Reversable pulpitis - hyperemia Irreversible pulpitis Pulpal necrosis

D Acute pulpitis ( painful ) Chronic pulpitis (painless) Pulp undergo necrosis ass a sequel of
e acute or chronic pulpitis , as the
Occurs when the amount of irritation intensifies Chronic ulcerative pulpitis Chronic hyperplastic pulpitis ( pulp
f inflammation progress tissue
causing great increase in the interpulpal polyp)
pressure beyond the threshold limits of the Chronic inflammation of cariously Chronic inflammation of cariously continue to disintegrate until entire
sensory nerves causing variables degrees of exposed pulp characterized by exposed pulp characterized by ana pulp is necrotic .
pain. formation of abcess at the point over growth of granulomatous
of exposure leading to ulceration. tissue into the carious cavity
forming a polyp.
E - Incipient caries This response may arise at the end of acute phase or may develop from
t - Cervical erosion onset in case where the irritant is of low grade.
i - Occlusal attrition
o Usually seen secondry to acute
- Deep periodontal curettage pulpitis
l
o - Filling without insulation
g - Leaking restoration
y - Exposed dentinal tubules

It’s a reversible inflammation , if Acute Irreversible , starts initial then moderate

cause eliminated , inflammation & lastly advanced
reverse pulp will return to normal
S Nature of pain: Nature of pain: Nature of pain: Nature of pain: Nature of pain:
i - Type of pain : Sharp transient - Type of pain : Initially :mild shooting - Pain : usually abscent as no - Pain : usually polyp not - Pain:very mild & mostly
g pain By time: sharp shooting ( ↑by lying down) accumulation of fluids occur painful , it bleeds easily on abscent
n iside pulp & intra-pulpal probing ( open apex)
s - Stimulus: initially : cold (last 4 few min’s) pressure does not rise
& - Stimulus : cold (↓ immediately By time: spontaneous without stimulus - Stimulus: heat sometimes
after removal of stimulus)
s - Course of pain :transient - Course of pain : initially : intermittent
y By time: continues
m
p - Vitality testing : normal - Vitality testing : normal
t - Vitality testing : respond at - Vitality testing : pulp responds - Vitality testing : negative
o higher stimulation
m - Palpitation & percussion : -ve - Palpitation & percussion test : -ve
s - Palpitation & percussion : -ve - Palpitation & percussion : -ve
- Palpitation & percussion : -ve
- Stimulus : initially : cold
Followed by a stage : cold & hot - Visual examination reveals - This form seen in young
Advanced stage : heat causes sever the presence of long patients where this polyp
pain( relieved 4 few sec.’s by cold standing carious cavity appears as pinkish red globule
application ‘’Hot tooth ‘’) of tissue protruding from the
- Pain referred → neighboring teeth , pulp chamber.
opposing dentition & temporal area & ear
- Distribution of pain: always diffuse , cannot
localize correctly offended tooth .
- Pain control : initially : by analgesics
Advanced stage : nothing can stop pain
h Local vasodilatation & ↑ in
i permeability of blood vessels can
s cause slight ↑ in local pulpal
t pressure. Infiltration for few
o numbers of inflammatory cells . if
irritation of pulp continues or ↑ ,
case changesto irreversible pulpitis
& eventually necrosis.
↑ pulpal pressure , tissue damage & bacterial
toxins lead to formation of micro-abcesses at
the site of the carious exposure. The neutrophils
are the primary cells present. Surrounding the
abcess , a dense infiltration of lymphocytes,
plasma cells & macrophages is seen.
A zone of necrosis is seen at the
surface of the pulp followed by a
zone of leukocytic infiltration.
Beyond this zone, a zone of
proliferating fibroblasts is seen.
The polyp is a complex of new
capillaries, proliferating fibroblasts
& inflammatory cells.

R
a Normal No radiographic changes except No changes seen, except in some No changes seen, except in some No changes seen, except some cases
d Advanced stage :some widening in the cases there can be some widening cases there can be some widening there can be some widening in the
i periodontal membrane space in the periodontal membrane in the periodontal membrane periodontal membrane space.
o space. space.
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