January 7, 2015

Oral Pathology Lab Two types according to the

Pulp Abnormalities
PULP ABNORMALITIES
Pulp Calcification
Internal Resorption
External Resorption
Pulp abnormalities cannot be seen by the
naked eye but through a radiograph.
*Resorption hard tissue being resorbed not
because of abrasion, erosion or attrition but by
some other factors.
1. Pulp Calcification
- A common phenomenon that occurs
with increasing age.
*Calcified hard tissues inside the pulp
which is a soft tissue
- No apparent cause
- No relation to inflammation, trauma or
systemic disease. (ex. dental caries)
- Variation of the normal pulp
2 types:
a. Diffused/Linear
- Typically found in root canals and
parallel to blood vessels.
- It takes up the space
- The calcification is in line with the
dentin.
- The pulp obliteration is like a line
and more or less will leave a very
thin root canal or completely
obliterated.
b. Pulp Stones
Found in pulp chambers
Also known as Denticles
because it is composed of dentin.
Two types according to
composition:
i. True denticles composed
of dentin
ii. False denticles represent
the foci of calcification (there
is calcium and other minerals)
attachment to the dentin:
i. Attached denticle-
incorporated in the dentin
walls.
ii. Free denticles surrounded
by pulp tissue; in the middle of
the pulp.
You may restore Class II cavity with Pulp
Calcification because there is no problem
regarding infection or inflammation. It is just a
variation of the normal pulp.
You may restore Class III cavity with diffused
pulp calcification because the thin pulp will not
be a hindrance during cavity preparation.
You may perform RCT in a tooth with pulp
stones if the instruments can work in between
the stones.
For numerous pulp stones consider the
instrumentation then check for the size and
number of stones to decide if RCT is to be
done
You cannot do RCT in a completely obliterated
pulp.
Do RCT or extraction if there is infection.
2. Internal Resorption
- Resorption comes from within the pulp.
- Also called pink tooth because it
contain blood.
- Resorption of the dentin of the pulpal
walls
- A part of an inflammatory response to
pulpal injury. (Trauma esp. luxation)
- Activation of osteoclasts/dentinoclasts
on internal surfaces of the root or crown
- Any tooth may be involved.
- Asymptomatic, until root fracture or
communication with the PDL occurs.
Treatment:
Root canal therapy before
perforation.
*If it has not perforated the tooth yet.
 *If there is still enough enamel and
dentin.
Occasionally, the process may
spontaneously stop for no apparent
reason.
3. External Resorption
- Resorption comes from outside.
- May involve one or more teeth.
- Resorption of teeth from external
surfaces (cementum)
- Lesions occur on root surfaces below
gingival epithelial attachment.
Treatment:
No effective treatment
Results in the loss of the affected
tooth. (Extraction)
Trauma external force, orthodontic
force or excessive force
Reimplantation or
Transplantation possible results
may be ankyloses or external
resorption.
Impaction mesioangular or
horizontal
Ex.
3rd molar is resting on the tooth
surface of the 2nd molar
(specifically on the distal root).
That area may produce external
resorption.
The impacted tooth is the one
that will undergo resorption.
Idiopathic no known cause

Etiology:
Pathologic process adjacent to
the tooth:
A. Chronic inflammatory lesion
(abscess)
Necrotic tooth toxins
abscess affected surrounding
tissues external resorption
B. Cysts - coming from the tooth
itself not at the apex of the tooth
Ex.
- Odontogenic dentigerous cyst
- 3rd molar cyst may cause
external resorption on the 2nd
molar roots.
C. Benign tumors (Oncology) -
near the root may cause external
resorption, usually in mandible.
Ex.
Central giant cell granuloma
- Benign tumor that is not
odontogenic in origin
- Usually occurs in mandible
- Causes external resorption of
the adjacent roots
D. Malignant Neoplasm/ cancers
malignant tumor inside the bone
(maxilla or mandible). This may
also cause external resorption of
the apices/roots of the teeth
adjacent to it.