1. The Classification symptom and diagnose of pulp diseases

2. 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

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

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

5. Steps： S F P
Symptom Find Pulp

6. PULP

7. 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

8. 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

9. 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（-）

10. 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

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

12. 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

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

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

15. 2)Exacerbation at night Hard to sleep

16. 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

17. 4) locating difficulty
Referred pain

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

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

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

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

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

23. acute
chronic
pain
location …

24. 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

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

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

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

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

29. Take a break

30. apical periodontitis

31. 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

32. Acute apical periodontitis
immune
inflammation
chronic
acute

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

34. 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)

35. 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

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

39. 2、From apical to crown #condition： large apex hole good root canal open crown

40. 3、from apical to periodontal pocket
Patient must have periodontitis

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

43. periapical granuloma

51. macrophage

52. Chronic
cyst
granuloma
abscess

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

54. 根尖囊肿
periapical cyst

55. condensing Osteitis

56. Treatment Root canal therapy
prepare
disinfection
filling
RCT

57. Thank You