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    Chronic Pulpitis

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    Chronic pulpitis is inflammation of the pulp tissue over an extended period of time which causes irreversible changes. It causes dull, persistent pain triggered by hot and cold. Diagnosis involves testing for increased sensitivity and looking for signs of past issues. Treatment options include root canal therapy or extraction depending on the situation.

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    Chronic Pulpitis

    Uploaded by

    api-3868619
    11K views20 pages
    Chronic pulpitis is inflammation of the pulp tissue over an extended period of time which causes irreversible changes. It causes dull, persistent pain triggered by hot and cold. Diagnosis involves testing for increased sensitivity and looking for signs of past issues. Treatment options include root canal therapy or extraction depending on the situation.

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    Chronic pulpitis is inflammation of the pulp tissue over an extended period of time which causes irreversible changes. It causes dull, persistent pain triggered by hot and cold. Diagnosis involves testing for increased sensitivity and looking for signs of past issues. Treatment options include root canal therapy or extraction depending on the situation.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    11K views20 pages

    Chronic Pulpitis

    Uploaded by

    api-3868619
    Chronic pulpitis is inflammation of the pulp tissue over an extended period of time which causes irreversible changes. It causes dull, persistent pain triggered by hot and cold. Diagnosis involves testing for increased sensitivity and looking for signs of past issues. Treatment options include root canal therapy or extraction depending on the situation.

    Copyright:

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    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!!

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