PULP-DENTINAL DAMAGE
Definition: This is the set of lesions that affect the CPD. The dentin clinic involves the exposure of the dentin by the disappearance of the enamel or cementum, it manifests itself by a short-term painful syndrome linked to stimuli that are usually thermal, evaporative, tactile, osmotic or chemical.
Etiologies:
- Tooth decay
- Trauma
- Erosion, abrasion, attrition and abfraction
- Amelogenesis imperfecta
- Gum recession
Pathogenesis:
These etiological factors have possible differences in intensity and duration, if the duration of the irritation is short the CPD can react by formation of sclerotic dentin and therefore more or less complete obliteration of the tubules. In addition if the duration is slow and permanent the complex by formation of sclerotic dentin, we can also witness an almost complete degeneration of the odontoblastic extensions and formation of the IIIrd reactional or reparative dentin. On the other hand if the virulence is too important of the aggressive agent, the pulp inflammation can be triggered.
Pathophysiology:
The third-stage dentin limits the relationships between the pulp and the exterior, thus, pulp inflammation tends to disappear, metabolic exchanges are less frequent, sensitivity is reduced, the canalicular pathway of diffusion of various toxic substances coming from caries or restorative materials gradually closes.
Symptomatology:
- Exposed dentin is sensitive to cold, heat, contact, sugary or acidic solutions. This sensitivity is of variable intensity in relation to the intensity of the irritant factor, to the subjectivity of the patient, but also to the structure of the dentin.
- “dental pain syndrome”
which is characterized by the existence of pain only provoked , during the action of the aggressive stimulus with cessation as soon as it disappears.
Theories of dentin sensitivity:
- A-nervous theory:
The theory of dentin innervation is based on the existence, in the dentinal tubules, of nerve fibers that, if injured, trigger the nerve impulse. However, it has been proven that FNs do not reach the JAD.
- B-chemical theory:
by the release of histamine-like chemicals also called transmission substances which act on neighboring nerve fibers.
- C-Odontoblast receptor hypothesis
The odontoblast could act as a receptor cell converting the energy of a stimulus into an electrical signal and transmitting it chemically or electrically to the nerve fibers with which it is intimately linked up to the dentinopulpal border.
D-BRANNSTÖM’s hydrodynamic theory
Brannstrom attributes dentinal pain to a hydrodynamic mechanism, a fluid movement in the dentinal tubules, which would cause a stimulus at the pulpal end of the nerve.
This movement would cause mechanical deformation at the level of the free nerve endings and trigger a painful influx.
PULP-DENTINAL DAMAGE
Clinical forms of APD:
- Superficial pulp-dentin damage:
The lesion is located at the level of the external third of the dentin, the tooth is little or not sensitive and there is no pulp inflammation.
- Deep pulp-dentin damage:
Here the lesion is too deep to the point of being close to the pulp. There is a slight pulp inflammation and the tooth is sensitive to the slightest contact. This sensitivity is reduced in the presence of reactive dentin.
| Superficial APD | Deep APD | |
| Pain caused | +/- | +++ |
| Spontaneous pain | – | – |
| Pulp vitality test | + | + |
| Axial and transverse percussions | – | – |
| Palpation of the bottom of the vestibule | – | – |
| X-ray | Radiolucency located in the superficial 1/3 of the dentin. | Radiolucency located in the deep 2/3 of the dentin. |
Differential diagnosis:
- Superficial APD: the differential Dg is done with deep APD.
- Deep APD: The differential Dg is done with superficial APD, chronic closed pulpitis and chronic open pulpitis.
PULP-DENTINAL DAMAGE
Conclusion:
APDs constitute a pathological entity characterized by painful dentin syndrome which constitutes a real inconvenience for the patient, early diagnosis and the appropriate treatment make it possible to intercept a pulp complication or even a locoregional complication and will preserve the health of the patient.
PULP-DENTINAL DAMAGE
Wisdom teeth can be painful if they are misplaced.
Composite fillings are aesthetic and durable.
Bleeding gums can be a sign of gingivitis.
Orthodontic treatments correct misaligned teeth.
Dental implants provide a permanent solution for missing teeth.
Scaling removes tartar and prevents gum disease.
Good dental hygiene starts with brushing twice a day.