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Concept
Pulp necrosis
Summary
Pulp necrosis is a clinical diagnostic category indicating the death of cells and tissues in the pulp chamber of a tooth with or without bacterial invasion. It is often the end result of many cases of dental trauma, caries and irreversible pulpitis.
In the initial stage of the infection, the pulp chamber is partially necrosed for a period of time and if left untreated, the area of cell death expands until the entire pulp necroses. The most common clinical signs present in a tooth with a necrosed pulp would be a grey discoloration of the crown and/or periapical radiolucency. This altered translucency in the tooth is due to disruption and cutting off of the apical neurovascular blood supply.
Sequelae of a necrotic pulp include acute apical periodontitis, dental abscess or radicular cyst and discolouration of the tooth.
Tests for a necrotic pulp include: vitality testing using a thermal test or an electric pulp tester. Discolouration may be visually obvious, or more subtle.
Treatment usually involves endodontics or extraction.
The dental pulp is located in the centre of a tooth, made up of living connective tissue and cells. It is surrounded by a rigid, hard and dense layer of dentine which limits the ability of the pulp to tolerate excessive build up of fluid. Normal interstitial fluid pressure in the pulp ranges from 5-20mm Hg, marked increases in pressure in the pulp due to inflammation can go up to 60mm Hg. The rise in pressure is commonly associated with an inflammatory exudate causing local collapse of the venous part of microcirculation. Tissues get starved of oxygen thus causing venules and lymphatics collapse which may lead to localized necrosis. A common clinical sign associated with the histopathology will be varying levels of suppuration and purulence.
Following the spread of local inflammation, chemical mediators such as IL-8, IL-6 and IL-1 are released from necrotic tissues leading to further inflammation and odema, which advances to total necrosis of the pulp.
Official source
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