Benign Oral and Dental Disease
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
Pulpitis (dental pulp inflammation) occurs most commonly secondary to microbial infection involving a carious lesion. Less common pathways of infection are through a tooth fracture or in a retrograde manner through the apical foramen. Pulpitis is characterized by inflammation within the confines of the pulp chamber resulting in pressure causing occlusion of the blood vessels and necrosis of the pulp tissue. The pain changes from pain exacerbated by thermal stimuli in reversible pulpitis to a dull, throbbing, persistent poorly localized pain of spontaneous onset in irreversible pulpitis. Ultimately, progressive infection of the pulp chamber is followed by an anaerobic bacterial biofilm colonizing the walls of the necrotic root canals leading to asymptomatic necrosis or acute inflammation. The involvement of the periapical tissues via the apical foramen may elicit an acute inflammatory host response resulting in acute periodontitis. Symptoms indicating the development of apical periodontitis are the development of tenderness on application of pressure of the involved tooth. Dentists typically use the end of a dental mirror handle to tap on the tooth to elicit this. Treatment of pulpitis and apical periodontitis is through root canal treatment or dental extraction. Systemic antibiotics are not routinely prescribed.
The gastrointestinal system
C. Simon Herrington in Muir's Textbook of Pathology, 2020
The periapical tissues are the site of a variety of lesions related to the root apices of teeth. The most frequent of these arise from the spread of infection from pulpitis, through the apical foramina of the tooth, to reach the periodontal ligament. This can result in an acute periapical abscess, a very painful condition that may be accompanied by cervical lymphadenopathy and generalized fever and malaise. Pus can track through the adjacent bone and, after the periosteum is breached, a soft-tissue abscess develops and later discharges. More frequently, after low-grade pulpitis, a periapical granuloma develops. This consists of a mass of granulation tissue heavily infiltrated with chronic inflammatory cells. There is resorption of the surrounding bone, seen radiologically as a periapical radiolucent lesion (Figure 10.2). Acute exacerbation may result in a secondary acute periapical abscess and, conversely, a periapical granuloma can develop after an acute periapical abscess has pointed and drained. Remnants of odontogenic epithelium that persist in the periradicular tissue after tooth development proliferate within a periapical granuloma, and these give rise to the most common cyst of the jaws, the inflammatory radicular cyst.
Bacterial Infections of the Oral Cavity
K. Balamurugan, U. Prithika in Pocket Guide to Bacterial Infections, 2019
Caries risk-assessment analysis can be performed using a systematic charting that includes dietary history, genetic factors, and other local presentations (Hillman, 2002). Salivary buffer capacity by analyzing the pH of saliva can tell the risk range from high to low. Such analysis can help the clinician understand the nature of the disease and its severity and to develop preventive measures to preserve, prevent, and restore the tooth. Dental caries can progress to pulp and result in pulpal inflammation, which can be either acute or chronic and is based on the symptoms. It can be classified as reversible or irreversible pulpitis based on the nature of symptoms. Irreversible pulpitis needs a root canal. Irreversible pulpitis can progress to spread the infection beyond the tooth to the surrounding bone where it results in periapical abscess. The abscess can consolidate to a granuloma or spread to the surrounding areas and into potential spaces of the face and oral cavity, resulting in serious infection. Sometimes, the abscess can divert its course to the path of least resistance and drain to the oral cavity in the form of a sinus opening. Granuloma can be a chronic presentation or can progress to a cyst with breakdown of the cells and development of lining of the cavity filled with fluid. The cyst related to the tooth is termed a radicular cyst and can either progressively increase in size, expanding to the bone, or can present as a symptomatic painful swelling if it is infected.
The pharmacological management of dental pain
Published in Expert Opinion on Pharmacotherapy, 2020
Joseph V. Pergolizzi, Peter Magnusson, Jo Ann LeQuang, Christopher Gharibo, Giustino Varrassi
A periapical abscess or pulpitis may develop when the tooth’s enamel is damaged by caries, facilitating a bacterial invasion. Pulpitis describes the infection of the pulp of the tooth. Note that if bacterial growth proceeds in such a way that there is a drainage for the infection, the infection may remain asymptomatic or have such mild and diffuse symptoms that they go unnoticed for days or weeks. Severe infections may move apically toward the bone and into soft tissues, becoming a periodontal abscess. In such cases, the abscess must be incised and drained and antimicrobial therapy initiated [66]. Periodontitis describes an abscess that occurs when pathogens invade the periodontal pocket and cannot find escape, spreading to the alveolar bone and/or adjacent tissue. Periodontitis may occur with the eruption of the wisdom teeth, which, in rare cases, may progress to a localized infection [66]. Periodontal disease also includes any of several types of gingival infections, infections of the periodontal ligament, or infection of the alveolar bone which anchors the tooth in the jaw. This condition may proceed without symptoms for a long time. Gingivitis or inflammation of the gingiva causes pain and bleeding of the gums due to infection. Acute infectious gingivitis may involve ulceration and advance to acute necrotizing ulcerative gingivitis (ANUG). Symptoms of ANUG include pain, fever, malaise, and the gingiva will be necrotic [66].
The protective effects of saxagliptin against lipopolysaccharide (LPS)-induced inflammation and damage in human dental pulp cells
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2019
Xinxing Guo, Jing Chen
Pulpitis (tooth pulp inflammation) is one of the most common oral diseases affecting millions of people worldwide. Oral bacterial infection has been extensively associated with the pathogenesis of pulpitis [1]. A variety of components and products of bacteria have been shown to invade the dentin and root canal, including lipopolysaccharide (LPS) [2]. LPS is also known as endotoxin, which has been identified as the major component of the outer membrane of Gram-negative bacteria [3]. LPS acts as an important inducer of pulpitis and plays a pivotal role in many intracellular responses to pulpal infection [4]. LPS can induce the expression and secretions of various proinflammatory cytokines and chemokines, including tumour necrosis factor alpha (TNF-α), interleukin (IL)-1β and IL-8 in human dental pulp cells (HDPCs) [5] through activating the expression of toll-like receptor 4 (TLR4) [6]. Excessive production of these cytokines facilitates the pathological progression of pulpitis [7]. Also, it has been reported that LPS treatment reduced cell survival rate of HDPCs [8]. LPS exposure leads to the initiation of many intracellular signalling pathways. For example, activation of the mitogen-activated protein kinase (MAPK) p38 plays an important role in mediating the production of pro-inflammatory cytokines in response to LPS exposure [9]. Importantly, LPS stimulation induces the activation of the NF-κB signalling pathway, which has acted as a central regulator in inflammation reactions [10]. Blockage of LPS-induced inflammation signalling and cellular insults has become an important strategy for the treatment of pulpitis.
Effect of intraosseous injection versus inferior alveolar nerve block as primary pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis: a prospective randomized clinical trial
Published in Acta Odontologica Scandinavica, 2018
Alireza Farhad, Hamid Razavian, Maryam Shafiee
Endo Ice (Hygienic Corp., Akron, OH) was used for diagnosis of symptomatic irreversible pulpitis after isolating the affected tooth with cotton rolls [1,4,8,10–12]. Patients expressed the level of pain experienced using Heft-Parker visual analogue scale (VAS).This is a psychometric response scale used to measure subjective characteristics along a continuous line between two end-points. Score zero indicated no pain, scores 1–54 indicated mild pain, scores 55–113 indicated moderate pain and scores 114–170 indicated severe pain [17]. Patients reporting moderate and severe lingering pain to cold testing, diagnosed with symptomatic irreversible pulpitis, were included. Diagnosis was made by a single operator (trained post-graduate endodontic student) to prevent bias in establishing the correct pulp diagnosis. Patients with no response to cold testing or periradicular pathosis (other than a widened periodontal ligament) were excluded from the study [4,8,10–12].