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Презентация на тему Pulpitis etiology, pathogeny and classifications

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2. IntroductionEndodontics is the specialty of dentistry that
3. Causes of PulpitisPhysical irritation Most generally brought
4. Signs and SymptomsPain when biting downPain when
5. Endodontic DiagnosisSubjective examinationChief complaint Character and duration
6. Important questions?What do you think the problem
7. Objective examinationExtent of decay Periodontal conditions surrounding
8. Challenges in diagnosis of pulpitisReferred pain &
9. Diagnostic TestsPercussionPalpationThermalElectricalRadiographs
10. 1. Percussion testsUsed to determine whether the
11. Used to determine whether the inflammatory process
12. 3. Thermal sensitivity
13. Evaluation of thermal test results4 distinct responses:No
15. Causes of false positives/negativeCalcified canalsImmature apex –
16. 4. Electric pulp testingDelivers a small electrical
17. Placement of a pulp tester.
19. 5. Radiographs Pre-operative radiograph Invaluable diagnostic toolPeriapical radiolucencyWidening of PDLDeep cariesResorptionPulp stonesLarge restorationsRoot fractures
20. Requirements of Endodontic FilmsShow 4-5 mm beyond
21. Quality radiograph in endodontics.
22. Diagnostic Conclusions Normal pulp Pulpitis
23. Normal pulp There are no subjective symptoms
24. Pulpitis The pulp tissues have become
25. Acute Pulpitismainly occurs in children teeth and adolescentpain is more pronounced than in chronic
26. Symptoms and Signs of acute pulpitis
28. Forms of acute pulpitis 1. Form of
29. Chronic PulpitisReversibleIrreversible
30. Reversible pulpitisThe pulp is irritated, and the
31. Irreversible pulpitisThe tooth will display symptoms of
32. Periradicular abscess An inflammatory reaction to pulpal
34. An inflammatory reaction frequently caused by bacteria
36. Periradicular cyst A cyst that develops
37. Pulp fibrosis The decrease of living cells
38. Necrotic toothAlso referred to as non-vital. Used
39. Plan of TreatmentDepends widely on the diagnosis
40. Simple plan of treatmentVisit 1:Medical historyHistory of
41. Visit 2:Working length determinationDebridement using the hybrid
42. Visit 3:Obturation with GP using lateral condensationPlaced temporary/permanent restoration (IRM/Kalzinol)
43. ReferralTo appropriate discipline
44. Remember Access cavity shapes:Anterior – inverted trianglePremolars
45. Contraindications for RCTCaries extending beyond bone levelRubberdam
46. Inter & cross-departmental diagnosisMobile teeth Teeth associated
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IntroductionEndodontics is the specialty of dentistry that manages the prevention, diagnosis, and treatment of the dental pulp and the periradicular tissues that surround the root of the tooth

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Pulpitis etiology, pathogeny and classifications

Pulpitis: etiology, pathogeny and classifications. Pathomorphology of acute

IntroductionEndodontics is the specialty of dentistry that manages the prevention, diagnosis, and

Causes of PulpitisPhysical irritation Most generally brought on by extensive decay.Trauma Blow

Signs and SymptomsPain when biting downPain when chewing Sensitivity with hot or

Endodontic DiagnosisSubjective examinationChief complaint Character and duration of pain Painful stimuli Sensitivity

Important questions?What do you think the problem is? Does it hurt to

Objective examinationExtent of decay Periodontal conditions surrounding the tooth in question Presence

Challenges in diagnosis of pulpitisReferred pain & the lack of proprioceptors in

Diagnostic TestsPercussionPalpationThermalElectricalRadiographs

1. Percussion testsUsed to determine whether the inflammatory process has

Used to determine whether the inflammatory process has extended into the periapical

3. Thermal sensitivity Necrotic pulp will not

Evaluation of thermal test results4 distinct responses:No response

Pulpitis etiology, pathogeny and classifications

Causes of false positives/negativeCalcified canalsImmature apex – usually seen in young patientsTraumaPremedication

4. Electric pulp testingDelivers a small electrical stimulus to the pulp

$5. Radiographs Pre-operative radiograph Invaluable diagnostic toolPeriapical radiolucencyWidening of PDLDeep cariesResorptionPulp stonesLarge restorationsRoot fractures$ Requirements of Endodontic FilmsShow 4-5 mm beyond the apex of the tooth

Requirements of Endodontic FilmsShow 4-5 mm beyond the apex of the tooth

Diagnostic Conclusions Normal pulp Pulpitis

Normal pulp There are no subjective symptoms or objective signs. The pulp

Pulpitis The pulp tissues have become inflamedCan be either:Acute –

Acute Pulpitismainly occurs in children teeth and adolescentpain is more pronounced than in chronic

Symptoms and Signs of acute pulpitis The pain not localized in

Forms of acute pulpitis 1. Form of purulent acute where the pulp

Reversible pulpitisThe pulp is irritated, and the patient is experiencing pain to

Irreversible pulpitisThe tooth will display symptoms of lingering painpain occurs spontaneously or

Periradicular abscess An inflammatory reaction to pulpal infection that can be chronic

An inflammatory reaction frequently caused by bacteria entrapped in the periodontal sulcus

Periradicular cyst A cyst that develops at or near the root

Pulp fibrosis The decrease of living cells within the pulp causing fibrous

Necrotic toothAlso referred to as non-vital. Used to describe a pulp that

Plan of TreatmentDepends widely on the diagnosis

Simple plan of treatmentVisit 1:Medical historyHistory of the toothAccess cavityPlace rubberdamExtirpation +

Visit 2:Working length determinationDebridement using the hybrid techniqueIrrigationPlaced intra-canal medication (calcium hydroxide)Place

Visit 3:Obturation with GP using lateral condensationPlaced temporary/permanent restoration (IRM/Kalzinol)

Remember Access cavity shapes:Anterior – inverted trianglePremolars – roundMolars – rhomboidAlways use

Contraindications for RCTCaries extending beyond bone levelRubberdam cannot be placedCrown of tooth

Inter & cross-departmental diagnosisMobile teeth Teeth associated with severe periodontal problemsConfusion between

Referral to post-grad clinicsExtensive internal or external root resorptionSeverely curved, narrow, tortuous

Слайды презентации

Слайд 2 Introduction
Endodontics is the specialty of dentistry that manages

IntroductionEndodontics is the specialty of dentistry that manages the prevention, diagnosis,

the prevention, diagnosis, and treatment of the dental pulp

and the periradicular tissues that surround the root of the tooth

Слайд 3 Causes of Pulpitis

Physical irritation
Most generally brought on

Causes of PulpitisPhysical irritation Most generally brought on by extensive decay.Trauma

by extensive decay.

Trauma
Blow to a tooth or the

jaw

Anachoresis
- retrograde infections

Слайд 4 Signs and Symptoms
Pain when biting down
Pain when chewing

Signs and SymptomsPain when biting downPain when chewing Sensitivity with hot

Sensitivity with hot or cold beverages
Facial swelling
Discolouration

of the tooth

Слайд 5 Endodontic Diagnosis
Subjective examination
Chief complaint
Character and duration of

Endodontic DiagnosisSubjective examinationChief complaint Character and duration of pain Painful stimuli

pain
Painful stimuli
Sensitivity to biting and pressure
Discolouration of

tooth

Слайд 6 Important questions?
What do you think the problem is?

Important questions?What do you think the problem is? Does it hurt

Does it hurt to hot or cold?
Does it

hurt when you’re chewing?
When does it start hurting?
How bad is the pain?
What type of pain is it?
How long does the pain last?
Does anything relieve it?
How long has it been hurting?

Слайд 7 Objective examination
Extent of decay
Periodontal conditions surrounding the

Objective examinationExtent of decay Periodontal conditions surrounding the tooth in question

tooth in question
Presence of an extensive restoration
Tooth

mobility
Swelling or discoloration
Pulp exposure

Слайд 8 Challenges in diagnosis of pulpitis
Referred pain & the

Challenges in diagnosis of pulpitisReferred pain & the lack of proprioceptors

lack of proprioceptors in the pulp

localizing the problem to the correct tooth can often be a considerable diagnostic challenge
Also of significance is the difficulty in relating the clinical status of a tooth to histopathology of the pulp in concern
Unfortunately, no reliable symptoms or tests consistently correlate the two.

Слайд 9 Diagnostic Tests
Percussion
Palpation
Thermal
Electrical
Radiographs

Слайд 10 1. Percussion tests
Used to determine whether the inflammatory

process has extended into the periapical tissues
Completed

by the dentist tapping on the incisal or occlusal surface of the tooth in question with the end of the mouth mirror handle held parallel to the long axis of the tooth

Слайд 11
Used to determine whether the inflammatory process has

Used to determine whether the inflammatory process has extended into the

extended into the periapical tissues
The dentist applies firm pressure

to the mucosa above the apex of the root

2. Palpation tests

Слайд 12 3. Thermal sensitivity
Necrotic

3. Thermal sensitivity Necrotic pulp will not respond

pulp will not respond to cold or hot

Cold test
Ice,

dry ice, or ethyl chloride used to determine the response of a tooth to cold
Heat test
Piece of gutta-percha or instrument handle heated and applied to the facial surface of the tooth

Слайд 13 Evaluation of thermal test results
4 distinct responses:

No response

Evaluation of thermal test results4 distinct responses:No response non-vital

non-vital pulp or false

negative

Mild response normal

Strong but brief reversible

Strong but lingering irreversible

Слайд 14

Слайд 15 Causes of false positives/negative
Calcified canals
Immature apex – usually

Causes of false positives/negativeCalcified canalsImmature apex – usually seen in young

seen in young patients
Trauma
Premedication of the patient – pulp

sedated

Слайд 16 4. Electric pulp testing
Delivers a small electrical stimulus

to the pulp

Factors that may influence readings:
Teeth

with extensive restorations
Teeth with more than one canal
Dying pulp can produce a variety of responses
Moisture on the tooth during testing
Batteries in the tester may be weak

Слайд 17 Placement of a pulp tester.

Слайд 18

Слайд 19 5. Radiographs
Pre-operative radiograph
Invaluable diagnostic tool
Periapical radiolucency
Widening

$5. Radiographs Pre-operative radiograph Invaluable diagnostic toolPeriapical radiolucencyWidening of PDLDeep cariesResorptionPulp stonesLarge restorationsRoot fractures$

of PDL
Deep caries
Resorption
Pulp stones
Large restorations
Root fractures

Слайд 20 Requirements of Endodontic Films
Show 4-5 mm beyond the

Requirements of Endodontic FilmsShow 4-5 mm beyond the apex of the

apex of the tooth and the surrounding bone or

pathologic condition.
Present an accurate image of the tooth without elongation or fore-shortening.
Exhibit good contrast so all pertinent structures are readily identifiable.

Слайд 21 Quality radiograph in endodontics.

Слайд 22 Diagnostic Conclusions

Normal pulp

Pulpitis

Слайд 23 Normal pulp

There are no subjective symptoms or

Normal pulp There are no subjective symptoms or objective signs. The

objective signs. The pulp responds normally to sensory stimuli,

and a healthy layer of dentine surrounds the pulp

Слайд 24 Pulpitis
The pulp tissues have become inflamed

Can be

Pulpitis The pulp tissues have become inflamedCan be either:Acute – inflammation

either:
Acute
– inflammation of the periapical area
–

usually quite painful

Chronic
Continuation of acute stage or
low grade infection

Слайд 25 Acute Pulpitis
mainly occurs in children teeth and adolescent
pain

is more pronounced than in chronic

Слайд 26 Symptoms and Signs of acute pulpitis

The pain not

Symptoms and Signs of acute pulpitis The pain not localized

localized in the affected tooth is constant and throbbing

worse by reclining or lying down
The tooth becomes painful
with hot or cold stimuli
The pain may be sharp and stabbing
Change of color is obvious in the affected tooth
swelling of the gum or face in the
area of the affected tooth

Слайд 27

Слайд 28 Forms of acute pulpitis
1. Form of purulent

Forms of acute pulpitis 1. Form of purulent acute where the

acute where the pulp is totally inflammed
2. Form

of gangrenous acute where the pulp begins to die in a less painful manner that can lead into the formation of an abscess

Слайд 29 Chronic Pulpitis
Reversible
Irreversible

Слайд 30 Reversible pulpitis

The pulp is irritated, and the patient

Reversible pulpitisThe pulp is irritated, and the patient is experiencing pain

is experiencing pain to thermal stimuli
Sharp shooting pain
Duration

of the pain episode lasts for seconds
The tooth pulp can be saved
Usually this condition is caused by average caries

Слайд 31 Irreversible pulpitis

The tooth will display symptoms of lingering

Irreversible pulpitisThe tooth will display symptoms of lingering painpain occurs spontaneously

pain
pain occurs spontaneously or lingers minutes after the stimulus

is removed
patient may have difficulty locating the tooth from which the pain originates
As infection develops and extends through the apical foramen, the tooth becomes exquisitely sensitive to pressure and percussion
A periapical abscess elevates the tooth from its socket and feels “high” when the patient bites down

Слайд 32 Periradicular abscess

An inflammatory reaction to pulpal infection

Periradicular abscess An inflammatory reaction to pulpal infection that can be

that can be chronic or have rapid onset with

pain, tenderness of the tooth to palpation and percussion, pus formation, and swelling of the tissues.

Слайд 33

Слайд 34 An inflammatory reaction frequently caused by bacteria entrapped

An inflammatory reaction frequently caused by bacteria entrapped in the periodontal

in the periodontal sulcus for a long time. A

patient will experience rapid onset, pain, tenderness to palpation and percussion, pus formation, and swelling.
Destruction of the
periodontium occurs

Periodontal abscess

Слайд 35

Слайд 36 Periradicular cyst

A cyst that develops at

or near the root of a necrotic pulp. These

types of cysts develop as an inflammatory response to pulpal infection and necrosis of the pulp

Слайд 37 Pulp fibrosis

The decrease of living cells within

Pulp fibrosis The decrease of living cells within the pulp causing

the pulp causing fibrous tissue to take over the

pulpal canal

Слайд 38 Necrotic tooth

Also referred to as non-vital. Used to

Necrotic toothAlso referred to as non-vital. Used to describe a pulp

describe a pulp that does not respond to sensory

stimulus
Tooth is usually discoloured

Слайд 39 Plan of Treatment
Depends widely on the diagnosis

Слайд 40 Simple plan of treatment
Visit 1:
Medical history
History of the

tooth
Access cavity
Place rubberdam
Extirpation + irrigation with sodium hypochlorite
Placed intra-canal

medication (calcium hydroxide)
Place cotton pellet
Placed temporary restoration (IRM/Kalzinol)

Слайд 41 Visit 2:
Working length determination
Debridement using the hybrid technique
Irrigation
Placed

Visit 2:Working length determinationDebridement using the hybrid techniqueIrrigationPlaced intra-canal medication (calcium

intra-canal medication (calcium hydroxide)
Place cotton pellet
Placed temporary restoration (IRM/Kalzinol)

Слайд 42 Visit 3:
Obturation with GP using lateral condensation

Placed temporary/permanent

restoration (IRM/Kalzinol)

Слайд 43 Referral
To appropriate discipline

Слайд 44 Remember
Access cavity shapes:
Anterior – inverted triangle
Premolars –

Remember Access cavity shapes:Anterior – inverted trianglePremolars – roundMolars – rhomboidAlways

round
Molars – rhomboid
Always use rubberdam
Never to use Cavit as

a temporary restoration
Always place an intra-canal medication….calcium hydroxide!!!
Always use RC Prep or Glyde when filing

Слайд 45 Contraindications for RCT
Caries extending beyond bone level
Rubberdam cannot

Contraindications for RCTCaries extending beyond bone levelRubberdam cannot be placedCrown of

be placed
Crown of tooth cannot be restored in restorative

dentistry nor prosthodontics
Patient is physically/mentally handicapped and therefore cannot follow OH instructions
Putrid OH
Unmotivated patient
Severe root resorption
Vertical root fractures
Cost factor

Слайд 46 Inter & cross-departmental diagnosis
Mobile teeth
Teeth associated with

Inter & cross-departmental diagnosisMobile teeth Teeth associated with severe periodontal problemsConfusion

severe periodontal problems
Confusion between TMJ dysfunctional symptoms and RCT

pain
Many decayed teeth
Sclerosed canal due to trauma
Uncertainty of prognosis related to abscess, severe caries, facial swelling, cellulites, and medical condition of patient