Classification of pulpal diseases
The diagnosis are based on clinical signs and symptoms rather than on histopathologic findings.

Reversible pulpits
Reversible pulpitis is inflammation of the pulp is not severe.
If the cause is eliminated , inflammation will resolve.

Symptoms
Reversible pulpitis is usually asymptomatic.
Application of stimuli may produce sharp transient pain.

Treatment
Removal of irritants and sealing as well as insulating exposed dentin or vital pulp usually result in diminished symptoms .

Irreversible pulpitis
Irreversible pulpitis is often a sequel to and a progression from reversible pulpitis.
Irreversible pulpitis is a severe inflammation that will not resolve even if the cause is removed. Symptoms
Irreversible pulpitis is usually asymptomatic , may also be associated with intermittent or continuous episodes of spontaneous pain.
Localization of pulpal pain is more difficult than localization of periradicular pain.

Tests and treatments
Extension of inflammation to the periodontal ligament causes percussion sensitivity and better localization of pain.
Root canal treatment or extraction is indicated .

Hyperplastic pulpitis
Hyperplastic pulpitis (pulp polyp) is a form of irreversible pulpitis , which results from growth of chronically inflamed young pulp into occlusal surfaces.

Hyperplastic pulpitis is usually asymptomatic. The teeth respond within normal limits when palpated or percussed.

Hyperplastic pulpitis

Pulp calcification
Extensive calcification occurs as a response to trauma , caries , periodontal diseases , or other irritants.

Responses to palpation and percussion are usually within normal limits.
This condition in and of itself is not a pathosis and does not require treatment.

Pulp calcification

Internal resorption
Inflammation in the pulp may initiate resorption of adjacent hard tissues.
Most cases of intracanal resorption are asymptomatic. Teeth respond within normal limits to pulpal and periapical tests.

The pink spot

Internal resorption

Internal resorption

Immediate removal of inflamed tissue and instruction of root canal treatment is recommended. Teeth with perforated resorption are difficult to treat nonsurgically.

Pulpal necrosis
Pulp is encased in rigid walls , and its venules and lymphatics collapse under increased tissue pressure , therefore irreversible pulpitis leads to liquefaction necrosis. Symptoms
Pulpal necrosis is usually asymptomatic but may be associated with episodes of spontaneous pain and discomfort or pain. Tests and treatment
Because of the spread of inflammatory reactions to periradicular tissues , teeth with necrotic pulps are often sensitive to percussion. Root canal treatment or extraction is indicated for these teeth.

Periradicular pathosis
As a consequence of pulpal necrosis pathologic changes can occur in the
Periradicular tissues.

Classification of Periradicular lesions Periradicular lesions have been classified on the basis of their clinical and histologic findings.

Acute apical perodntitis
Etiology
Described as symptomatic apical perodntitis.
The pulp may be irreversible inflamed or necrosis. Signs and symptoms
Clinical features are moderate to severe spontaneous discomfort as well as pain on mastication or occlusal contact.
“thickening” of periodontal ligament space may be a radiographic feature.

Treatment
Removal of irritants or a pathologic pulp , or release of periradicular exudate usually results in relief.

Acute apical perodontitis

Chronic apical perodntitis
Etiology
• Chronic apical perodntitis results from pulpal necrosis and usually is a sequel to
AAP

Signs and symptoms
CAP is without symptoms or is associated with slight discomfort and would be better classified as asymptomatic apical perodontitis. There may be slight sensitivity to palpation
, indicating an alteration of the cortical plate of bone.

Treatment
Removal of inciting irritants and complete obturation usually result in resolution of CAP.

Chronic apical perodontitis

Acute apical abscess
Etiology
Acute (symptomatic) apical abscess is localized or diffuse liquefaction lesion that destroys periradicular tissues.

Signs and symptoms
Depending on the severity of the reaction patients have moderate to severe discomfort or swelling.
These teeth are usually painful to percussion and palpation.

Acute apical abscess

Acute apical abscess

Acute apical abscess

Chronic apical abscess
• Chronic apical abscess results from a long standing lesion that has caused an abscess which is draining to a surface.

Etiology
Similar to that of AAAs.
It also results from pulpal necrosis and is usually associated with CAP that has formed an abscess.

Signs and symptoms
Because draining exists , CAP is usually asymptomatic except when there is occasional closure of the sinus pathway.

Chronic apical abscess

Nonendodontic periradicular pathosis Differential diagnosis
A number of radiolucent and radiopaque lesions of nonendodontic origin simulate the radiographic appearance of endodontic lesions.
Unfortunately , many clinicians use only radiographic for diagnosis and treatment without taking a complete history of the signs and symptoms. Normal and pathologic entities
Normal structures
Such anatomic variations include large marrow spaces , maxillary sinus , apical dental papillae of developing teeth , nasopalatine foramen , mental foramen.

Nonendodontic pathosis
Benign lesions include : lateral periodontal cyst , dentigerous cyst , nasopalatine duct cyst , central hemangioma , myxoma , and ameloblastoma.
Malignant lesions include : lymphoma squamous cell carcinoma , osteogenic sarcoma , chondrosarcoma.