ABNORMALITI
ES OF THE
PULP
Prepared by:
Dr. Rea Corpuz
Pulp Calcification
may be located
pulp chamber
OR
root canals
Pulp Calcification
Cause
no clear-cut etiology
no relation between
inflammation + irritation
since pulp calcification
can be found in unerupted
teeth
Sundell Schematic
Presentation
Local
Metabolic
Dysfunction
Growth
Pulp Stones
Trauma
Mineralization
Hyalinization
of injured cell
Fibrosis
Vascular
Damage
Thrombosis
Vessel Wall
Damage
Classification
Three types :
(1) Denticles
(2) Pulp stones
(3) Diffuse linear calcifications
(1) Denticles
believed to form as a result
of epitheliomesenchymal
interaction within
developing pulp
form during period of root
development
occur in root canal + pulp
chamber adjacent to furcation
areas of multirooted teeth
(2) Pulp Stones
believed to develop around
central nidus of pulp tissue
examples:
collagen fibril
ground substance
formed within coronal portions
of pulp
(2) Pulp Stones
may arise as part of age-
related or local pathologic
changes
most develops after tooth
formation is completed
usually free or attached
some instances, may be embedded
(3) Diffuse Linear
Calcifications
doesnt demonstrate lamellar
organization of pulp stones
exhibit areas of:
fine
fibrillar
irregular calcification
may be present in pulp
chamber or canals
frequency increases with age
(3) Diffuse Linear
Calcifications
Clinical Significance:
very little clinical significance
except insofar as they may
obstruct endodontic treatment
(3) Diffuse Linear
Calcifications
Clinical Significance:
discovered on radiograph
only as radioopacity
may cause pain from
mild pulpal neuralgia to
severe excruciating pain
resembling tic douloureux
as denticle may impinge
on nerve of pulp
(3) Diffuse Linear
Calcifications
Clinical Significance:
difficulty may be encountered
in extirpating pulp
during root canal therapy
(3) Diffuse Linear
Calcifications
Treatment & Prognosis
No treatment is required
Resorption of the Teeth
deciduous teeth are progressively
loosened
result of progressive
resorption of roots
physiological process arising
from pressure of underlying
successors
resorption of permanent is
always pathological
Resorption of the Teeth
Pathology
pressure is probably main
factor
resorption is mainly carried
out by osteoclast
humoral mediators, such
as prostgalndins
may contribute to resorption
Idiopathic Resorption
(1) Internal Resorption
(2) External Resorption
Idiopathic Resorption
Internal Resorption
pink spot
curious + uncommon
condition
dentin is resorbed from
within the pulp
Idiopathic Resorption
(1) Internal Resorption
tends to be localized
well-defined rounded area
of rediolucency in crown
can affect any part of teeth
NO signs until pulp is
opened + allows access to
infection
Idiopathic Resorption
(1) Internal Resorption
may be detected by chance
in routine radiograph
Idiopathic Resorption
(1) Internal Resorption
Idiopathic Resorption
(1) Internal Resorption
Idiopathic Resorption
(2) External Resorption
may be localized or
generalized
unkown cause
mild degree of inflammation
is often suspected
Idiopathic Resorption
(2) External Resorption
Idiopathic Resorption
(2) External Resorption
Heithersay Classification
Idiopathic Resorption
(2) External Resorption
usually a limited area of
root is attacked from
external surface near
amelocemental junction
resorption goes on until
pulp is reached
Idiopathic Resorption
(2) External Resorption
often preferentially
destroys root before
penetrating the pulp
Idiopathic Resorption
(2) External Resorption
accessible defects may be
amenable to restoration
with mineral trioxide or
other materials
long term success in infrequent;
unpredictable
Idiopathic Resorption
(2) External Resorption
Pathology
vascular granulation
tissue replaces part
or periodontal ligament
or pulp
osteoclasts border the
affected dentin or enamel
Idiopathic Resorption
(2) External Resorption
Treatment
usually untreatable
if a pink spot in an incisor
tooth is noticed at an early
stage
endodontic treatment should
be carried out before
Idiopathic Resorption
(2) External Resorption
Treatment
resorption of teeth may
result from pressure
exerted by impacted teeth
indication for removal
of unerupted teeth
DISEASES OF
PERIAPICALTISSU
ES
Prepared by:
Dr. Rea Corpuz
Diseases of Periapical Tissues
(1) Periapical Abscess
(2) Periapical Granuloma
(3) Radicular Cyst
(4) Phoenix Abscess
(5) Condensing Osteitis
(1) Periapical Abscess
also known as Dento-alveolar
Abscess; Alveolar Abscess
acute or chronic supporative
process of dental periapical
region
usually arises as a result of
infection
(1) Periapical Abscess
abcess ay develop directly
as an acute apical periodontitis
following an acute pulpitis
but more commonly it
originates in an area of
chronic infection
(1) Periapical Abscess
Clinical Feature
presents features of
acute inflammation of
apical peridontium
tooth is extremely painful
slightly extruded from its
socket
(1) Periapical Abscess
Clinical Feature
chronic periapical
abscess generally presents
no clinical features
mild, circumscribed area
of suppuration that shows
little tendency to spread from
local area
(1) Periapical Abscess
Radiographic Feature
except for SLIGHT thickening
of periodontal membrane
no roentgenographic
evidence of its presence
chronic abscess, developing
in a periapical granuloma
radioluscent area at apex
(1) Periapical Abscess
(1) Periapical Abscess
Histopathologic Features
area of suppuration is
composed chiefly of central
area of disintegrating
polymorphonuclear
leukocytes
dilation of blood vessels
in periodontal ligament
(1) Periapical Abscess
Histopathologic Features
tissue surrounding area
of suppuration contains
serous exudate
(1) Periapical Abscess
Treatment & Prognosis
drainage must be
established
open pulp chamber
extract the tooth
(1) Periapical Abscess
Treatment & Prognosis
under some circumstances
tooth may be retained
root canal therapy
(1) Periapical Abscess
Treatment & Prognosis
left untreated, spread
of infection
osteomyelitis
cellulitis
bacterimia
formation of fistulous
tract opening on skin
or oral mucosa
(2) Periapical Granuloma
also known as Apical
Periodontitis
one of the most common
sequeala of pulpitis
localized mass of chronic
granulation tissue
response to infection
(2) Periapical Granuloma
Clinical Features
1st evidence; spread beyond
confines of tooth pulp
may be noticeable sensitivity
of involved tooth to
percussion
mild pain when biting or
chewing on solid food
(2) Periapical Granuloma
Clinical Features
some cases tooth feels
elongated in its socket
sensitivity is due to
hyperemia
edema
inflammation of apical
periodontal ligament
(2) Periapical Granuloma
Radiographic Features
earliest evidence,
thickening of ligament at root
apex
proliferation of granulation
tissue
concomitant resorption of bone
continue
(2) Periapical Granuloma
Radiographic Features
appear as a radiolucent
area of variable size
seemingly attached to
root apex
some cases, well
circumscribed lesion
definitely demarcated
from surrounding bone
(2) Periapical Granuloma
Histologic Features
arises as chronic process
from onset
does not pass through an
acute phase
(2) Periapical Granuloma
Histologic Features
begins as:
hyperemia
edema of periodontal
ligament with infiltration
of chronic inflammatory cells
chiefly lymphocytes
plasma cells
(2) Periapical Granuloma
Histologic Features
inflammation + locally
increased vascularity
of tissue
induce resorption
of supporting bone
adjacent to this area
(2) Periapical Granuloma
Histologic Features
as bone is resorbed
proliferation of fibroblast
+ endothelial cells
formation of more tiny
vascular channels
numerous delicate connective
tissue fibrils
(2) Periapical Granuloma
Treatment & Prognosis
extraction of involved
teeth
under certain conditions,
root canal therapy with or
without subsequent
apicoectomy
(2) Periapical Granuloma
Treatment & Prognosis
(2) Periapical Granuloma
Treatment & Prognosis
left untreated, may
undergo transformation
into an apical periodontal
cyst
proliferation of epithelial
rests in the area
(3) Radicular Cyst
also known as Apical
Periodontal Cyst;
Periapical Cyst;
Root End Cyst
common
not inevitable sequela of
periapical granuloma originating
as a result of:
bacterial infection
necrosis of dental pulp
following carious involvement of tooth
(3) Radicular Cyst
Pathogenesis
initial reaction leading
to cyst formation
proliferation of epithelial
rest in the periapical
area involved by granuloma
epithelial proliferation
follows an irregular pattern of
growth
(3) Radicular Cyst
Clinical Features
asymptomatic
present no clinical evidence
of their presence
seldom painful or even
sensitive to percussion
(3) Radicular Cyst
Clinical Features
represents chronic
inflammatory process
develops only over
a long period of time
(3) Radicular Cyst
Radiographic Features
identical with periapaical
granuloma
since the lesion is a chronic
progressive one developing
in a pre-existing granuloma
cyst may be of greater
size than granuloma
due to longer duration
(3) Radicular Cyst
Radiographic Features
occasionally, exhibits
thin, radioopaque line
around the periphery
of radiolucent area
indicates reaction of
bone to slowly expanding
mass
(3) Radicular Cyst
Radiographic Features
(3) Radicular Cyst
Histologic Features
epithelium lining apical
periodontal cyst is usually
stratified squamous in
type
(3) Radicular Cyst
Treatment & Prognosis
similar to periapical
granuloma
involved tooth may be
removed
periapical tissue carefully
curetted
(3) Radicular Cyst
Treatment & Prognosis
under some condition;
root canal therapy
with apicoectomy
of cystic lesion
(3) Radicular Cyst
(4) Phoenix Abscess
localized collection of pus
surrounded by an area of
inflammed tissue
hyperemia
infiltration of leucocytes
(4) Phoenix Abscess
(4) Phoenix Abscess
(4) Phoenix Abscess
can occur immediately
following root canal treatment
another cause is due to untreated
necrotic pulp (chronic apical
periodontitis)
result of inadequate debridement
during endodontic procedure
(4) Phoenix Abscess
Bacteriology
Staphylococci are frequently
associated with pus formation
produce enzyme called
coagulase
causes fibrin formation
helps in walling off of lesion
(4) Phoenix Abscess
Bacteriology
coagulase promotes
virulence by inhibiting
phagocytosis
(4) Phoenix Abscess
Clinical Features
when palpated clinically
superficial abscess is
fluctuant
offending tooth is carious
+ mobile
symptoms of acute inflammation
swelling
fever
(4) Phoenix Abscess
Treatment
repeating endodontic
treatment with improved
debridement
tooth extraction
antibiotics may be indicated
to control a spreading or
systemic infection
(5) Condensing Osteitis
also known as Chronic
Focal Sclerosing Osteomyelitis
unusual reaction of bone
occuring in instances of
extremely high tissue resistance
or in cases of low grade infection
(5) Condensing Osteitis
Clinical Features
occurs in almost young
person before the age of
20 years old
commonly affected is
mandibular 1st molar
with large carious lesion
(5) Condensing Osteitis
(5) Condensing Osteitis
(5) Condensing Osteitis
Clinical Features
associated with non vital
teeth or teeth undergoing
process of degeneration
tooth is usually asymptomatic
some cases, pain or tenderness
percussion
palpation
(5) Condensing Osteitis
Radiographic Features
well circumscribed
radiopaque mass of
sclerotic bone surrounding
extending below apex of
one or more roots
(5) Condensing Osteitis
Histologic Features
dense mass of bony trabeculae
with little interstitial
marrow tissue
(5) Condensing Osteitis
Histologic Features
dense mass of bony trabeculae
with little interstitial
marrow tissue
chronic inflammatory cells;
plasma cells, lymphocytes
are seen scanty in bone
marrow
(5) Condensing Osteitis
Treatment & Prognosis
endodontic treatment
extraction
surgical removal of sclerotic
should not be attempted
unless symptomatic
References:
Books
Cawson, R.A: Cawsons Essentials of Oral
Oral Pathology and Oral Medicine,
8th Edition
(page 70-72)
Ghom, Ali & Mhaske, Shubhangi: Textbook of
Oral Pathology
(pages 429-433)
Neville, et. al: Oral and Maxillofacial Pathology
3rd Edition
(pages 127-138)
Shafer, et al: A textbook of Oral Pathology,
3rd Edition
