Sources of “Insults” to the Pulp

Insults Reason For Pulpal Damage
Dental caries Microbial invasion and host inflammatory response to microbes and their byproducts.
Microleakage in restored teeth The presence of a gap between the tooth and restoration leads to bacterial entry and resultant pulpal inflammation.
Trauma (Mechanical trauma; With intact tooth structure) This is associated with luxation / avulsion injuries. The fine blood vessels at the root apex are torn, leading to “avascular necrosis”.
Trauma (Mechanical trauma; With associated tooth fracture not involving pulp) The exposed dentinal tubules act as pathway for entry of bacteria from oral fluids, leading to pulpal inflammation.
Trauma (Mechanical trauma; With associated tooth fracture involving pulp) The exposed pulp is directly contaminated with bacteria from oral fluids, leading to pulpal inflammation.
Iatrogenic (Pulp exposed during Tooth Preparation) Failure of isolation leads to contamination by oral flora, with resultant pulpal inflammation.
Iatrogenic (Pulp exposed during Caries Removal). The exposed pulp is directly contaminated by cariogenic, leading to pulpal inflammation.
Trauma (Thermal) Heat generated due to tooth cutting, especially when coolants are not used.
Trauma (Chemical) Chemicals (dental materials) applied especially to freshly-cut dentin.

[From: Inoki R, Kudo T, Olgart LM. Dynamic aspects of dental pulp. Cambridge, Great Britain: Chapman and Hall. 1990].

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