انت هنا الان : شبكة جامعة بابل > موقع الكلية > نظام التعليم الالكتروني > مشاهدة المحاضرة
الكلية كلية طب الاسنان
القسم ترميم ومعالجة الاسنان
المرحلة 4
أستاذ المادة احمد غانم مهدي الهلال
4/18/2011 7:31:49 AM
Inflammatory conditions of the pulp
The long term response of the pulp to sever irritation is different than in other tissues, so in contrast to other soft tissue the pulp has no room to swell, this inability to swell may lead to increasing cell death. It is generally the coronal pulp that is injured and it lacks a collateral blood supply.
The most sever reaction occurs at the time of pulp exposure, in progressive order the status of the pulp in response to caries are as follows:
1. Healthy pulp.
2. Hyperemia.
3. Acute pulpitis.
4. Chronic partial pulpitis (without necrosis).
5. Chronic partial pulpitis (with necrosis).
6. Chronic total pulpitis with partial necrosis.
7. Total necrosis of the pulp.
8. Acute pulpitis superimposed on chronic pulpitis.
1. Healthy pulp:
Normal pulp, free of disease, or healthy and there are no histological signs of inflammatory cells.
2. Hyperemia:
Is a physiological term meaning an increase in blood supply through the tissue. Histologically, dilated and congested vessels can be seen. The pulp could not be inflamed, hyperemia could be an early sign of inflammation, and treated by treating or removing the cause.
3. Acute pulpitis:
This occurs as a sequent to various operative procedures including traumatic pulp exposure and deep scaling, and the acute reaction develops beneath the affected dentinal tubules, acute infection could superimpose on existing chronic inflammation.
Histologically, the odontoblast cells may be destroyed, and there is increased eosinophilia of the connective tissue, marked dilation of the lymphatics and blood vessels accompanied by packing of erythrocytes and pavement of the vessel walls with leukocytes, then the leukocytes soon infiltrates to the area around the vessel. This reaction lasts 3 days and it either disappears and resolved or changes into chronic process depending on the irritant.
The clinical manifestation is mild pain during hot or cold application; the pain remains as long as the stimulus remains.
4. Chronic partial pulpitis:
This develops from deep dental caries, pulp exposure, incorrect operative procedures, deep periodontal lesion and orthodontic tooth movement. The inflammation is confined to the coronal part of the pulp.
Histologically, small lymphocytes, monocytes, macrophages and plasma cells are abundant.
In children and young adults, the hyperplastic tissue reaction occurs because the young pulp has rich blood supply and favorable immune response that is more resistant to bacterial infection. This hyperplastic tissue called (pulp polyp), it’s uncommon and specific type of inflammatory hyperplasia that is easily bleed on touch. This polyp should be differentiated from gingival polyp by following the origin of each one with probe.
Treatment of pulp polyp includes:
A. Pulpatomy: it’s successful in selected cases when only the coronal pulp is affected (no necrosis in the pulp).
B. Root canal therapy: if all the pulp is affected with little necrosis.
C. Extraction: if there is massive pulp necrosis.
5. Chronic partial pulpitis with partial necrosis:
It develops from the same previous irritant but it must be persistent, this produces an area of liquefaction or coagulation necrosis and the inflammation process pass deeply into the pulp.
The pain is spontaneous and is duo to pressure of the abscess on the nerve surrounding it, sometimes the pain lasts for ½ hour and doesn’t disappear with analgesics.
Radiograph should be taken, there may be pulp exposure (chronic open pulpitis), or the inflammation is caused by bacterial toxins or sever irritants.
Treatment includes root canal treatment or extraction.
6. Chronic total pulpitis with partial necrosis:
This develops with the extension of inflammation to involve the entire pulp tissue due to persistence of irritants. The patient has sever pain sometimes lasting for many hours or when the patient is sleeping this will increase the pressure inside the pulp and cause throbbing pain and awakens the patient. The available treatment for this type is either root canal treatment or extraction.
7. Total necrosis of the pulp:
The cells of the pulp have died as a result of liquefaction or coagulative necrosis.
8. Acute pulpitis superimposed on chronic pulpitis:
There are sever pain especially at night until the abscess is formed, then there is slight relief but not complete relief until we do drainage through the tooth (access opening) or surgical incision with antibiotic cover, the treatment then either root canal or extraction.
المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .
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