DEFINITION/OVERVIEW
- Pulpitis: inflammation of the pulp in response to stimuli; most commonly used in reference to a tooth discolored (pink, purple to gray) by blunt trauma
- Reversible: inflammatory changes of the pulp with potential resolution
- Irreversible: significant inflammatory changes with the end result of pulpal death and necrosis
- Reversible: inflammatory changes of the pulp with potential resolution
ETIOLOGY/PATHOPHYSIOLOGY
- Dogs/cats
- Noxious stimulus to the pulp that stimulates inflammation
- Blunt trauma/concussive force.
- Thermal trauma: improper scaling, polishing, electrosurgery, or cavity preparation
- Chemical trauma: improper use of restorative material
- Ischemic insult due to apical avulsion/intrusion or thromboembolism
- Pulpal exposure due to fracture or caries with resultant bacterial colonization
- Excessive orthodontic or occlusal forces
- Blunt trauma/concussive force.
- Pulpal edema or hemorrhage
- Intrapulpal hemorrhage apparent when blood cells or pigments enter dentinal tubules
- Size of pulp chamber and vascularity can influence its progression and prognosis
- Immature patient with wide canal and minor insult: may be reversible
- Pink discoloration resolves
- Older, more constricted pulp has less capacity to accommodate swelling and pressure, so pulpal compromise more likely
- Pink discoloration transforms to gray or purple as pigment in dentinal tubules degrades
- 92% of discolored teeth are nonvital and need treatment, despite apparently normal radiographic findings in some (47% had radiographic evidence of nonvitality (see Hale in the “Suggested Reading” section)
- Pink discoloration transforms to gray or purple as pigment in dentinal tubules degrades
- Nonvital pulp can be contaminated with bacteria anachoretically through a hematogenous route
- Infective pulpitis can extend into a periapical infection with bone loss
- Immature patient with wide canal and minor insult: may be reversible
- Noxious stimulus to the pulp that stimulates inflammation
SIGNALMENT/HISTORY
- Any age, breed, or size
- Younger patients more likely to have resolution (reversible pulpitis)
- History of facial trauma
- Aggressive chewing behavior
- Discolored tooth
- In small animals, there is seldom evidence of discomfort or apical drainage
- In people, acute pulpitis in a closed tooth can initially be painful due to the pressure, until the nerve of the pulp dies
CLINICAL FEATURES
- Discoloration of tooth: pink to purple/gray; tooth often intact (Fig. 36-1)
- Transillumination of tooth: light does not transmit through tooth—it appears dark or dull (see Chapter 3) (Fig. 36-2)
- Radiographic signs
- Radiographic evidence is lacking in 42% of intrinsically discolored, nonvital teeth (see Hale in the “Suggested Reading” section)
- Wider than normal pulp canal due to odontoblast death and delayed maturation (Fig. 36-3)
- Narrowed, strictured, or obliterated pulp canal due to accelerated calcification
- Periapical radiolucency
- Internal or external root resorption
- Radiographic evidence is lacking in 42% of intrinsically discolored, nonvital teeth (see Hale in the “Suggested Reading” section)
Figure 36-1 Discolored left maxillary canine.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
