Signs and Symptoms of Pulpal Diseases

SIGNS AND SYMPTOMS
OF PULPAL DISEASES
Dr.Amithbabu.c.b.
M.Sc.D-ENDO
INTRODUCTION
 The pulp is a connective tissue that is almost
totally surrounded by hard tissue i.e. the dentine
walls.
 The inflammatory process in the pulp is
basically the same as elsewhere in the body
connective tissue.
 There are a few major vessels that supply the
pulp through the apical foramen and small
vessels that enter through lateral or accessory
canals.
• The pulp is the only organ that can
produce reparative dentine to keep a wall
of dentine between the irritant and itself as
a mean of protecting itself from injury.
 During inflammation, exudates leaves the
vessels and rise the interstitial pressure.
 Since the fluid is not compressible and there is
little room for oedema, this may cause local
tissue hypoxia leading to localized necrosis.
 Total pulp necrosis may result from the
continued spread of local inflammation
 Formerly, it was thought that the pulp responded
initially by acute inflammation, followed by
chronic inflammation, regardless of the etiologic
factor.
 However, it was recently shown that the initial
response might be chronic inflammation
because of the relatively slow progression of the
irritant.
 Operative procedures, because of their rapid
effect, probably result in a transient acute
inflammation
CLASSIFICATION
 Duration and severity
Acute
Chronic
Sub acute
 Presence or absence of symptoms
Symptomatic
Asymptomatic
 Ability or inability to heal
Reversible
Irreversible
 Pulpal conditions can be classified as
reversible and irreversible pulpitis
hyperplastic pulpitis
necrosis.
Hard tissue responses include
calcifications and resorption.
REVERSIBLE PULPITIS
 reversible pulpitis is inflammation of the
pulp that is not severe ( Local
vasodilatation leading to slight edema ).
 If the cause is eliminated, inflammation will
resolve and the pulp will return to normal.
CAUSES
Mild or short-acting stimuli such as
 incipient caries,
 cervical erosion,
 occlusal attrition,
 most operative procedures,
 a recent deep filling without a protective base,
 deep periodontal curettage
 enamel fractures
SIGNS AND SYMPTOMS
• Reversible pulpitis is usually asymptomatic (No
spontaneous pain ).
• Application of stimuli such as cold or hot liquids
or even air, may
• produce sharp transient pain.
• Hypersensitive dentin.
• Removal of these stimuli, which do not normally
produce pain or discomfort, results in immediate
relief
Distinguished from irreversible pulpitis
--- thermal test
reversible pulpitis
momentary, painful response
subsides as soon as the stimulus
removed
irreversible pulpitis
painful, linger after the stimulus
removed
Reversible pulpitis
SYMPTOMATIC IRREVERSIBLE
PULPITIS
 The pulp has been damaged beyond

repair, and even with removal of the irritant
it will not heal.
 The pulp will progressively degenerate,
causing necrosis and reactive destruction
SIGNS AND SYMPTOMS
 A rapid onset of pain when any stimulus like cold

foods, or sweet food, pressure from packing of
food into cavity, or pressure exerted by tongue,
that results in congestion of the blood vessels of
the pulp.
 The pain may be caused by sudden temperature
changes, which is prolonged. prolonged
episodes of pain even after the source of the
pain is removed
 The pain may be sharp, shooting or
piercing in nature.
 The pain may be referred to adjacent teeth
sometimes, and also to ear if lower teeth
are involved, and to temple region if the
upper teeth are involved.
 The pain caused by cold stimulation can
be relieved by heat, and similarly, the pain
caused by heat can be relieved by cold
Chronic Hyperplastic Pulpitis
(PULP POLYP)
• It is a productive pulpal inflammation due
to extensive carious exposure of any
young pulpal tissue.
• This is a type of irrversible pulpitis, which

is chronic and usually asymptomatic in
nature.
SIGNS AND SYMPTOMS
 Hyperplastic pulpitis is usually asymptomatic.
 It appears as a reddish cauliflower-like
outgrowth of connective tissue into caries that
has resulted in a large occlusal exposure.
 It is occasionally associated with clinical signs of
irreversible pulpitis such as spontaneous pain as
well as lingering pain to cold and heat stimuli.
 The teeth respond within normal limits when
palpated or percussed.
PULP POLYP
PULP CALCIFICATION
• Extensive calcification (usually in the form

of pulp stones or diffuse calcification)
occurs as a response to trauma, caries,
periodontal disease, or other irritants
SIGNS AND SYMPTOMS
• Yellowish discoloration of the crown
• Pain threshold to thermal and electrical

stimuli usually increases; teeth are
nonresponsive, palpation and percussion
PULP CALCIFICATION
INTERNAL RESORPTION
• Internal resorption is a
pathological process initiated
within the pulp space with the
loss of dentin
• Asymptomatic and detectable
by routine radiographs
• Oval-shaped enlargement of the
root canal space
• Advanced internal resorption involving the
pulp chamber is often associated with pink
spots in the crown.
• Teeth with intracanal resorptive lesions
usually respond within normal limits to
pulpal and periapical tests.
INTERNAL RESORPTION
(clinical view)
PULPAL NECROSIS WITH
ACUTE APICAL PERIODONTITIS
• Extension of pulp inflammation, bacteria,
and chemicals into the periradicular tissue.
Signs and symptoms

Usually Asymptomatic
Pain on biting or percussion, moderate to
severe spontaneous discomfort
NECROSIS WITH ACUTE APICAL
ABSCESS
• It is an acute condition characterized by the
formation and retention of pus in the alveolar
bone around the root apex of a tooth with a
necrotic pulp along with the extension of
infection through the apical foramen into the
periapical tissues.
SIGNS & SYMPTOMS
 Pain-severe intensity, constant and
spontaneous, throbbing.
 Slight to severe swelling
 Pain on biting
 Tooth may be mobile
 Fever
 Regional lymph node may be involved
NECROSIS WITH CHRONIC
APICAL ABSCESS
• Chronic periradicular abscess is similar to
chronic apical periodontitis except that it is
characterized by the presence of a
draining sinus tract.
SIGNS & SYMPTOMS
• A tooth with a chronic periradicular abscess
(suppurative periradicular periodontitis) will not
generally present with clinical symptoms.
• This tooth will not respond to pulp vitality
tests and the radiograph or image will exhibit a
periradicular radiolucency.
• The tooth is generally not sensitive to biting
pressure but can “feel different” to the patient
upon percussion
PHOENIX ABSCESS
• A phoenix abscess is a chronic apical
periodontitis that suddenly becomes
symptomatic.
• A phoenix abscess may develop spontaneously,

almost immediately after endodontic treatment
has been initiated on a tooth diagnosed as
having chronic apical periodontitis without a
sinus tract.
SIGNS AND SYMPTOMS
• pain
• fever and malaise
• Swelling
• Halitosis
PERIAPICAL GRANULOMA
• Bone destruction around apex of tooth, mostly
secondary to pulp exposure due to caries or
trauma.
• Bacterial invasion of pulp produces toxic
metabolites which escape to the periapical bone
through apical foramen and cause inflammation.
•
• Periapical granuloma: Localized mass of
chronic granulation tissue containing PMN’s,
lymphocytes, plasma cells.
PERIAPICAL GRANULOMA
CONDENSING OSTEITIS
• Condensing Osteitis is defined as
pathologic growth of maxillomandibular
bones characterized by mild clinical
symptoms.
SIGNS & SYMPTOMS
• Could be symptomatic or asymptomatic
depending on the condition of the pulp and
periradicular tissues
REFERENCES
• Pathways of pulp ,stephen cohen .9
edition
• Endodontic john i.ingle
• Torebinejad Principles and Practice
of endodontics

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SIGNS AND SYMPTOMS

 The pulp has been damaged beyond

 A rapid onset of pain when any stimulus like cold

• This is a type of irrversible pulpitis, which

• Extensive calcification (usually in the form

• Pain threshold to thermal and electrical

Signs and symptoms

• A phoenix abscess may develop spontaneously,

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