Causes of Endodontic Pain and Preventive Strategies
The most common cause of pulp/periapical pathosis is caries. In this chapter host–microbial interaction and the pulp’s dynamic response to the inflammatory process is described. The process occurs within a unique low-compliance environment due to the hard
- PDF / 523,589 Bytes
- 23 Pages / 439.37 x 666.14 pts Page_size
- 90 Downloads / 211 Views
Causes of Endodontic Pain and Preventive Strategies
5.1
Causes of Endodontic Pain
Prior to discussing pain-preventive strategies, it is essential to understand basic pulp biology and the pulp’s response to caries and other irritants. Pulpal disease and concomitant pain is caused by caries, trauma, or as a result of restorative procedures. Although there are differences in the disease processes, ultimately microbiological factors are of critical importance. Although caries is not the only cause of pulpal disease, understanding the principles of the pulp’s dynamic response to caries is an important step in developing a pain-preventive strategy. Onset of pain subsequent to caries varies depending on a number of factors including presence of prior restorations, individual pain thresholds and host inflammatory and immune resistance. The response to advancing caries is so varied that even a carious exposure may occur without pain and is classified as asymptomatic irreversible pulpitis.
5.2
Caries
Even at early stages of the carious process, pulpal inflammation is seen in the pulp. Dentin permeability permits ingress of bacterial toxins into the pulp long before there is actual exposure of the pulp. This may or may not be accompanied by symptoms [29]. As caries progresses and the inflammatory process builds, the pulp’s unique hard-tissue encasement has a role in ongoing tissue damage [29]. The repair of damaged pulp tissue is also affected by the limited capacity for drainage, and thinwalled vessels that are prone to collapse as intra-pulpal pressure builds. Intra-pulpal pressure increases as a consequence of inflammatory edema. As circulation shuts down, local areas of pulpal ischemia may expand quickly or over an extended period.
P.A. Rosenberg, Endodontic Pain, DOI 10.1007/978-3-642-54701-0_5, © Springer-Verlag Berlin Heidelberg 2014
91
92
5
Causes of Endodontic Pain and Preventive Strategies
Fig. 5.1 Within the circled area, repair of dentin has occurred in response to a previous carious lesion. In the upper right-hand corner, the arrow indicates the result of a restoration
Radiographs provide little or no insight into the dynamics of the pulp’s reaction to caries. However, a radiograph may reveal calcification of a chamber adjacent to a long-standing carious lesion. This reaction represents a defensive reaction of the pulp to an irritant that may ultimately complicate endodontic access. Similarly, long-term low-level inflammation may cause diffuse calcification in the root canal system that can impede endodontic instrumentation. Long-term inflammation can also sensitize nociceptors (pain receptors) and complicate local anesthesia (Fig. 5.1).
5.2.1
Host–Microbe Interactions in the Root Canal System
Multiple complex reactions involving attempts at repair and tissue breakdown may go on either asymptomatically or with pain ranging from mild to unbearable. Pulpitis, due to caries, has been described as an infection where the host reaction has the capacity to produce more damage than that caused simply by
Data Loading...
