Division of Pathological Stages of the Pulp

Normal pulp (sound pulp)

 * Positive cold test


 * Negative percussion test


 * Radiology
 * May show varying degrees of pulpal calcification, but no evidence of resorption, caries or mechanical pulp exposure


 * No endodontic treatment necessary

Reversible pulpitis

 * Inflammatory changes of the pulp


 * Heals after filling


 * Stimulation (hot and cold test) is uncomfortable to the patient but reverses quickly after irritation


 * Upon test -> sharp, quickly reversible pain


 * No night pain !


 * CAUSES
 * caries
 * exposed dentin (mostly in cervical area)
 * recent dental treatment
 * defective restoration


 * Histopathology
 * Hyperemia pulpae
 * Pulpitis acuta serosa


 * Analgetics work


 * Caries profunda simplex or pulpam penetrans


 * Treatment
 * After preparation of caries, indirect pulp capping

Irreversible pulpitis

 * Classification


 * Symptomatic


 * Asymptomatic --> will lead either to symptomatic or to necrotic pulp


 * Typically irreversible pulpitis occurs when symptomatic irreversible pulpitis remains unteated, thus the pulp will eventually become necrotic


 * Analgesics DOESN'T work


 * Percussion test might be positive in the end because of edema of pulp and vessels in the apex


 * Symptoms
 * Pain without stimulus
 * Sudden pain especially during supine position
 * Night pain
 * Pain fluctuates (vs periodontal pain --> stable pain!)

Pulp necrosis, gangrene

 * Pulpal blood supply nonexistent


 * Pulpal nerves are nonfunctional


 * Results from symptomatic or asymptomatic irreversible pulpitis


 * After the pulp becomes completely necrotic, the tooth will typically become asymptomatic until the time that the infection will spread to the periradicular tissues (per continuitatem spread)


 * Negative response to cold stimulation


 * Pulpal necrosis


 * Complete


 * Partial --> not all root canals of the tooth are involved