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Lezan Fattah

on 7 January 2013

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Transcript of PULPALGIA

Pulp pain, or pulpalgia, is by far the most commonly experienced pain in and near the oral cavity and may
be classified according to the degree of severity and the
pathologic process present into: 1. Hyperreactive pulpalgia
a. Dentinal hypersensitivity
b. Hyperemia
2. Acute pulpalgia
a. Incipient (reversable)
b. Moderate (irreversable)
c. Advanced (irreversable)
3. Chronic pulpalgia
4. Hyperplastic pulpitis
5. Necrotic pulp
6. Internal resorption
7. Traumatic occlusion
8. Incomplete fracture 1-Hyperreactive Pulpalgia Characterized by a short, sharp, shock—that is, “pain” best described as a sensation of sudden shock. The sensation is as sharp as it is sudden and must be elicited by some exciting factors like hot, cold or sweets.. Brännström pointed out that “the displacement of
tubule contents, if the movement occurs rapidly
enough, may produce deformation of nerve fibers in
the pulp or predentin or damage to the cells; both of
these effects may be capable of producing PAIN.” DENTIN Hyperreactive pulpalgia is common following the

Placement of a new restoration.

Patients also complain after root planing and curettage,also after Periodontal surgery, which exposes the root surface. Also may be present in the tooth with a carious lesion. Teeth traumatized by bruxism, abrasion, erosion or incompletely fractured teeth. A-Dentinal Hypersensitivity The exciting factors of a hypersensitive pulp are usually: Stimulation of the exposed dentin on the root surface by cold, sweet, vegetable or fruit acid, or often just touching the surface with a fingernail, a toothbrush, or an explorer. It has also been reported that the use of the
new “calculus-removing” toothpastes leads to an
increased dentinal hypersensitivity.
Evidently, these
agents remove the surface smear layer and open the
dentinal tubuli orifices. Fruit juices, Sugar, Salt, and dis-similar metals, which may be described as an electric current flowing between the oral cavity and the pulp.

SICHER postulated that the oral cavity is positively charged and the pulp is negatively charged, Any electrolyte, such as salt or fruit acid, upsets
this ionic balance, and the resultant current stimulates
the nerve endings to the odontoblasts. B-Hyperemia The increased pressure against the sensory nerve endings in the pulp might well produce the sensation associated with hyperemia. An increase in intra pulp tissue pressure is produced only when heat is applied to the tooth. This difference in the character of the painful response between cold and hot might well be explained
by the difference in the nerve fibers supplying the pulp:

The pulp contains both Myelinated A nerve fibers
and Unmyelinated C nerve fibers. The MYELINATED A :
are fast-conducting and have a low response
threshold and cause a sharp
localized response,

UNMYELINATED [C] are slow-con-ducting with a higher activation threshold.
whereas activation of C fibers
will cause poorly localized response. Cold stimulates the fast-conducting A fibers, producing the sharp, localized pain. Continued Heat application, on the other hand, will more likely stimulate the
slower-conducting C fibers, deeper in the pulp. The pain is frequently
described as a “nagging”or a “boring”pain, which may
at first be localized but finally becomes diffuse or
referred to another area. True pulpalgia begins with the development of pulpitis. 2-ACUTE PULPALGIA a) Incipient Acute Pulpalgia. Excitation: Incipient acute pulpalgia must be stimulated by an irritant such as cavity preparation, cold,
sugar, or traumatic occlusion. Examination:
The pain will be vanish for 1-3second when we remove the stimulus factors.
If the pulpalgia follows cavity preparation, the involved tooth is obvious.
If dental caries is the noxious stimulus, the cavity is found by an explorer and radiographs. The lesion may be quite small, just into the dentin. The patient can usually tell which quadrant is involved and may even point out the involved tooth. Cold is the best stimulus to initiate incipient acute pulpalgia. b) Moderate Acute Pulpalgia. The pain of moderate acute pulpalgia is a true toothache, but one the patient can usually tolerate. The pain does not necessarily resolve when the irritant is removed, but the tooth may go on aching for minutes or hours, or days. may start spontaneously from such a simple acts as lying down Some patients report that the pulp aches each evening, when they are tired. Others say that leaning over to tie a shoelace or going up or down stairs—any act that raises the {Cephalic Blood Pressure} will start the pain. Radiographs may give an immediate clue in the form of a huge interproximal cavity or a restoration impinging on the pulp chamber. TREATMENT: R.C.T.(root canal therapy ) if we can save the tooth. EXO (extraction) if the tooth is hopeless. c) Advanced Acute Pulpalgia. This patient is in exquisite agony and sometimes becomes hysterical from the pain. The patient often is crying and virtually unmanageable. The relief for this pain is so simple,cold water, preferably iced. Cold water rinsed over the tooth is all that is usually needed to arrest the pain temporarily. The involved tooth always has a closed pulp chamber, as revealed by the radiograph. Otherwise, intrapulp pressure could not develop.
In addition, the radiograph may reveal a thickened periodontal membrane space at the apex as the inflammation spreads out of the pulp. TENDER TO PERCUSSION....WHY? TREATMENT: R.C.T.(root canal therapy) for good prognosis tooth. EXO. (extraction) for poor prognosis tooth. Complete anesthesia of an inflamed pulp may be difficult so intra pulpal injection indicated........... Tooth should be relieved of occlusal contact by grinding.............WHY? 3-Chronic Pulpalgia: The discomfort from chronic pulpalgia is best
described as a “grumble,” a term commonly used by
patients who withstand the mild pain for weeks,
months, or years. The patient seeks relief only when the pulp begins to ache every night. The pain from chronic pulpalgia is quite diffuse, and
the patient may have difficulty locating the source of
annoyance. Patients frequently say that they have a
“vague pain in my lower jaw.”Chronic pulpalgia is likely to cause referred pain, which is also mild. Other patients may appear with beginning acute apical
abscess and confess to knowing that something was
“wrong”with the tooth for months. Other patients
comment on the bad taste or odor constantly noted. The pulp involved in chronic pulpalgia is not affected by cold but may ache slightly on contact with hot liquids. The most common report is that the tooth is sore to bite on. 4-Hyperplastic Pulpitis The exposed tissue of a hyperplastic pulp is practically free of symptoms unless stimulated directly. REFERRED PAIN IS SO COMMON TREATMENT: Same as moderate and advanced pulpalgia THE PULP POLYP CAN EASILY LIFTED BY SHARP SPOON EXCAVATOR...... TREATMENT: R.C.T. OR EXTRACTION There are no true symptoms of
complete pulp necrosis for the simple reason that the
pulp, with its sensory nerves, is totally destroyed. Often,
however, only partial necrosis has occurred, and the patient has the same vague, comparatively mild dis-comfort described for chronic pulpalgia. 5-NECROSIS Coronal discoloration may present the first indication that something is amiss in the case of the tooth with a necrotic pulp. On questioning, the patient may recall
an accident of years ago or a bout of pulpalgia long
since forgotten. TREATMENT: ROOT CANAL THERAPY OR EXTRACTION OF THE TOOTH Cold water will worse the pain It is never spontaneous. STRONIUM CHLORIDE POTASIUM OXALATE COLD doesnt lead to pain. THANK YOU ! Done by: Dr. LEZAN
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