The Classification symptom and diagnose of pulp diseases

The Classification of the pulp diseases According to the symptom 1、reversible pulpitis 2、irreversible pulpitis acute pulpitis chronic pulpitis Retrograde pulpitis 3、Necrotic pulp 4、pulp calcification 5、internal resorption of tooth

Classification revisable pulpitis degeneration narcosis Normal pulp outcome revisable pulpitis degeneration narcosis Normal pulp irreversible pulpitis periodontitis internal resorption of tooth

Symptom and diagnose Which tooth? A precise diagnose is the key to solve the problem Which tooth?

Steps： S F P Symptom Find Pulp

PULP

Pulp is vital intense and sharp sensation ① Revisable pulpitis Pulp is vital intense and sharp sensation thermal stimuli Normal pulp Revisable pulpitis irreversible pulpitis

① Revisable pulpitis 1、Symptom a、thermal induced pain When the teeth meet cold or hot conditions, sharp and intense sensation occur at once. Pain disappeared as the stimuli removed. b、no spontaneous pain

① Revisable pulpitis 2）Examination： a、Caries(hard tissue problems) 、deep periodontal pocket、occlusal trauma… b、thermal test，symptom only last for seconds c、percussion（-）

Differentiation 1.Deep caries caries : sensation in the cavity reversible pulpitis: sensation on the surface of the tooth 2.Irreversible pulpitis spontaneous pain continuous pain after remove of the stimuli 3. dentine hypersensitivity mechanic stimuli

② irreversible pulpitis Definition：severe pulpitis enable to become normal pulp inflammation and necrosis Acute Chronic Residual pulpitis Retrograde pulpitis

② irreversible pulpitis 1.Acute pulpitis acute server pain secondary to chronic pulpitis Also can be the result of trauma, or thermal or pharmic stimuli during a caries treatment

②Acute pulpitis 1、symptom 1）server pain： a、spontaneous pain b、specially in night c、thermal stimuli pain d、locating difficulty

1)spontaneous pain No stimuli Paroxysmal pain Early stage: lasting time short later stage: lasting time very long(hours)

2)Exacerbation at night Hard to sleep

3)Thermal induced pain Both cold and hot will cause server pain But if necrosis happens, hot Exacerbation and cold remission That is because in the later stage of irreversible pulpitis, gas may be produced by the microbial in the root canal

4) locating difficulty Referred pain

trigeminal nerve 5th cerebral nerves Feeling of face, oral cavity and nose Movement of masseter muscle

diagnose Acute pulpitis Key: which tooth 2）tooth check 1）Chief complain：Pain 2）tooth check 3) Thermal test, electric test

chronic pulpitis most common result of caries or acute pulpitis easily to be ignored

chronic pulpitis long history involving the periodontal tissue spontaneous pain not server long history involving the periodontal tissue precise location

Classification 1）necrotic 2）polyp 3）closed pulp chamber

acute chronic pain location …

residual pulpitis 1symptom：a.pulp treatment history b.Spontaneous pain, stimulated pain c.Occlusal pain 2examination：a. pulpitis b. treatment history c. pain or blood in root canal

retrograde pulpitis 1 a. perfect teeth b. pulpitis c. periodontitis

pulp necrosis symptom： a、no pain b、change in color c、injury history examination：vital(-)

pulp calcification Pulp blood circulation disorder. 1 symptom： 1）most no pain very few body position based pain 2 examination: X-ray

internal resorption Osteoclast(when normal pulp tissue become granulation tissue) 1、symptom： a、X-ray b、mostly no pain

Take a break

apical periodontitis

Classification 1、Acute： 1）serosity apical periodontitis 2）pyogenic apical periodontitis apical; Subperiosteum submucosal 2、chronic： 1）periapical granuloma 2）periapical cyst 3） chronic apical periodontal abscess 4）condensing Osteitis

Acute apical periodontitis immune inflammation chronic acute

serosity apical periodontitis Pathology：  vasodilation and congestion  edema  neutrophilic leukocyte  Bone tissue of the periapical is normal between the abscess and the chronic periodontitis

serosity apical periodontitis Examination： a、caries、filling、deep pocket b、change in color , pulp vital(-) c、 percussion （+）—（++) d、I°remove e、X-ray(not obvious)

Acute Apical Abscess （一）Pathogen A.A.A （一）Pathogen  develop from serosity apical periodontitis，or chronic periodontitis  pus  at first pus is only in a local area, as the diseases progressing it can discharge in different ways 3 main ways

Acute Apical Abscess # periapical--cancellous bone-- external circumferential lamella-- Nutrition hole – Subperiosteum server pain # submucous abscess or subcutaneous abscesses easement of pain # cellulitis

2、From apical to crown #condition： large apex hole good root canal open crown

3、from apical to periodontal pocket Patient must have periodontitis

#P.51 Chronic periapical # 1）periapical granuloma 2）periapical cyst 3） chronic apical periodontal abscess 4）condensing Osteitis

periapical granuloma

macrophage

Chronic cyst granuloma abscess

chronic periapical abscess enlarge of the granuloma--enter area lack of blood- --necrosis--pus

根尖囊肿 periapical cyst

condensing Osteitis

Treatment Root canal therapy prepare disinfection filling RCT

Thank You