Classification of pulpal diseases

The diagnosis are based on clinical

signs and symptoms rather than on
histopathologic findings.

Reversible pulpits

Reversible pulpitis is inflammation of the

pulp is not severe.
If the cause is eliminated , inflammation
will resolve.

Symptoms

Reversible pulpitis is usually asymptomatic.

Application of stimuli may produce sharp
transient pain.

Treatment

Removal of irritants and sealing as

well as insulating exposed dentin or
vital pulp usually result in diminished
symptoms .

Irreversible pulpitis

Irreversible pulpitis is often a sequel to and a

progression from reversible pulpitis.
Irreversible pulpitis is a severe inflammation
that will not resolve even if the cause is
removed.

Symptoms

Irreversible pulpitis is usually asymptomatic ,

may also be associated with intermittent or
continuous episodes of spontaneous pain.
Localization of pulpal pain is more difficult than
localization of periradicular pain.

Tests and treatments

Extension of inflammation to the

periodontal ligament causes percussion
sensitivity and better localization of pain.
Root canal treatment or extraction is
indicated .

Hyperplastic pulpitis

Hyperplastic pulpitis (pulp polyp) is a form

of irreversible pulpitis , which results from
growth of chronically inflamed young pulp
into occlusal surfaces.

Hyperplastic pulpitis is usually

asymptomatic.
The teeth respond within normal limits when
palpated or percussed.

Hyperplastic pulpitis

Pulp calcification

Extensive calcification occurs as a

response to trauma , caries ,
periodontal diseases , or other irritants.

Responses to palpation and percussion are

usually within normal limits.
This condition in and of itself is not a
pathosis and does not require treatment.

Pulp calcification

Internal resorption

Inflammation in the pulp may initiate

resorption of adjacent hard tissues.
Most cases of intracanal resorption are
asymptomatic.
Teeth respond within normal limits to
pulpal and periapical tests.

The pink spot

Internal resorption

Internal resorption

Immediate removal of inflamed tissue and

instruction of root canal treatment is
recommended.

Teeth with perforated resorption are

difficult to treat nonsurgically.

Pulpal necrosis

Pulp is encased in rigid walls , and its

venules and lymphatics collapse under
increased tissue pressure , therefore
irreversible pulpitis leads to liquefaction
necrosis.

Symptoms

Pulpal necrosis is usually asymptomatic

but may be associated with episodes of
spontaneous pain and discomfort or
pain.

Tests and treatment

Because of the spread of inflammatory

reactions to periradicular tissues , teeth
with necrotic pulps are often sensitive to
percussion.
Root canal treatment or extraction is
indicated for these teeth.

Periradicular pathosis

As a consequence of pulpal necrosis

pathologic changes can occur in the
Periradicular tissues.

Classification of Periradicular
lesions

Periradicular lesions have been

classified on the basis of their clinical
and histologic findings.

Acute apical perodntitis

Etiology

Described as symptomatic apical perodntitis.

The pulp may be irreversible inflamed or
necrosis.

Signs and symptoms

Clinical features are moderate to severe

spontaneous discomfort as well as pain
on mastication or occlusal contact.
thickening of periodontal ligament
space may be a radiographic feature.

Treatment

Removal of irritants or a pathologic pulp ,

or release of periradicular exudate usually
results in relief.

Acute apical perodontitis

Chronic apical perodntitis

Etiology
Chronic apical perodntitis results from
pulpal necrosis and usually is a sequel to
AAP

Signs and symptoms

CAP is without symptoms or is associated

with slight discomfort and would be better
classified as asymptomatic apical
perodontitis.
There may be slight sensitivity to palpation
, indicating an alteration of the cortical
plate of bone.

Treatment

Removal of inciting irritants and complete

obturation usually result in resolution of CAP.

Chronic apical perodontitis

Acute apical abscess

Etiology

Acute (symptomatic) apical abscess is

localized or diffuse liquefaction lesion that
destroys periradicular tissues.

Signs and symptoms

Depending on the severity of the reaction

patients have moderate to severe
discomfort or swelling.
These teeth are usually painful to
percussion and palpation.

Acute apical abscess

Acute apical abscess

Acute apical abscess

Chronic apical abscess

Chronic apical abscess results from a long
standing lesion that has caused an abscess
which is draining to a surface.

Etiology

Similar to that of AAAs.

It also results from pulpal necrosis
and is usually associated with CAP
that has formed an abscess.

Signs and symptoms

Because draining exists , CAP is usually

asymptomatic except when there is
occasional closure of the sinus pathway.

Chronic apical abscess

Nonendodontic periradicular
pathosis
Differential diagnosis

A number of radiolucent and radiopaque lesions

of nonendodontic origin simulate the radiographic
appearance of endodontic lesions.
Unfortunately , many clinicians use only
radiographic for diagnosis and treatment without
taking a complete history of the signs and
symptoms.

Normal and pathologic entities

Normal structures

Such anatomic variations include large

marrow spaces , maxillary sinus , apical
dental papillae of developing teeth ,
nasopalatine foramen , mental foramen.

Nonendodontic pathosis

Benign lesions include : lateral periodontal

cyst , dentigerous cyst , nasopalatine duct
cyst , central hemangioma , myxoma ,
and ameloblastoma.
Malignant lesions include : lymphoma
squamous cell carcinoma , osteogenic
sarcoma , chondrosarcoma.