Handbook of Oral Pathology and Oral Medicine. S. R. Prabhu

Dentine caries. (a) Carious tooth with clinical crown lost to decay. Note bacterial colonies infiltrating dentinal tubules(source: by kind permission of Associate Professor Kelly Magliocca, Department of Pathology and Laboratory Medicine, Winship Cancer Institute at Emory University, Atlanta, GA, USA).(b) Decalcified section showing softened dentinal tubules filled with colonies of bacteria. Multiple clefts caused by spreading infection of dentine are visible(source: by kind permission of David Wilson, Adelaide, Australia).

2.9 Management

       Goal: preserve tooth structure and prevent further spread

       Non‐cavitated lesions: arrest of caries by remineralization (optimum oral hygiene and topical fluoride application) and reduction of frequency of refined sugar intake (non‐operative treatment)

       Cavitated lesions: dental restorations with dental amalgam, composite resin, porcelain etc.

       Tooth extraction: non‐restorable carious teeth

       Dental sealants

2.10 Prevention

       Oral hygiene maintenance

       Dietary modification

       Use of fluoridated water (0.7–1.0 ppm) during tooth development periods

       Topical fluoride applications (fluoride toothpaste, varnish, and mouth wash)

Recommended Reading

      1 Featherstone, J.D.B. (2008). Dental caries: a dynamic disease process. Australian Dental Journal 53: 286–293.

      2 Machiulskiene, V., Campus, G., Carvalho, J.C. et al. (2020). Terminology of dental caries and dental caries management: consensus report of a workshop organized by ORCA and Cariology research group of IADR. Caries Research 54: 7–14.

      3 Major, I. (2005). Clinical diagnosis of recurrent caries. Journal of the American Dental Association 136 (10): 1426–1433.

      4 Odell, E.W. (2017). Dental caries. In: Cawson's Essentials of Oral Pthology and Oral Medicine, 9ee (ed. E.W. Odell), 53–70. Edinburgh: Elsevier.

      5 Petersen, P.E., Bourgeois, D., Ogawa, H. et al. (2005). The global burden of oral diseases and risks to oral health. Bull World Health Organ 83: 661–669.

      6 Philip, N., Suneja, B., and Walsh, L.J. (2018). Ecological approaches to dental caries prevention: paradigm shift or shibboleth? Caries Research 52: 153–165.

      7 Pitts, N., Zero, D., and Partnership, C.P. (2012). White Paper on Dental Caries Prevention and Management. A summary of the current evidence and the key issues in controlling this preventable disease. Geneva: FDI World Dental Federation.

3 Diseases of the Pulp and Apical Periodontal Tissues

      CHAPTER MENU

      1  3.1 Classification of Diseases of the Pulp and Apical Periodontal Tissues

      2  3.2 Pulpitis

      3  3.3 Apical Periodontitis and Periapical Granuloma

      4  3.4 Apical Abscess (Dentoalveolar Abscess)

      5  3.5 Condensing Osteitis

3.1 Classification of Diseases of the Pulp and Apical Periodontal Tissues

Disease	Description
Reversible pulpitis	A clinical diagnosis based upon subjective and objective findings indicating that the inflammation should resolve and the pulp return to normal
Symptomatic Irreversible pulpitis	A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing. Additional descriptors: lingering thermal pain, spontaneous pain, referred pain
Asymptomatic irreversible pulpitis	A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing. Additional descriptors: no clinical symptoms but inflammation produced by caries, caries excavation, trauma, etc.
Pulp necrosis	A clinical diagnostic category indicating death of the dental pulp. The pulp is usually nonresponsive to pulp testing
Symptomatic apical periodontitis	Inflammation, usually of the apical periodontium, producing clinical symptoms including a painful response to biting and/or percussion or palpation. It may or may not be associated with an apical radiolucent area
Asymptomatic apical periodontitis	Inflammation and destruction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area, and does not produce clinical symptoms
Acute apical abscess	An inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation and swelling of associated tissues
Chronic apical abscess	An inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little or no discomfort, and the intermittent discharge of pus through an associated sinus tract
Condensing osteitis	Diffuse radiopaque lesion representing a localized bony reaction to a low‐grade inflammatory stimulus, usually seen at apex of tooth

      Source: Based on ENDODONTICS: Colleagues for Excellence, Endodontic Diagnosis, Fall 2013. American Association of Endodontists (2012 update)

3.2 Pulpitis

      3.2.1 Definition/Description

       Pulpitis refers to inflammation of the dental pulp. Types include:Reversible pulpitis: pulpal inflammation resolves once the aetiology is removedIrreversible pulpitis: pulpal inflammation does not resolve once the aetiology is removedChronic hyperplastic pulpitis (pulp polyp)

      3.2.2 Frequency

       Prevalence varies from country to country. Ranges from 27%‐54% of the population

       Irreversible pulpitis is more common in females

      3.2.3 Aetiology/Risk Factors

       Caries

       Traumatic exposure of the pulp

       Fracture of the crown or cusp

       Cracked tooth

       Thermal or chemical irritation