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Connie R. Textbook of Diagnostic Microbiology, 6e. Pulpitis inflammation of the pulp can be triggered by various stimuli insults , including mechanical, thermal, chemical, and bacterial irritants, or rarely barometric changes and ionizing radiation. Because the pulp is encased in a rigid outer shell, there is no space to accommodate swelling caused by inflammation.


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Inflammation therefore increases pressure in the pulp system, potentially compressing the blood vessels which supply the pulp. This may lead to ischemia lack of oxygen and necrosis tissue death. Pulpitis is termed reversible when the inflamed pulp is capable of returning to a state of health, and irreversible when pulp necrosis is inevitable. Reversible pulpitis is characterized by short-lasting pain triggered by cold and sometimes heat. Irreversible pulpitis causes spontaneous or lingering pain in response to cold. Hypersensitivity is most commonly caused by a lack of insulation from the triggers in the mouth due to gingival recession receding gums exposing the roots of the teeth, although it can occur after scaling and root planing or dental bleaching , or as a result of erosion.

Many topical treatments for dentin hypersensitivity are available, including desensitizing toothpastes and protective varnishes that coat the exposed dentin surface. In general, chronic periodontal conditions do not cause any pain. Rather, it is acute inflammation which is responsible for the pain. Apical periodontitis is acute or chronic inflammation around the apex of a tooth caused by an immune response to bacteria within an infected pulp. The periodontal ligament becomes inflamed and there may be pain when biting or tapping on the tooth.

On an X-ray, bone resporption appears as a radiolucent area around the end of the root, although this does not manifest immediately. The tooth may be raised in the socket and feel more prominent than the adjacent teeth. Food impaction occurs when food debris, especially fibrous food such as meat, becomes trapped between two teeth and is pushed into the gums during chewing.


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  • Decay can lead to collapse of part of the tooth, or a dental restoration may not accurately reproduce the contact point. Irritation, localized discomfort or mild pain and a feeling of pressure from between the two teeth results.

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    The gingival papilla is swollen, tender and bleeds when touched. The pain occurs during and after eating, and may slowly disappear before being evoked again at the next meal, [nb 1] or relieved immediately by using a tooth pick or dental floss in the involved area.

    A periodontal abscess lateral abscess is a collection of pus that forms in the gingival crevices , usually as a result of chronic periodontitis where the pockets are pathologically deepened greater than 3mm. A healthy gingival pocket will contain bacteria and some calculus kept in check by the immune system.

    As the pocket deepens, the balance is disrupted, and an acute inflammatory response results, forming pus. The debris and swelling then disrupt the normal flow of fluids into and out of the pocket, rapidly accelerating the inflammatory cycle. Larger pockets also have a greater likelihood of collecting food debris, creating additional sources of infection. Periodontal abscesses are less common than apical abscesses, but are still frequent. The key difference between the two is that the pulp of the tooth tends to be alive, and will respond normally to pulp tests.

    However, an untreated periodontal abscess may still cause the pulp to die if it reaches the tooth apex in a periodontic-endodontic lesion. A periodontal abscess can occur as the result of tooth fracture, food packing into a periodontal pocket with poorly shaped fillings , calculus build-up, and lowered immune responses such as in diabetes. Periodontal abscess can also occur after periodontal scaling, which causes the gums to tighten around the teeth and trap debris in the pocket.