Thoughts on the physiologic pathology of regressive and reparative changes in the dentine and dental pulp

Background:The relationship between periodontal disease and dental pulp changes is controversial and has been debated for many years. This human study was performed to evaluate the possible effects of moderate to advanced periodontal disease on the different aspect of dental pulp structure.Materials and Methods:Twenty hopeless permanent teeth were extracted from systemically healthy adults because of moderate to advanced chronic periodontitis, with a bone loss of >6 mm and a mobility of grade 2 or 3. Upon extraction, the apical 2 to 3 mm of the roots were immediately sectioned. Four to five sections were mounted on each slide, and every third slide was stained with hematoxylin and eosin. The specimens were histologically processed and examined by an oral pathologist.Results:Non-inflamed pulp, with partial or complete necrosis in some sections and several non-necrotic sections, was found in only 6.3% of teeth. Most teeth (58.3%) displayed edematous pulps. Slightly fibrotic pulps were seen in 52.1% of sections. Odontoblastic integrity was seen in 31.3% of teeth. Most teeth (77.1%) displayed no pulp stones. In 43.8% of teeth, the pulp vessels displayed dilatation.Conclusions:Moderate to advanced periodontal disease can affect the dental pulp. Careful consideration of diagnostic and treatment planing in patients with endodontic-periodontal involvement is therefore recommended.

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“…[11] Thus, age per se cannot be regarded as the causative factor for the observed pulpal changes. [1213]…”

Section: Discussionmentioning

confidence: 99%

Influence of moderate to severe chronic periodontitis on dental pulp

Fatemi¹,

Disfani²,

Zare³

et al. 2012

J Indian Soc Periodontol

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“…Dead tracts have been described in the hterature as areas of empty non-functioning dental tubules, which appear dark when ground sections are examined under transmitted light, and white under reflected light (Bhaskar 1976, Fish 1931. Dead tracts are the resuh of odontoblasts being injured sufficiently to inhibit a defensive response (Bodecker & Applebaum 1931, Fish 1928, Fish 1932, Shroff 1952a.…”

Section: M-11mentioning

confidence: 99%

“…As the age increases, the frequency of dentin sclerosis in the total root increases. Shroff (1952a) recalls that chronologically, odontoblasts of the root are younger than those of the crown. Yet, crown dentin sclerosis precedes root sclerosis.…”

Section: M-11mentioning

confidence: 99%

The detection and prevalence of reactive and physiologic sclerotic dentin, reparative dentin and dead tracts beneath various types of dental lesions according to tooth surface and age

Stanley

Pereira²,

Spiegel

et al. 1983

J Oral Pathology Medicine

105

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The pulpo-dentinal complex responds to external injuries with dentin sclerosis (DS), dead tracts (DT), or reparative dentin (RD). This investigation correlates the prevalence of these responses with age, sex, type and surface location of tooth lesions (caries, restorations, attrition, abrasion and erosion) utilizing ground sections, microradiographs and decalcified paraffin-embedded tooth sections treated with the Pollak trichome stains (270 teeth from 113 patients). The main response to caries, restorations and erosion was DS, followed by RD and DT. DS, RD and DT occurred equally in any tooth, on any tooth surface and even beneath the same lesion. DS did not necessarily prevent RD. Root and furcation DS and RD in the floor of the pulp chamber and root canals were unrelated to particular lesions but did relate to increasing age. Root DS extended from apical to cervical area with increasing age. Beneath caries and restorations DS and RD were more prevalent in males, but DT was more prevalent in females. Pollak staining of decalcified paraffin sections for DS was approximately 80% as accurate as ground sections and microradiography. In pulp studies, where the result is contrary to previous experience, the Pollak stains reveal whether DS has decreased dentin permeability.

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“…Peritubular dentin formation begins in the coronal, enamel covered dentin and continues progressively with increasing age until the entire odontoblastie process (Tomes' proeess) ean be obliterated. This process supposedly occurs during the whole life span of the individual (Shroff 1952a, Baume 1964. The peritubular dentin eventually becomes twice as dense minerally as the intertubular matrix.…”

Section: Sclerosismentioning

confidence: 99%

Detecting dentinal sclerosis in decalcified sections with the Pollak trichrome connective tissue stain

Stanley

Broom

Spiegel

et al. 1980

J Oral Pathology Medicine

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The supply of young human teeth for controlled human pulp studies is inadequate. Dentinal sclerosis in older teeth modifies the expected pulpal responses. Decalcification, necessary to interpret pulpal responses, destroys the primary evidence of sclerosis. At present we are unable to detect the degree of sclerosis and the pulp response in the same preparation. Valid interpretations on older teeth cannot be accomplished until this problem is resolved. Fifty‐seven teeth, normal and carious, representing a wide age span were fixed, embedded in Bioplastic and sectioned with the Bronwill Model #77 through the middle of the M‐D plane on the labio‐lingual plane to obtain an undecalcified ground section for examination with reflected and transmitted light and Faxitron 805 microradiography. The remaining portions of the tooth were decalcified, processed in paraffin and subjected to a variety of histochemical reactions including the Pollak trichrome slain. The Pollak trichrome and the Pollak trichrome solution #6 modification stains provided the greatest correlations with the sclerotic areas in the radiographs of the ground sections. Areas of dentin indicative of sclerosis prior to decalcification stained orange‐red with the Pollak trichrome stain and deep orange with the Pollak trichrome solution #6 modification.

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Thoughts on the physiologic pathology of regressive and reparative changes in the dentine and dental pulp

Cited by 23 publications

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Influence of moderate to severe chronic periodontitis on dental pulp

Influence of moderate to severe chronic periodontitis on dental pulp

The detection and prevalence of reactive and physiologic sclerotic dentin, reparative dentin and dead tracts beneath various types of dental lesions according to tooth surface and age

Detecting dentinal sclerosis in decalcified sections with the Pollak trichrome connective tissue stain

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