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Pulpal pathosis and severe alveolar lesions: a clinical study
Author(s) -
Hirsch Robert S.,
Clarke Nigel G.,
Srikandi Woro
Publication year - 1989
Publication title -
dental traumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.82
H-Index - 81
eISSN - 1600-9657
pISSN - 1600-4469
DOI - 10.1111/j.1600-9657.1989.tb00336.x
Subject(s) - medicine , dental alveolus , dentistry , gingivitis , pulp (tooth) , periodontal fiber , periodontitis , periodontium , root canal , irritation , alveolar process , immunology
Gingivitis is widely believed to be the precursor of crestal alveolar bone destruction (periodontitis) in some individuals. However, there is no correlation between gingivitis and severe localized lesions of alveolar bone. Specific ‘periodontopathogens’ of the indigenous oral flora are hypothesized to be the cause of localized lesions but the evidence to date is one of association only. Acute and chronic pulpal inflammation are known causes of irritation to the periodontal ligament and alveolar bone; retrograde pockets may subsequently form. Contamination by indigenous organisms best adapted to the special environment of the deep pocket could be expected to follow the establishment of the new conditions. This study was undertaken to examine the clinical and histological status of the pulps of teeth affected by severe localized alveolar lesions. A total of 153 teeth in 90 subjects were studied; full periodontic and endodontic assessments were made. Seventy‐seven teeth responded in the normal range to pulp testing, but 52% of these had no recoverable tissue from their root canal systems on endodontic opening. The findings indicated that pulpal pathosis was not clinically detectable in the majority of teeth studied when conventional endodontic diagnostic tests were applied. Rather, the presence of localized severe alveolar defects was a more accurate predictor of pulpal pathosis. The strong association between pulpal pathosis and localized, severe alveolar defects and the appearance of similar lesions in dry skulls indicates that the alveolar lesions were of pulpal origin with spread to localized periodontal sites.