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Acute pulpitis: diffuse acute inflammatory infiltrate (boxes) predominantly consisting of neutrophils with multilobate nuclei integer and/or altered eosinophils and extravasated red blood cells (HE, ×400).
Source publication
Dental pulp represents a specialized connective tissue enclosed by dentin and enamel, the most highly mineralized tissues of the body. Consequently, the direct examination as well as pathological evaluation of dental pulp is difficult. Within this anatomical context, our study aimed to evaluate the correlation between dental pulp lesions and clinic...
Citations
... The relationship between the clinical status of the pulp and its histologic state was assessed in many studies, and an inconsistent association between histologic pictures and clinical signs was often found. 42,45,46 Nevertheless, the gold standard for assessment of the actual state of pulpal tissue remains the histologic examination of the dental pulp. 4 Unfortunately, to apply the gold standard, the extraction of the tooth shortly after the use of the diagnostic tests would be necessary, which makes this method inappropriate and unethical, especially when clinical indication suggests that the tooth can be saved. ...
... The mechanism of pH changes in the inflamed pulp has not been thoroughly investigated. It has been proposed that the blood pH of the inflamed pulp is reduced as compared to the blood pH of the healthy pulp [17]. The inflammatory acidosis could develop due to formation of a hypoxic environment in the pulp, as determined by the specific tooth anatomy. ...
... However, histological evaluation is not possible in clinical practice where the clinician should decide regarding the treatment method either before or during management of the pulpitis. Moreover, the correlation between clinical symptoms and pathological pictures of the pulp status is still arguable [17,24]. In particular, the intensity and duration of bleeding from the inflamed pulp were considered important for determination of the disease severity stage, suggesting various time limits needed for hemostasis [5,25]. ...
The severity of pulpitis is a crucial factor in determining the suitable treatment. There are no clear objective indicators to assess the stage of pulp inflammation that could be used in clinical practice. The change in blood pH of the pulp during the inflammatory phase could hypothetically serve as an indicator of the pulp inflammation severity. The aim of this study was to assess the pH values in the pulpal blood of mature teeth in patients with symptomatic pulpitis, in comparison with the healthy controls. The study included patients with symptoms of pulpitis in premolar or molar teeth (Test group; n = 24, mean age 36.04, SD 7.10), and healthy controls (Control group, n = 6, mean age 24.5, SD 5.94) referred for extraction of premolars or third molars, for orthodontic reasons. The pulpal blood was taken at the opening of the endodontic access cavity, and the pH value was measured in both groups. Statistical analysis was performed using the SPSS 27.0 program with a significance level of p ≤ 0.05. The Mann–Whitney test for dependent samples was performed to evaluate the statistical difference between the groups. The patients with symptomatic pulpitis had significantly decreased pulpal blood pH compared to the healthy controls (p ≤ 0.05). The mean pulpal blood pH was 7.27 (SD 0.06) and 7.40 (SD 0.02) in Test and Control groups, respectively. In the Test group, the pulpal blood pH values were significantly lower in the patients who had symptoms for 3 days or more (7.25, SD 0.05) than in those who had symptoms for up to 3 days (7.33, SD 0.03) (p < 0.001). The pH value of the pulpal blood gradually declines in cases of symptomatic pulpitis, along with increasing duration of the symptoms.
... In daily clinical practice, dentists are confronted with much more challenging situations, where pulp might be mild, moderately orseverely inflamed, even partially necrotic [24]. The correlation between the clinical status of the pulp and its histological state was assessed in many studies, in which no strong connection of histological pictures and clinical signs were confirmed [24][25][26]. ...
Objectives
The aim of our study was to assess the correlation between T2 relaxation times and their variability with the histopathological results of the same teeth in relation to caries progression. Materials and methods: 52 extracted permanent premolars were included in the study. Prior to extractions, patients underwent magnetic resonance imaging (MRI) scanning and teeth were evaluated using ICDAS classification. Pulps of extracted teeth were histologically analysed. Results: MRI T2 relaxation times (ms) were 111,9 ± 11.2 for ICDAS 0, 132.3 ± 18.5* for ICDAS 1, 124.6 ± 14.8 for ICDAS 2 and 112. 6 ± 18.2 for ICDAS 3 group (p = 0,013). A positive correlation was observed between MRI T2 relaxation times and macrophage and T lymphocyte density in healthy teeth. There was a positive correlation between vascular density and T2 relaxation times of dental pulp in teeth with ICDAS score 1. A negative correlation was found between T2 relaxation times and macrophage density. There was a positive correlation between T2 relaxation time variability and macrophage and T lymphocyte density in teeth with ICDAS score 2. In teeth with ICDAS score 3, a positive correlation between T2 relaxation times and T2 relaxation time variability and lymphocyte B density was found. Conclusion: The results of our study confirm the applicability of MRI in evaluation of the true condition of the pulp tissue. Clinical relevance: With the high correlation to histological validation, MRI method serves as a promising imaging implement in the field of general dentistry and endodontics.
... On the other hand, mineral trioxide aggregates face multiple challenges, including long clinical setting times, insufficient antibacterial activity against specialized anaerobic bacteria, poor dentin bonding, and potential tooth discoloration [8]. It is worth emphasizing that when reversible pulpitis progresses into acute and chronic irreversible pulpitis, pulp tissue will not be able to heal itself due to anatomical constraints such as a narrow apical foramen and may further deteriorate into pulp necrosis or periapical disease [9]. At present, the first-selected treatment strategy for dental pulp necrosis is root canal treatment, which involves root canal preparation, root canal disinfection, and sealing of canal space with inert materials [10]. ...
Pulpitis is a common and frequent disease in dental clinics. Although vital pulp therapy and root canal treatment can stop the progression of inflammation, they do not allow for genuine structural regeneration and functional reconstruction of the pulp–dentin complex. In recent years, with the development of tissue engineering and regenerative medicine, research on stem cell-based regenerative endodontic therapy (RET) has achieved satisfactory preliminary results, significantly enhancing its clinical translational prospects. As one of the crucial paracrine effectors, the roles and functions of exosomes in pulp–dentin complex regeneration have gained considerable attention. Due to their advantages of cost-effectiveness, extensive sources, favorable biocompatibility, and high safety, exosomes are considered promising therapeutic tools to promote dental pulp regeneration. Accordingly, in this article, we first focus on the biological properties of exosomes, including their biogenesis, uptake, isolation, and characterization. Then, from the perspectives of cell proliferation, migration, odontogenesis, angiogenesis, and neurogenesis, we aim to reveal the roles and mechanisms of exosomes involved in regenerative endodontics. Lastly, immense efforts are made to illustrate the clinical strategies and influencing factors of exosomes applied in dental pulp regeneration, such as types of parental cells, culture conditions of parent cells, exosome concentrations, and scaffold materials, in an attempt to lay a solid foundation for exploring and facilitating the therapeutic strategy of exosome-based regenerative endodontic procedures.
... Pulpitis is classified as reversible or irreversible. Although there are several diagnostic methods, it is challenging to establish a reliable diagnosis in all cases [16]. Pain intensity, patient history, and responses to dental pulp sensitivity tests are the only clinical tools available to evaluate the severity of dental pulp inflammation [17]. ...
In regions where preventive dentistry is widespread, tooth loss due to root fracture occurs approximately 10 times more frequently than that due to caries and periodontal disease. Root fracture is most likely to occur in non-vital teeth, where the dental pulp has been removed, often through a procedure known as pulpectomy. However, super minimally invasive pulp (SMIP) therapy has recently been reported as a novel treatment approach for pulpitis of any degree. In this study, SMIP therapy was performed to preserve the vitality of teeth in two patients with severe pulpitis.
Case one involved a 35-year-old man with a history of hypertension who presented with intense spontaneous pain in tooth #34. The pain was particularly severe while sleeping at night and on exposure to cold water or heat, but it was absent on percussion. Following the detection of cervical caries and severe pulp exposure, SMIP therapy was administered, and the tooth was subsequently restored using glass ionomer cement.
Case two involved an 18-year-old woman with no significant medical history who had deep caries in tooth #46. She experienced mild tooth pain when exposed to cold water, and examination revealed pulp exposure. We applied mineral trioxide aggregate over the dental pulp and restored the tooth using composite resin. The vitality of both teeth was maintained at the three-month follow-up.
To our knowledge, this is the first report of SMIP therapy for teeth with severe pulpitis. SMIP therapy is an innovative treatment that may cause a paradigm shift from conventional dental treatment.
... The other commonly encountered condition is the progression of inflammation within the pulp tissue to acute, chronic, or chronic hyperplastic irreversible pulpitis. The anatomical constraints of the pulp tissue, such as a low-compliance environment and lack of collateral circulation, may worsen the situation and can quicken the complete loss of the pulp vitality, which is followed by necrosis, root canal infection, and periapical disease [12]. In these circumstances, the pulp is not amenable to treatment and should be removed by pulpectomy or extraction [8]. ...
This mini-review was conducted to present an overview of the use of exosomes in regenerating the dentin-pulp complex (DPC). The PubMed and Scopus databases were searched for relevant articles published between January 1, 2013 and January 1, 2023. The findings of basic in vitro studies indicated that exosomes enhance the proliferation and migration of mesenchymal cells, as human dental pulp stem cells, via mitogen-activated protein kinases and Wingless-Int signaling pathways. In addition, they possess proangiogenic potential and contribute to neovascularization and capillary tube formation by promoting endothelial cell proliferation and migration of human umbilical vein endothelial cells. Likewise, they regulate the migration and differentiation of Schwann cells, facilitate the conversion of M1 pro-inflammatory macrophages to M2 anti-inflammatory phenotypes, and mediate immune suppression as they promote regulatory T cell conversion. Basic in vivo studies have indicated that exosomes triggered the regeneration of dentin-pulp-like tissue, and exosomes isolated under odontogenic circumstances are particularly strong inducers of tissue regeneration and stem cell differentiation. Exosomes are a promising regenerative tool for DPC in cases of small pulp exposure or for whole-pulp tissue regeneration.
... Previous longitudinal clinical studies have used a sample size of 20 (24,25) In the current study, subjects' recruitment, and availability for follow up at different study intervals were among the main faced challenges which explain the relatively small sample size used that might add another study (26,27) limitation. ...
... The histologic diagnosis of acute/chronic inflammation was made according to the criteria described by Giuroiu [41]. For acute inflammation perivascular infiltration of PMNs with associated degeneration of odontoblasts, vascular congestion and edema were noted. ...
... The histological diagnosis of our samples agreed with the clinical diagnosis in 9/13 samples (69.2%). These results are consistent with Giuroiu's finding who found a 68.62% agreement between clinical and histological diagnoses [41]. However, our results are inferior to the 84% agreement between the clinical and histologic findings reported by Ricucci [83]. ...
Background
Toll like receptors (TLR) 2 and 4 present on innate immune cells of the dental pulp detect cariogenic bacteria. Along with bacteria, C. albicans may also be present in dental caries. The presence of C. albicans can be detected by Dectin-1 a C type Lectin receptor. Expression of Dectin-1 in human pulpits has not been reported. Similarly, cytokines are released as a consequence of dental pulp inflammation caused by cariogenic bacteria. The T helper (Th) 1 inflammatory response leads to exacerbation of inflammation and its relationship with Osteopontin (OPN) is not known in pulp inflammation.
Objective
The aim of this study was to observe the expression of Dectin-1, TLR-2, OPN and pro-inflammatory cytokines in irreversibly inflamed human dental pulp and to observe relationship between Dectin-1/TLR-2 and OPN/Pro-inflammatory cytokines in the presence of appropriate controls.
Methods
A total of 28 subjects diagnosed with irreversible pulpitis were included in this ex-vivo study. Fifteen samples were subjected to standard hematoxylin and Eosin (H&E) and immunohistochemistry staining. Whereas, gene expression analysis was performed on 13 samples to observe mRNA expression of pro-inflammatory cytokines; tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1 beta (ß), IL-6 Dectin-1, OPN, TLR-2 and TLR-4. SPSS version 21 was used for statistical analysis. One way analysis of variance (ANOVA), Pearson correlation and Chi-square test were used at p ≤ 0.05.
Results
Gene expressions of Dectin-1, TLR-2 and TLR-4 were observed in all samples. Dectin-1 and TLR-2 expressions were significantly correlated (r = 0.5587, p = 0.0002). Similarly, OPN and TNF-α expression showed a significant correlation (r = 0.5860, p = 0001). The agreement between histologic and clinical diagnosis was 69.2% in the cases of irreversible pulpitis.
Conclusion
Dectin-1 was expressed by inflamed human dental pulp. Dectin-1 and TLR-2 expression pattern was suggestive of a collaborative receptor response in inflamed pulp environment. OPN and TNF-α expressions showed a positive correlation indicating a possible relationship.
... BV, blood vessels; EC, endothelial cells; NVB, neurovascular bundle F I G U R E 3 Line plot graph showing the mean total non-endothelial cell nuclei and blood vessel count/section in T2D and non-T2D dental pulp samples using an unpaired Student's t-test (*p-value .05). The error bar indicates standard deviation to the histological pattern described for cases of chronic pulpitis (Giuroiu et al., 2015) and was consistent with the gross appearance of the pulp in T2D samples, which tended to be fibrous and hard. The localization of type 3 collagen and other connective tissue proteins have been well described in the pulp (Ferreira Martinez et al., 2000); however, the findings from the current study suggest that the presence of hyperglycaemia results in denser connective tissue which may potentially alter the ability of the tissue to heal. ...
Aim:
To investigate the effect of type 2 diabetes (T2D) on clinically normal dental pulp tissue by using special stains and immunohistochemistry (IHC) to determine the morphology of the coronal pulp and distribution of immune markers in non-T2D and T2D groups.
Methodology:
Ethical approval for this in-vitro pilot study was obtained from the University of Otago Human Ethics Committee (16/069). Twenty extracted permanent molar teeth diagnosed as having clinically normal pulp status were collected. Ten teeth were from participants with well-controlled T2D and ten from participants without diabetes (non-T2D). Each tooth was sectioned transversely at the cemento-enamel junction before the crowns were decalcified and embedded in paraffin. Sections were stained with haematoxylin and eosin, Massons trichrome, and van Gieson stains for histological and morphological evaluation. Immunohistochemistry using anti-CD4, anti-CD68 and anti-CD83 anti-IL1β, anti-IL6, anti-IL17, anti-TNF-α, anti-TLR2, anti-TLR4 and anti-FOXP3 identified proteins of interest. Qualitative and semi-quantitative analyses evaluated the morphology of the dental pulp and protein expression. Data analyses were performed with GraphPad Prism, using students t-test and multiple regression using SPSS at p < 0.05.
Results:
Special stains demonstrated morphological differences in the T2D dental pulp compared to non-T2D. Qualitative analysis indicated that the pulp in the T2D samples was consistently less cellular, less vascular, showed evidence of thickened blood vessel walls, increased pulp calcification and collagen deposition. Semi-quantitative analysis of IHC samples showed the T2D pulp had significantly increased expression of macrophage and dendritic cell markers CD68 (p <0.001) and CD83 (p =0.04), and there was significantly greater expression of inflammatory cytokines IL1β (P=0.01), IL6 (p <0.0001), IL17 (p <0.0001) and TNF-α (p =0.01). T2D samples showed a significant increase in markers of innate inflammation, TLR2 (p <0.001) and TLR4 (p <0.001) and decreased expression of regulatory T cell marker, FOXP3 (p =0.01). Multiple regression showed that age corrected differences were statistically significant.
Conclusion:
Preliminary findings suggest that T2D may exert a similar response in the pulp to complications in other body sites. Hyperglycaemia is associated with changes in the morphology of the clinically normal dental pulp with altered immune cell and cytokine expression.
... Dental pulp pathology classification may vary according to different authors and dental schools, and as a result, may lead to confusion. Irreversible pulp inflammation may be acute or chronic, depending on the clinical and histological findings [10]. Other terms for "irreversible acute inflammation" may be "irreversible symptomatic pulpitis", while "irreversible chronic inflammation" may be found as "irreversible asymptomatic pulpitis". ...
... Clinical and histological traits of irreversible dental pulp inflammation can characterize acute or chronic pulpitis [10]. Concerning the clinical terminology of pulp inflammation, manifestations depend on the duration of the injurious agent and the onset or lack of dental treatment, which will prevent further extension of the infection and will provide pulpal healing. ...
... Most cases of irreversible chronic pulpitis can be painless or a dull located pain may be present [10]. With chronic dental pulp inflammation, accumulation of a granuloma-like tissue and irreversible destruction of the parenchymal tissue, which is covered by a connective and fibrous tissue, takes place [13]. ...
Inflammation in primary teeth (PT) is commonly associated with a lower sensibility to painful stimuli, compared to permanent teeth, and usually leads to late presentation for dental treatment. Data obtained on the molecular assessments of dental pulp and clinical examinations could guide practitioners to conduct precise diagnoses and correct treatments. The aim of our pilot study was to assess the levels of several biomarkers (e.g., mineralization, oxidative stress, and inflammation) in primary teeth. The research included 46 dental pulp specimens collected from the primary teeth of children and adolescents between the ages of 6 and 12. The experimental groups consisted of 18 samples collected from primary teeth with acute pulpitis and 15 samples from chronically inflamed pulp tissues. The control group was represented by 13 specimens acquired from clinically healthy primary teeth. The enzyme-linked immunosorbent assay (ELISA) technique was used to determine the protein expression of tumor necrosis factor-α (TNF-α), superoxide dismutase-3 (SOD-3), osteocalcin, and transforming growth factor-β1 (TGF-β1) in the lysates. Our results revealed that all of the studied parameters presented statistically significant (p ≤ 0.05) increased levels in both experimental groups compared to the control samples. Furthermore, osteocalcin presented statistically significant increased concentrations in chronically-versus acute-inflamed pulp samples (p ≤ 0.05). The studied molecules may have an influential role in acute and chronic pulp inflammation in primary teeth.
