Classification of Pulpal Diseases

Pulp in the essence of the tooth. Pulp is the structure that makes a tooth vital and we can very well say that the survival of any tooth depends on the vitality of the pulp. And just like any other vital things pulp is also prone to infections and injury . The diseases of pulp can occur due to bacterial, physical, chemical or radiation reasons.

The initial stages of diseases affect the external surfaces of the tooth i.e. Enamel and from there to dentin. If the progress of the infection is not controlled then finally the infection reaches the pulp. It is at this time when the infection becomes completely symptomatic with complaints of severe pain . sensitivity and some times swelling.

Grossman classified the diseases of pulp into various categories, depending on the type of pathology, namely –

Pulpitis

Pulp Degeneration

Pulp Necrosis

Classification of Pulipitis

Pulpitis as the name indicates is the infection of  dental pulp.

Inflammation of the pulp. This may occur due to caries, or trauma or due to multiple restorations, where recurrent caries can occur. The principal symptom of Pulpitis is pain. The pulpitis begins as a reversible condition initially, which later progresses to become irreversible if not treated by a simple filling. The pulp becomes necrotic, and leads to infection around the apex of the root in the later stages.

(A) Reversible Pulpitis

– Symptomatic (Acute)
– Asymptomatic (Chronic)

Irreversible Pulpitis

i. Acute

– Abnormally responsive to cold
– Abnormally responsive to heat

ii. Chronic

– Asymptomatic with pulp exposure
– Hyperplastic pulpitis
– Internal resorption

(B) Depending on direct communication between pulp and oral cavity.

Open Pulpitis (pulpitis aperta)

When the apex is opened

Closed Pulpitis (pulpitis clausa)

When the apex is closed .

Clinically and histologically these are different entity i.e. presence or absence of drainage which in turn determine the degree of pain.

(C) Depending on the direction of the spread of infection

Orthograde : When the infection spreads from coronal to apical portion

Retrograde : When the infection spreads from the blood circulation in the apical portion.

(D) Depending upon the extend of involvement

Partial pulpitis(Focal)

Subtotal pulpitis(Generalised)

II. Pulp Degeration

This condition is usually seen in older people, where persistent mild irritation to the teeth leads to degeneration of the pulp. It may be induced by the attrition of the teeth, bacteria, erosion etc. and if that progresses, it may get discolored and there would be no response from the pulp to any type of stimulation.
It may be –

a. Calcific degeneration (confirmed by radiographic diagnosis)
b. Other (confirmed by histopathologic diagnosis)

II. Pulp Necrosis

Necrosis is the death of the pulp, and it may be partial or total, depending on the amount of pulp involved and can occur due to either inflammation or due to any traumatic injury. The necrosis of the pulp can be either Coagulation necrosis or Liquefaction necrosis.

There are several other classifications suggested for the Pulpal pathologies, but the most standard one is the Grossman classification, which groups them based on the type of pathology.

The following slide gives an idea regarding  the structures associated with tooth and how they play a role in maintain health of the tooth .

Opy notes (pulp)

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