Diagnosis of Dental Pulp and Periapical Area Disorders

I- Diagnosis of Dental Pulp Disorders

Diagnosis of Dental Pulp * Diagnosis of focal reversible pulpitis (Pulp hyperemia): Disorders 1-Tooth is sensitive to thermal changes especially the cold. 2-Pain disappears after removal of stimulus. 3-Tooth is vital and responds well to electric pulp tester (lower level of current). 4-Tooth is usually with deep carious lesion, or large metallic restoration without adequate isolation, or restoration with defective margins. 5-Recent restoration may be with poor lining, or cavity preparation without cooling. 6-Tooth return to a normal condition after removing the cause.

* Diagnosis of acute pulpitis:

1-Severe pain in thermal changes especially the cold. 2-Pain persists even after removal of stimulus. 3-Tooth is vital and responds well to electric pulp tester (very low level of current). 4-Tooth is usually with large carious lesion, or defective restoration with recurrent caries. 5-General symptoms such as fatigue with delirium. 6-Damage of pulp is irreversible and the tooth does not return to normal after treatment.

Diagnosis of Dental Pulp Disorders

* Diagnosis of chronic pulpitis:

1-Reaction to in thermal changes is dramatically reduced. 2-Dull intermittent pain. 3-Tooth is necrosis and may respond to electric pulp tester (high level of current). 4-Tooth is usually with large carious lesion, or defective restoration with recurrent caries. 5-Probing of the pulp is painless in most cases. 6-Damage of pulp is also irreversible.

Diagnosis of Dental Pulp Disorders

Diagnosis of Dental Pulp * Diagnosis of chronic hyperplastic pulpitis (Pulp polyp): Disorders
1-Tooth has a large, open carious lesion. 2-It is usually found in children and young adult. 3-Most commonly teeth involved are deciduous molars and first permanent molars. 4-Pulp tissue appears asymptomatic pinkish red protruding from the pulp chamber and filling the entire cavity. 5-Probing may or may not cause bleeding depending upon vascularity of lesion. 6- It must be differentiated from gingival polyp which is due to inflammation of the gingival near a broken tooth------it proliferates to the broken area. To differentiate between them by probe where the gingival polyp is usually attached to the gingival, while the pulp polyp coming from the pulp.

Clinical features of pulp polyp.

* Diagnosis of Pulp necrosis (Pulp gangrene):

1-It is the final stage of untreated pulpitis. 2-It is asymptomatic condition. 3- Tooth is usually with large carious lesion, or defective restoration with recurrent caries, or traumatic fracture. 4-Tooth is necrosis and does not respond to electric pulp tester. 5-Probing of the pulp is painless. 6- It may cause discolored tooth due to degeneration of the dentinal tubules caused by death of the pulp.

Diagnosis of Dental Pulp Disorders

Clinical feature of pulp necrosis

II- Diagnosis of Periapical Area Disorders

*Diagnosis of periapical sclerosis:

1- It may be due to very mild and long standing irritation. 2-It is asymptomatic condition. 3-Radiographically, it appears as a thin well-defined radiopaque layer around the apical area.

Diagnosis of Periapical Area Disorders

*Diagnosis of apical periodontitis:

1-Tooth may be with penetrating carious lesion, or old defective restoration, or old traumatic fracture. 2-Gingival inflammation with infrabony pocket. 3-Tooth is tender to percussion. 4-Painful in bitting or chewing a solid food. 5-Negative vitality test. 6-Radiography reavels to widening of the periodontal ligament at the apical area.

Diagnosis of Periapical Area Disorders

*Diagnosis of periapical abscess:

1-The involved tooth is extremely painful. 2-The involved tooth is extremely sensitive to percussion. 3-The involved tooth is slightly extruded from its socket. 4-Presence of systemic manifestations such as pain, swelling, fever and redness of overlying skin. 5-The periapical abscess may be intraorlly (buccally or lingually) or extraorally. 6-Radiographically, it appears as an amorphous radiolucent area with ill-defined irregular margin in the periapical area of the involved dental root. 7-Complications of untreated periapical abscess: a-Osteomyelitis. b-Cellulitis. c-Bacteremia. d-Maxillary sinusitis.

Diagnosis of Periapical Area Disorders

Radiographical features of periapical abscess

*Diagnosis of periapical granuloma:

1-Mild pain when bitting or chewing on solid food. 2-The involved tooth is mild sensitive to percussion. 3-The involved tooth is slightly extruded from its socket. 4-No presence of systemic manifestations. 5-It could be discovered by routine radiographical examination. 6-Radiographically, it appears as a rounded radiolucent area with well-defined regular margin surrounding the apical foramen of the involved dental root and ranges from few millimeters to 1 cm in diameter. 7-Complications of untreated periapical granuloma: a-Pain due to infected periapical granuloma. b-Periapical cyst develops due to proliferation of the epithelial rests of Malassez presenting in the histological structure of periapical granuloma.

Diagnosis of Periapical Area Disorders

Radiographical features of periapical granuloma

*Diagnosis of periapical cyst:

1-It usually occurs in adult life. 2-It is more common in males than females. 3-It is more frequently in the maxilla, specially the anterior region. 4-It is asymptomatic condition. 5-There is usually a non-vital tooth from which the cyst has developed. 6-Radiographically, it appears as a round or ovoid well-defined radiolucent area with narrow opaque margin that is continuous with the lamina dura of the involved tooth and ranges from 5 mms to several cms in diameter. 7-Complications of untreated periapical cyst: a-Increase in size. b-Residual cyst develops due to extraction of tooth without enucleating or defective enucleating the periapical cyst.

Diagnosis of Periapical Area Disorders

Radiographical features of periapical cyst