Pulp Inflammation: From the Reversible Pulpitis to Pulp Necrosis During Caries Progression
The advances of pulp biology combined with detailed description of the carious lesion environment, as well as the clinical evidence of treating deep lesions, have modified the view of pulp inflammation as being “the nonstopping train” toward apoptosis and
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Pulp Inflammation: From the Reversible Pulpitis to Pulp Necrosis During Caries Progression Lars Bjørndal and Domenico Ricucci
9.1
Setting the Stage
This chapter aims to present an overview of the pulpal events taking place in relation to caries progression and in different stages of lesion activity, from the very first cellular pulp reactions to the non-cavitated enamel caries toward progressive stages of pulpal inflammation including necrosis. Where is the border between a beneficial/reversible inflammation as opposed to unwanted/irreversible inflammation? The former is a prerequisite of repair, from which treatment can be successfully carried out with or without exposure of the pulp, whereas the latter leads to apoptosis and necrosis, and, if left untreated, to further bacterial invasion in the pulp cavity. To improve the connection between the science of pulp biology in the laboratory and actual clinical treatment concepts, it is important to maintain a link between the visible signs of disease at both a macroscopic and histological level of examination. For example, what do caries look like in progressive stages of caries lesion
L. Bjørndal, DDS, PhD (*) Department of Odontology, Section of Cariology and Endodontics/Pediatric and Clinical Genetics, University of Copenhagen, Nørre Allé 20, Copenhagen-N DK-2200, Denmark e-mail: [email protected] D. Ricucci, MD, DDS Private Practice, Piazza Calvario 7, Cetraro 87022, Italy e-mail: [email protected]
formation? For obvious reasons, it is not possible to repeat histological data from the same carious lesion over time. Therefore, when progressive cellular events are described, it must be based on different carious lesions in progressive stages of lesion development. In previous papers [1, 2] and textbooks [3–5], it has been stated that the signs and symptoms do not allow to consistently diagnose the histological status of the pulp and consequently the reversibility or irreversibility of pulp inflammation. However, is it possible to clarify at what lesion stages these problems of interpreting do most often occur? In this chapter we will specify the lesions by using information on progression stage, lesion activity and estimated length of progression time (patient age), including recent clinical evidence from treatment of deep caries lesions. Finally, from a histological viewpoint, it is clear that the point of no return for unwanted inflammation in the pulp can be defined and will be clarified in this chapter because confusion exists among clinicians and researchers.
9.2
The Dilemma of the Difference Between Histology and Clinical Pulp Diagnosis
Although the pulp is the vital tissue connecting the tooth with the body, it constitutes an entity that in the clinical setting is very difficult to monitor in terms of stage of inflammation. No device
M. Goldberg (ed.), The Dental Pulp, DOI 10.1007/978-3-642-55160-4_9, © Springer-Verlag Berlin Heidelberg 2014
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Fig. 9.1 Macroscopical views of progressive stages of
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