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Lecture - 6-2 - Acute Pulpitis. Clinical Features, Diagnostic Methods

1. Acute pulpitis is inflammation of the dental pulp caused by bacterial infection or trauma that results in tooth pain. Symptoms include sharp, intermittent pain that is exacerbated by temperature extremes and persists after stimulus removal. 2. Diagnosis involves examining the tooth for signs of decay, percussion for tenderness, and thermal or electric tests to determine an exaggerated response to stimuli. Radiographs show normal periapical tissues early on. 3. Irreversible pulpitis occurs when inflammation becomes persistent and the pulp cannot recover, leading to eventual necrosis if left untreated. Acute pulpitis causes rapid onset pain that remains after stimulus removal.

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1K views

Lecture - 6-2 - Acute Pulpitis. Clinical Features, Diagnostic Methods

1. Acute pulpitis is inflammation of the dental pulp caused by bacterial infection or trauma that results in tooth pain. Symptoms include sharp, intermittent pain that is exacerbated by temperature extremes and persists after stimulus removal. 2. Diagnosis involves examining the tooth for signs of decay, percussion for tenderness, and thermal or electric tests to determine an exaggerated response to stimuli. Radiographs show normal periapical tissues early on. 3. Irreversible pulpitis occurs when inflammation becomes persistent and the pulp cannot recover, leading to eventual necrosis if left untreated. Acute pulpitis causes rapid onset pain that remains after stimulus removal.

Uploaded by

A.J. Younes
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Acute Pulpitis:

Clinical Features
Diagnostic Methods

E.L.Kolb
1
Pulpitis is a condition in which the
pulp (nerve) of the tooth becomes
inflamed, causing pain and pressure
in the tooth
Main cause
”You can fill a microbe-free root
Bacterial: with anything, as long as it is
sterile” Kakehashi et al. 1965
– caries
– microleakage around a restoration
– periodontal pocket and abscess
Pulpal Reactions: Cellular Events
Establishment and progression of
pulpal infection
1. Dentin tubule infection
2. Inflammation and pulp necrosis
3. Biofilms and infestation of accessory canals
4. Cementum surface colonization
5. Granuloma formation
6. Epithelial stimulation
7. Radycular cyst formation
International Classification ICD-10
K 04 Diseases of pulp and periapical tissues
K04.0 Pulpitis
K04.00 Initial (hyperaemia)
K04.01 Acute
K04.02 Suppurative [pulpal abscess]
K04.03 Chronic
K04.04 Chronic, ulcerative
K04.05 Chronic, hyperplastic [pulpal polyp]
K04.08 Other specified pulpitis
K04.09 Pulpitis, unspecified
K04.1 Necrosis of pulp
Pulpal gangrene
Examination
I. Complaints at the time of treatment
Dental history:
Characteristics of pain:
•Dull or sharp
•Paroxysmal (intermittent) or constant
•Localized or generalized
•Radiating or not
•What causes or relieves pain, etc.
Life history:
•Allergic history
•Past history of common diseases: information about the
patient's health status and concomitant diseases, current
medications
•Identification of risk factors
II. Inspection in accordance with the WHO
recommendations
•Extraoral (external)
•Intraoral (systematic examination of the oral
cavity)

III. The main clinical tests:


•probing
•percussion
•palpation
•determination of tooth mobility
IV. Additional tests
•temperature test
•electroexcitability
tooth test
•X-ray examination
•visualization (using
a microscope,
telescope magnifying
glass)
Visualization
using a microscope
Temperature tests
Heating test
Gutta-percha is heated
over a flame until it
becomes soft and shiny,
but we cannot allow it
smoked (temperature is
about 65.5 C). Heated
gutta-percha is placed
on the middle third of
the vestibular surface of
the crown and the
dentist assesses pain
Temperature tests
Cooling test
It is better to
use chlorethyl
on a cotton
tampon; ice
can also be
used for this
test
RESPONSE TO THE TEMPERATURE TEST
1. Immediately passing healthy intact tooth, non-
reaction carious lesions, tooth decay
2. Pain disappears quickly initial (hyperemia) pulpitis
3. Pain reaction occurs
quickly from the cold
acute pulpitis
stimulus, tooth hurts for
some time
4. Pain reaction occurs
rapidly from the hot
stimulus; the tooth hurts for acute purulent pulpitis
some time; pain is relieved
by the cold
RESPONSE TO THE TEMPERATURE TEST
5. Pain reaction occurs chronic forms of pulpitis
slowly and increases from
any temperature stimuli;
the patient feels pain for
some time
pulp necrosis, chronic
apical periodontitis,
6. No reaction complete obliteration of
the pulp cavity in
advanced age
ELECTRIC PULP TEST
Threshold values of
№ Tooth disease
amperage (mcA)
1. Intact tooth 2 -6
2. Caries tooth 2 -10
3. Hyperemia of the pulp 12 -18
4. Acute pulpitis 20 -30
5. Acute purulent pulpitis 30 -60
6. Chronic pulpitis 40 -60
7. Chronic ulcerative pulpitis 60 -90
8. Chronic hyperplastic pulpitis 50 -70
9. Necrosis of the pulp (dry) 60 -80
10. Necrosis of the pulp (wet) 100
11. Chronic apical periodontitis > 100
X-ray examination
Indications for the X-ray examination:
 To identify hidden cavities: on the contact surfaces of teeth;
under artificial crowns; identification of other inaccessible for
inspection foci which contribute to the development of pulp
inflammation (periodontal pocket, etc.)
 To determine: the depth of caries; the proximity of the cavity
bottom to the pulp
 The proximity of the filling material to the pulp
 For differential diagnosis of caries, pulpitis and different types
of apical periodontitis
 In case of teeth or jaws injury, which can lead to the pulp
inflammation
X-ray examination

Types of X-ray

Film Digital
Types of X-ray

Intraoral Extraoral

Bisecting angle technique Orthopantomography


(isometric) Computed Tomography
Paralleling technique
Bitewing radiography
Occlusal radiography
X-ray examination
REVERSIBLE PULPITIS / HYPEREMIA /
HYPERACTIVE PULPALGIA
Reversible pulpitis is mild-to-moderate
inflammatory condition of the pulp caused
by noxious stimuli in which the pulp is
capable of returning to the normal state
following removal of stimuli
REVERSIBLE PULPITIS / HYPEREMIA /
HYPERACTIVE PULPALGIA

Etiology
•Trauma
accident or occlusal trauma
•Thermal injury
during the tooth preparation with a blunt bur
without coolant
overheating when polishing the restoration
keeping the bur in contact with teeth too long
•Chemical stimulus, like sweet or sour foodstuff
•Following insertion of a deep restoration
REVERSIBLE PULPITIS / HYPEREMIA /
HYPERACTIVE PULPALGIA

Symptoms
•Reversible pulpitis is characterized by sharp
pain lasting for a moment, commonly caused
by cold stimuli
•Pain does not occur spontaneously and does
not continue when the irritant is removed
•It may result from incipient caries and is
resolved on removal of caries and proper
restoration of the tooth
REVERSIBLE PULPITIS / HYPEREMIA /
HYPERACTIVE PULPALGIA
•Visual examination and history: Diagnosis
may reveal caries, traumatic occlusion and undetected
fracture
•Radiographs:
show normal PDL and lamina dura, in other words,
normal periapical tissue
Depth of caries or restoration may be evident
•Percussion test:
shows negative response, i.e. the tooth is normal to
percussion and palpation without any mobility
•Vitality test:
pulp responds readily to cold stimuli. Electric pulp tester
requires less current to cause pain
REVERSIBLE PULPITIS / HYPEREMIA /
HYPERACTIVE PULPALGIA
X-ray examination
Deep filling
IRREVERSIBLE PULPITIS
It is a persistent inflammatory condition of the
pulp, symptomatic or asymptomatic, caused by
noxious stimuli
It has both acute and chronic stages in pulp
IRREVERSIBLE PULPITIS
Acute Pulpitis: Symptoms
•A rapid onset of pain, which can be caused by sudden
temperature change, sweet or acidic food
•Pain remains even after the stimulus is removed
•Pain can be spontaneous in nature, which is sharp,
intermittent or continuous in nature
•Pain exacerbated on bending down or lying down due
to change in intrapulpal pressure
•Presence of referred pain
•In later stages (suppurative acute pulpitis, pulpal
abscess) pain is severe, boring, throbbing in nature,
which increases with a hot stimulus
Pain is so severe that it keeps the patient
awake at night
Pain can be relieved simply by using cold
water
The patient may come to the dental office
with a jar of ice water
IRREVERSIBLE PULPITIS
Acute Pulpitis: Diagnosis
•Visual examination and history
examination of the involved tooth
may reveal previous symptoms
on inspection, one may see a
deep cavity involving pulp or
secondary caries under restorations
•Radiographic findings
may show depth and extent of
caries
periapical area shows normal
appearance but a slight widening
may be evident in advanced stages
of pulpitis
IRREVERSIBLE PULPITIS
Acute Pulpitis: Diagnosis

•Percussion
The tooth is tender on percussion (due to increased
intrapulpal pressure as a result of exudative
inflammatory tissue)
•Vitality tests
Thermal test: hyperalgesic pulp responds more
readily to cold stimulation than that of the normal
tooth; pain may persist even after removing the irritant
Electric test: Iess current is required in initial stages.
As tissue becomes more necrotic, more current is
required to generate the response
Difference between PARTIAL acute
pulpitis and GENERAL acute pulpitis

In acute PARTIAL pulpitis there is no


radiating pain; pain attack is always less
prolonged compared to the pain-free
period

Acute GENERAL pulpitis is characterized


by painful reaction on percussion
healthy dental bleeding is marked purulent exudate in
pulp without after opening the the nude dental pulp
signs of bleeding tooth cavity – acute – acute GENERAL
or exudation PARTIAL pulpitis pulpitis
after opening
the cavity of the
tooth
DIFFERENTIAL DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
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