Acute and chronic pulpitis

By Dr. Vishaal Bhat on Tuesday 10 June 2008 with 0 comments



Trauma, an injury to living tissue caused by extrinsic agent. Surgical or caused by accident.


Bacteria, rod shaped. Dentin wall if you have infected tooth under fluorescent microscope.


Necrosis. Localized death of living tissue. Pulp necrosis, indicates that dental pulp has died, doesn't react to sensitivity testing. If pus collects then its an abscess. Pulp abscess or facial abcess in patient.


Periradicular space is part of periodontium. In periodontal abscess, through food impaction, inflamed pocket with abscess. Rapid onset of pain etc. Pulp is vital. Inflammation doesn't have to do with root canal system. Acute periradicular also rapid onset but the pulp is pulpitic, already become necrotic. In vital pulp if you put cold stimulus on tooth that’s vital, cold stimulus goes away immediately, with pulpitis, if you do cold testing, pain will linger, for minutes tooth is still hurting from cold. No reaction, pulp tissue is dead.

Chronic periradiuclar abscess, four kinds of abscesses. If no treatment is undertaken, pulpitis exists for longer period of tiem. Situation becomes chronic, reaction to pulp necrosis. Onset is gradual, in most cases don’t know there is a lesion there.


Acute is a state of inflammation. Location of inflammation. Intraraducular, inside root canal, and extra radicular. Also foreng body reactions like irrigating and rinsing root canals then drying them with paper points. Paper point through apex, cellulose, in periapical space will cause foreign body reaction.


Intra radicular infection, bacteria inside the root canal system. Bacteria contamination can happen, micro organism reaching pulp space through breeches in pulp space. Bone level has gone down, horizontal bone loss in distal area of tooth, crown margin doesn't fit too well. Interesting, not necessary for bacteria to reach pulp space, before bacteria enter pulp, severe inflammation, bacteria shed parts of cell wall, lipopolysaccharides that can reach pulp through dentinal tubules, initiate inflammation. Main source of contamination is carious.


Carious is a slow lesion, chronic, takes time to reach the pulp. Protective mechanisms is that axons of odontoblasts processes shed minerals trying to occlude the tubules, make them less permeable for fluids and bacteria. Position of materials is one way to protect pulp from invading micro organisms.

Longitudinal cross section through the tooth.

Don’t obturate the tooth right away, use extra disinfecting agents, to disinfect dentin walls and that takes some time. Bacteria to depth of 300 microns. Can be through and through contamination.


Category: Endodontics Notes , Featured

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