Dental Problems

Pediatric Endodontics

Pediatric endodontics deals with the management of the pulpally involved teeth in kids. It deals with the dynamics of dental pulp, its pathologies affecting it with clinical features and its diagnostic procedures. In this article, there is a brief discussion on the pediatric endodontics and histopathology and clinical symptoms. Read on to know more.

Pediatric Endodontics

Pediatric endodontics is one relatively new terminology. It deals with the management of the pulpally involved teeth in kids. The pulp therapy in kids is still a subject of controversy mainly due to the lack of efficacious skill and medicaments, which requires a lot more of patience on the operator’s part in handling this age group of patients.

In spite of an increased awareness regarding the deciduous teeth importance and emphasis on the prevention of dental caries, pre-mature loss of young permanent teeth and primary teeth continues to be a common in dental practice.

Histopathology and Clinical Symptoms

  • Normal:

    • A normal tooth is asymptomatic and exhibits a mild to moderate transient response to thermal and electric pulpal stimuli, the response subsides almost immediately where such stimuli are removed.
    • The tooth and its attachment apparatus do not cause a painful response when percussed or palpated.
    • Radiographs usually reveal a clearly delineated canal that tapers toward the apex.
    • There is no evidence of canal calcification and the lamina dura is intact.
    • The diseases of the pulp can be classified as below:
      • 1. Hyperemia:

        It is of two types.

        • a.

          Reversible

        • b.

          Irreversible

      • 2. Pulpitis:

        It is of three types.

        • a.

          Acute pulpitis

        • b.

          Chronic ulcerative pulpitis

        • c.

          Chronic hyperplastic pulpitis

      • 3. Pulp degeneration:

        • a.

          Calcific

        • b.

          Fibrous

        • c.

          Atropic

        • d.

          Internal resorption

      • 4. Necrosis of pulp

  • Pulp pulpitis:

    • Painful pulpitis is a clinically detectable inflammatory responsible of the pulpal connective tissue to an irritant.
    • This exudative (acute) force is hyperactive and the painful symptoms are indicative of an intrapulpal pressure increase that surpassed the threshold limits of pain fibers.
  • Reversible pulpitis:

    • The pulp is inflamed to the extent that thermal stimuli cause a quick, sharp hypersensitive response that subsides as soon as the stimulus is removed. Otherwise, the tooth is asymptomatic.
    • Any irritant that can affect the pulp may cause reversible pulpitis, e.g., caries.
    • Reversible pulpitis is not a disease but merely a symptom.
    • If the cause can be removed, the pulp should revert to an uninflamed state and the symptom should subside.
    • A reversible pulpitis can be clinically distinguished from a symptomatic irreversible pulpitis by two methods.
      • 1.

        Pain in reversible pulpitis subsides almost immediately after the stimulus is removed while in an irreversible pulpitis there is a sharp painful response to thermal stimuli and the pain lingers even after the stimulus is removed.

      • 2.

        With a reversible pulpitis there is no spontaneous pain as there often is with a symptomatic irreversible pulpitis.

  • Irreversible pulpitis:

    • Irreversible pulpitis may be acute, subacute or chronic.
    • It may be partial or total.
    • The pulp may be infected or sterile.
    • Clinically, the acutely inflamed pulp is thought to be symptomatic and the chronically inflamed pulp as asymptomatic.
    • With pulpal inflammation there is an exudate, if the exudate can be vented out to relieve pain that accompanies edema, the tooth may remain quiescent.
    • Conversely, if the exudate that is being continuously formed remains within the hard confines of the root canal, pain will probably occur.
  • Symptomatic irreversible pulpitis:

    • Characterized by spontaneous intermittent or continuous paroxyme of pain.
    • “Spontaneous” means that no stimulus is evident.
    • Sudden temperature changes induce prolonged episodes of pain.
    • There may be a prolonged painful response to cold (i.e. remaining after the stimulus is remoed) that can be relieved by heat, and painful response to heat which is relieved by cold.
    • Continuous spontaneous pain may occur merely by a change in posture (for example, when the patient lies down or bends over).
    • Pain from the symptomatic irreversible pulpitis tends to be moderate to severe, depending on the severity of inflammation.
    • It may be sharp or dull, localized or referred (example, referred from the mandibular molar towards the ear or up to the temporal area), intermittent or constant.
  • Asymptomatic irreversible pulpitis:

    • Asymptomatic irreversible pulpitis may develop on the conversion of a symptomatic irreversible pulpitis into a quiescent state, probably because the inflammatory exudates was quickly vented.
    • This can be due to any type of injury, but it is usually caused by a large carious exposure or by a previous traumatic injury that resulted in a painless pulp exposure of long duration.
  • Hyperplastic pulpitis:

    • One form of asymptomatic irreversible pulpitis is a reddish cauliflower-like overgrowth of pulp tissue through and around a carious exposure.
    • This is attributed to a low-grade chronic irritation and to the increased vascularity of the pulp that is characteristically found in young people.
  • Internal resorption:

    • The asymptomatic irreversible pulpitis can also be present in the form of internal resorption.
    • This is characterized by the presence of chronic inflammatory cells in the granulation tissue.
    • It is diagnosed by radiographs.
  • Necrosis:

    • Necrosis is the death of the pulp.
    • This may result from untreated irreversible pulpitis or may occur immediately after a traumatic injury that disrupts the blood supply to the pulp.
    • The necrotic remnants may be liquefied or coagulated.
    • Regardless of the type of necrosis, the endodontic treatment is the same.

The above articles discusses briefly about the pediatric endodontics, histopatholgy and clinical symptoms. Individuals with a tooth injury or infection must consult their dentists as immediately as possible for early treatment and prevention of the infection.

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