Chronic pulpitis

Dr.Mohammad salah qrea

Definition
• Inflammation of the pulp
tissue over an extended
period of time which
causes irreversible
changes in the quality of
pulp tissue.
Signs & Symptoms
• Dull pain but bearable
• Persistent for as long as
an hour
• May be symptom less in
some cases
• Pain triggered by hot and
cold
Diagnosis
• Patient usually had a previous
history of acute pain in the
same tooth
• Ep test above normal ( 60-80
mhz)
• No signs of a continuity from
cavity into pulp chamber
• Floor of cavity usually is
formed of hardened dentine
Radiographic examination:
• Not significant in exact
diagnosis but still important
since they may show other
pathologies.
• Radiographs may show :
- recurrent caries under old
restorations.
- pulp chamber
enlargement due to internal
resorption.
- calcification in cases of
long term low grade irritation.
Electric pulp testing
• Delivers a high frequency
current to desired tooth.
• To determine the
presence or absence of
sensory nerves (pulp
vitality).
• Stimulated nerves are of
the myelinated A- delta
fiber group.
 How to perform EPT ?
• Clean, dry & isolate tooth.
• Scrub facial surface with a dry cotton roll
and isolate with the same roll.
• Make sure tooth is dry by air syringe.
• Attach the clip of the device to patients lip
or let him hold it( closes the electrical
circuit).

• Apply toothpaste or conducting medium to

the electrode & touch tooth.

• A control test must be performed on a non

affected tooth to make sure patient has a
normal threshold of stimulation.
Differential diagnosis
• Acute pulpitis (pain is
spontaneous and more
intense)
• Deep situated carious
lesion ( pulp is stimulated
in the same way but
stimulus subsides
immediately)
Differential diagnosis
• Pulp necrosis ( same
symptoms but pain is only
triggered on hot irritant,
also a continuity between
cavity and pulp exists )
Pathologic progress
• recession of a case of
acute pulpitis or abscess
• slow progressing carious
lesions
• badly treated caries or
recurrent caries
• trauma
 Prognosis of untreated teeth:
• Inflamed tissue will change into
granulation tissue due to
persistent irritation.
• Later on fibrous tissue will form.
• From this point several
pathologies may arise
-necrosis
-internal resorption
-calcification of pulp chamber
-pulpal stones
It is important to keep in mind that a
chronic form may turn to the
acute form in cases of decreased
immunity.
Histopathology
The effects of inflammation
on the dental pulp.
2. obliteration of bv.
3. Increase in chamber
pressure.
4. Increase in neutrophils
later on replaced by
lymphocytes and
fibroblasts.
Histopathology
• Dilated
capillaries
and
neutrophils
suggest
acute
inflammation
.
• Lymphocyte
s and
fibroblasts
suggest
chronic
inflammation
.
Treatment options
• RCT is treatment of choice.
• In case there is insufficient
time, premature apex or
primary tooth :
-Pulpotomy
-Partial pulpectomy

• Extraction is less commonly

used but is significant in
patients of low socio-economic
status.
Complications & follow up
• The most common is a
transformation of a
chronic pulpitis into the
acute form either
simultaneously or post
operatively
• Most common causes of
post operative flare ups
include incomplete pulp
tissue removal, and lack
of isolation during
procedure.
 Intra operative tips:
• In some cases of pulpitis
profound anesthesia is difficult to
achieve. Recent studies
recommend the administration of
oral ibuprofen before procedure.
• Isolation is more important than
your fancy cavity preparation.
• Always make sure all pulp tissue is
removed from chamber at least.
• If bleeding persists after removal
of pulp chamber it may indicate
that the inflammation has reached
to the radicular pulp, therefore
proceed with a partial pulpectomy
or complete RCT.
Don’t wait on tooth pain!!!

THANK
YOU!!