PULPAL AND PERIRADICULAR

PATHOSIS.
DIAGNOSIS:
1- Questioning. Thermo-vitality test
2- Visual diagnosis Electro-vitality test
(examination). Roentgen diagnosis
3- Special method of (periapical,
diagnosis panoramic,..)
Probing Selected anesthesia
Percussion Transluminance
Palpation Diagnosis the pathway of
Movement the sinuses (fistula)
 Classification of pulp & periapical
diseases
Clinical
1-Reversable
2-Irreversable
Histo-pathological.
 Classification of pulp & periapical diseases

(Histo-pathological)

PULPITIS
Hyperaemia.Initial.
Acute.
Suppurative (Pulpal
abscess).
Chronic.
Chronic, ulcerative.
Chronic, hyperplastic.
(pulpal polyp)
Other specified pulpitis.
Pulpitis, unspecified.
NECROSIS OF PULP
* Pulp gangrene
PULP DEGENERATION
Denticles.
Pulpal calcification.
Pulpal stones.
ABNORMAL HARD TISSUE FORMATION IN
PULP
Secondary or irregular dentine.
ACUTE APICAL PERIODONTITIS OF
PULPALE ORIGIN
Acute apical periodonitis

CHRONIC APICAL PERODONTITIS

Apical granuloma
PERIAPICAL ABSCESS WITH SINUS
Dental
Dentoalveolar
Periodontal abscess of pulpal origin
Sinus to maxillary antrum
Sinus to nasal cavity
Sinus to oral cavity
Sinus to skin
Periapical abscess with sinus, unspecified
PERIAPICAL ABSCESS WITHOUT SINUS
Dental abscess
Dentoalveolar abscess
Periodontal abscess of pulpal origin
Periapical abscess with no reference to
sinus
RADICULAR CYST
Includes
Cyst
Apical periodontal
Periapical
Apical and Lateral
Residual
Inflammatory paradental
- Excludes Developmental lateral periodontal cyst
Radicular cyst, unspecified

OTHER AND UNSPECIFIED DISEASE OF PULP AND PERIAPICAL

 Pulpitis

Inflammation of the pulp tissue

Hyperemia:-
Blood collection in the pulp champers.

Active:- its arterial blood supply

Passive:- when Venuses blood draining.
Pathology &the reason:-
Microbial Toxins from Caries Lesion,
Trauma, preparation action.
Polishing of the restoration, drying the
cavity by air, Dehydration by alcohol.
Symptoms:-
Acute pain, not for a long time.
Pain from cold water, air, sweets& acid food.
The pain reduced after reducing the stimulator
the irritant.
The pain may be longed one weak or month.
Diagnosis:-
Thermo-vitality test to the cold water
Electro-pulp-vitality> than normal.
8-12mA
Differential diagnosis:-
with acute pulpitis where the pain more longer in
time for a while
Result:-
If the irritation is stopped it s reversible if
not pulpits (irreversible)
 Histopathology of the pulp:
- > diameter of the blood vessels
.Destruction of the capillary (small vessels)
Destruction of the tissues
Treatment:-
conservative to make control
 Acute pulpitis:-
acute inflammatory of the pulp tissue
with acute pain not all the time.
Pathology &the reason:-
like the Hyperemia if not stopped
 Symptoms:-
1.acute (Sharp) pain , (pulsing) irradiation to the ear,
temporal is, another teeths.
2. the pain with &without irritant, (alone)
3. the pain at night
4. after stopping the irritant the pain not
stopped immediately
5. (spontaneous)
Diagnosis:-
1. deep cavity EP vitality= 40 MHz.
2. Big Restoration
3. Thermo-probing (reaction) at the cold
water
4. no radiolucency
Differential Diagnosis:-
with hyperemia, Pulpal abscess (the pain is
lower than pulpitis).
* Pain from the hot (heat)
Results:
Chronic form or pulp Necrosis
Histopathology:
Inflammatory of the pulp tissue,
leukocytes
Destruction of the Odontoplast
Treatment:
Endodontic therapy (RCT)
Supportive (Pulpal abscess):

Acute inflammation of the pulp tissue with pass

formation of superficially or inside the pulp tissue.
The reason ( pathology) :
bacteria from Caries lesion the pulp is
closed by Debriss or restoration no
Draining of the Exudation from the p.ch.
which cased by inflammation.
Symptoms:
very acute pain, drilling pain, inside the teeth a (
pressure)
1-the pain realized at night
2-reduced &the pain all the time
3-pain from hot
4-pain decreased from cold
5-may be Periapical reaction
Diagnosis:
1. the skin relief dark
2. the patient tired
3. his hand holed at the side of the pain
4. E.P.V. > 40 MHz
X-Ray: Deep Caries
The restoration is too near to the pulp Horne
Thermo- test: the cold reduce the pain
the Hot stimulate the pain
May be percussion (+)
When opening the pulp we could have a pass
Differential Diagnosis:
with acute pulpitis
With apical abscess
Inflammation
percussion (+)
movement
sinus
EPV O
(fistula)
Histopathology:
infiltration of the zone with pass
Vein. Dilatation
Degeneration of the Odontoplast
&Destruction
Trumps of vein.
Local or generalization of the pass.
Results:
pulp necrosis
Treatment:
R C.T
Chronic pulpitis

Etiology & reason:

1. Weak progress f the caries lesion
2. bad treated caries.
3. trauma
Symptoms:
1. without symptoms.
2. a weak pain all the time which results
after irritation & not end a long time after
irritant
3. there is no pathway with dental cavity
4. probing the floor of the caries cavity
(decay ) Hard dentine ( not soft) or ( filling
material)
5. EP test > the normal
& depends on the percentage of the tissue
damage (died, necrosis).
Diagnosis:
1.deep Cavity
2. secondary caries (recurrent Caries)
3. EP test (vitality)> normal
Differential Diagnosis: with
1. deep caries reaction from irritant end
soon immediately.
2. Acute Pulpitis: Spontaneous pain
without irritation ----
- from anamnesis there was no pain in the
past.
3. pulp necroses: the pain just from hot
irritant.
But in chronic from all irritants
Pulp necroses: with pathway with dental
cavity (caries).
Deep probing is painful in p. necrosis
Histopathology:
at the beginning there is infiltration pulp
with lymphocytes & plasmocytes after that
infiltration performed in connective tissue
cells reduced,
Obliteration of the vessels
Around Micro abscess there is granulation
tissue& then capsules of fibrosis tissue
Result:
pulp necrosis
Treatment:
RCT
Chronic Ulcerative pulpitis

Formation of ulcer at the surfaces of the

pulp where is opened to the caries cavity (
in young people)
Ulcer ( in immune deficiency with old
people)
Etiology & reason:
open of the pulp tissue & collection of
Microbes ( colony)
Symptoms:
1. may be without pain
2. or very weak
3. the pain from the food which fold in the
cavity or under non hermetic restoration
Diagnosis:
1. the pulp champers opened with caries
cavity
2. over ulcerative pulp tissue collection of (
the food+ degenerative leucocytes +
microorganism + Blood cells
3. Bad Smell
4. probing the surfaces of ulcerative tissue
without pain , deeply probing with pain
&with bleeding.
5. weak pain ( hot + cold)
6. EP test
7. X-Ray: big restoration or cavity caries.
Differential diagnosis:
with acute pulpitis ulcerative
Pain acute pain weak or no pain
Alone without irritant
With pulp necrosis
ulcerative pulpitis

No pulp tissue+ no pain

there is pulp tissue
Ept > normal
ulcerative pulpitis
Histopathology :
ulcerative tissue of the pulp
May be beginning calcified round cells.
Infiltration
Inflamed pulp
Calcified
Granulation tissue
Results:
pulp necrosis
Treatment:
RCT
Chronic Hyperplastic (pulp polyp)

Production of inflamed pulp

granulationTissue + Epithelia its from a
long time irritant ( weak irritant for a long
time) non intensive irritant
 Etiology & reason:
weakly progressive caries
To get polyp there is a need of
Open pulp cavity
chronic weak Stimulation from food

infection from

bacteria
Young pulp resistant
Symptoms:
no symptoms or pain from pressure of the
food on the polyp
Diagnosis:
1.in children & young people
2. the pulp like the meat (red)
3. it fill the caries cavity or over the level of
the cavity
4. polyp less painful from probing than
normal pulp but more painful than gingival
5. propping not painful
6. bleeding
7. no sensitivity from cold & hot just a little
from (chlorethyl) cold
8. X-ray opened p.ch.
Differential diagnosis:
with hypertrophy gingivitis which fill the
caries cavity.
Histopathology:
surfaces of the pulp its epithelial
granulation tissue.
Proliferation (polipblast )
Dilatation of the
vessels.
*apical tissue
normal.
Results:
necroses of the pulp
Treatment:
RCT
Pulp Necrosis

Continuing of pulp inflammation with

destruction &death of the tissue
Gangrene of the pulp tissue (
coagulation+ solving)
Etiology & reason:
its the result of pulpitis ( inflamed pulp
tissue)
Or results of trauma
Symptoms or signs
1. no pain
2. discoloration of the teeth
3. Bad smell
4. maybe pain from hot ( that because of
exiting gazes which pain for the nearest
nerve in Periapical tissue.
 Diagnosis:
1. Big cavity or big restoration
2. on x-ray pathway from cavity to pulp champers
Periapical wideness of ligament.
3.maybe teeth intacted history of trauma
4. pulp destruction weakly without pain or in history
(pain just for few minutes or few hours ended).
5. at cold no pain
Hot maybe
6. Ep testing=0
Or high response ( that because of liquid
which fill the canal and pain response from Periapical
tissue.
Differential diagnosis:
with pulpitis & alveolar abscess
necroses may be partially bad differential
diagnosis
Histopathology:
necrotic pulp tissue
microorganism
PA tissue normal
Or
beginning of inflammation
Treatment;
Routine RCT.
Pulp Degeneration:
Denticles
Pulp calcification
Pulpal stones
Etiology:
a long time irritant ( weak)
( caries, trauma, teeth attrition, treatment of
reversible pulpitis).
Symptoms:
1.without symptoms.
2. maybe discoloration in internal resorption
3. maybe teeth movement
4. maybe a weak pain.
 Diagnosis:
1. in pulp extirpation one porticos ( the pulp had a
fibrosis tissue)
2. or extirpation partials without bleeding
3. in Pulpal calcification there is a calcified part of
pulp like dentin in strength
4. in x-ray we see a closed or constriction of the
pulp canal
5. in internal resorption we see in x-ray
destruction of the canal walls ( oval or round
maybe pain in palpation)
Results:
1. pulp necrosis
2. closed of canals (dentine or calcified)
3. fracture of the root.
Treatment:
Endodontic treatment or surgery ( internal
resorption) without treatment if there is no
symptoms.
Chronic apical periodontitis:

apical granuloma:
Etiology:
pulp necrosis, acute apical periodontitis
Symptoms:
without symptoms or discomfort.
Diagnosis:
no pain from irritation ( chemical thermo
test)
Percussion (-)
Palpation: may be pain ( Destruction of
cortical tissue) when granuloma gets in
soft tissue
X-ray: Periapical lesion ( bone resorption).
Histopathology:
Granulation tissue (Periapical ).
Infiltration macrophages, lymphocytes,
epithelium.
Results:
radycular cyst, osteamialitis
Treatment:
or conservative RCT with surgical (
Apicoectomy to keep the teeth).
Or
extraction.
Periapical abscess

collection of pass (Periapical)

Acute ( without fistula) chronic ( with
sinus)
Symptoms:
in acute abscess: acute pulsing pain from
touching the teeth, occlusion closing
(pain).
teeth movement
swilling soft tissue under teeth ( painful)
systemic discomfort t weak
Suppurative apical periodontitis
Chronic Periapical abscess:
no pain at percussion
There is a fistula opened a few time at soft
tissue.
Diagnosis:
acute Periapical abscess:
teeth with cavity dicey
with restoration
with crown necrotic pulp.
RCT (old)
Acute apical periodontitis
It may follow immediately after direct
infection of the pulp, or it may start as a
activation of chronic apical periodontities.
Symptoms:
pain (acute)
Swelling
Tenderness to percussion
Sometimes also abscess formatiom with
a later development of a sinus treat.
 Ap-bacteria maybe invading into P.
tissues
tissue destruction in AP.
Direct effect of bacterial enzymes as well
as hydrolytic enzymes released from
phagocyte cells, in particular neitrophilic
leukocytes.
when acute AP. Follows directly from
infection of the pulp the early radiographic
signs are small or even nonexistent.
Usually the first indication of acute AP
seen in the x-ray is a diffuse lesion around
the apex.