pulpal pain is more difficult thanlocalization of periradicular pain.


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Tests and treatments

Extension of inflammation to theperiodontal ligament causes percussionsensitivity and better localization of pain.

Root canal treatment or extraction isindicated .


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Hyperplastic pulpitis

Hyperplastic pulpitis (pulp polyp) is a formof irreversible pulpitis , which results fromgrowth of chronically inflamed young pulp

into occlusal surfaces.


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Hyperplastic pulpitis is usuallyasymptomatic.

The teeth respond within normal limits when

palpated or percussed.


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Hyperplastic pulpitis


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Pulp calcification

Extensive calcification occurs as aresponse to trauma , caries ,periodontal diseases , or other irritants.


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Responses to palpation and percussion areusually within normal limits.

This condition in and of itself is not a

pathosis and does not require treatment.


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Pulp calcification


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Internal resorption

Inflammation in the pulp may initiateresorption of adjacent hard tissues.

Most cases of intracanal resorption are

asymptomatic. Teeth respond within normal limits to

pulpal and periapical tests.


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The pink spot


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Internal resorption


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Internal resorption


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Immediate removal of inflamed tissue andinstruction of root canal treatment isrecommended.


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Teeth with perforated resorption aredifficult to treat nonsurgically.


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Pulpal necrosis

Pulp is encased in rigid walls , and itsvenules and lymphatics collapse underincreased tissue pressure , therefore

irreversible pulpitis leads to liquefactionnecrosis.


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Pulpal necrosis is usually asymptomaticbut may be associated with episodes ofspontaneous pain and discomfort or

pain.

Symptoms


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Tests and treatment

Because of the spread of inflammatoryreactions to periradicular tissues , teethwith necrotic pulps are often sensitive to

percussion. Root canal treatment or extraction is

indicated for these teeth.


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Periradicular pathosis

As a consequence of pulpal necrosispathologic changes can occur in thePeriradicular tissues.


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Classification of Periradicular

lesions

Periradicular lesions have beenclassified on the basis of their clinicaland histologic findings.


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Acute apical perodntitis

Described as symptomatic apical perodntitis.

The pulp may be irreversible inflamed ornecrosis.

Etiology


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Signs and symptoms

Clinical features are moderate to severespontaneous discomfort as well as painon mastication or occlusal contact.

thickening of periodontal ligamentspace may be a radiographic feature.


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Treatment

Removal of irritants or a pathologic pulp ,or release of periradicular exudate usuallyresults in relief.


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Acute apical perodontitis


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Chronic apical perodntitis

Chronic apical perodntitis results frompulpal necrosis and usually is a sequel toAAP

Etiology


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Signs and symptoms

CAP is without symptoms or is associatedwith slight discomfort and would be betterclassified as asymptomatic apicalperodontitis.

There may be slight sensitivity to palpation, indicating an alteration of the cortical

plate of bone.


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Treatment

Removal of inciting irritants and completeobturation usually result in resolution of CAP.


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Chronic apical perodontitis


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Acute apical abscess

Acute (symptomatic) apical abscess islocalized or diffuse liquefaction lesion thatdestroys periradicular tissues.

Etiology


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Signs and symptoms

Depending on the severity of the reactionpatients have moderate to severediscomfort or swelling.

These teeth are usually painful topercussion and palpation.


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Chronic apical abscess

Chronic apical abscess results from a longstanding lesion that has caused an abscess

which is draining to a surface.


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Similar to that of AAAs. It also results from pulpal necrosis

and is usually associated with CAPthat has formed an abscess.

Etiology


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Signs and symptoms

Because draining exists , CAP is usuallyasymptomatic except when there isoccasional closure of the sinus pathway.


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Chronic apical abscess

Nonendodontic periradicular


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Nonendodontic periradicular

pathosis

A number of radiolucent and radiopaque lesionsof nonendodontic origin simulate the radiographic

appearance of endodontic lesions. Unfortunately , many clinicians use only

radiographic for diagnosis and treatment withouttaking a complete history of the signs and

symptoms.

Differential diagnosis


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Normal and pathologic entities

Such anatomic variations include largemarrow spaces , maxillary sinus , apical

dental papillae of developing teeth ,nasopalatine foramen , mental foramen.

Normal structures


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Nonendodontic pathosis

Benign lesions include : lateral periodontalcyst , dentigerous cyst , nasopalatine ductcyst , central hemangioma , myxoma ,

and ameloblastoma. Malignant lesions include : lymphoma

squamous cell carcinoma , osteogenic

sarcoma , chondrosarcoma.

--Pulp and Periodontal Pathoses Cuwik

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