Lectures on pulp inflammation and around the tooth apex

2021-02-02 12:00 AM

Transient natural pain from 3 to 5 minutes, the pain increases with stimulation (sweet, sour, hot, cold, etc.). Painful nature: localized throbbing pain.




Most popular. Bacteria and its toxins enter the marrow in three ways:

Directly through the ivory tube.

Localization of bacteria in the blood -> in the pulp.

Spread of periodontal disease into the marrow.


Due to the improper treatment.

Teeth grinding: grinding teeth dry, too hot due to friction.

Get the mark.


Bite joint injury, accident.

Unknown origin: eg internal content.


Reversible myelitis

Transient natural pain from 3 to 5 minutes, the pain increases with stimulation (sweet, sour, hot, cold, etc.). Painful nature: localized throbbing pain.

There are no signs of disease in the film.

There was no previous pain history

Irreversible myelitis


Spontaneous pain.

When irritation occurs, pain begins and continues to persist when irritation ceases. Especially very painful with heat.

Painful nature: throbbing or dull pain, localized or diffuse. Pain in continuous attacks.


If the inflammatory fluid is not drained, after a while the acute condition will turn to a silent, asymptomatic phase.

Diagnosis: based on medical history, x-ray, clinical.

Forms: Osteomyelitis.

Internal content.

Lime canal.

Pathology around the apex



Complications from myelopathy.

Periodontal disease.



Mild, continuous (bite injury, filler).

Dental treatment

Take the treatment device to the apex.

Pushes the necrotic marrow tissue to the apical region.

Push the medication to the apical region.


Acute periapical inflammation (arthritis)

It can be found in a living tooth (due to a high fillet, teeth grinding, a gravel bite ...) or dead pulp.

Periodontal ligaments are normal, but they are very painful, do not dare to bite hard, teeth are loose and protruding. The pain is constant at times, but not completely.

Differential diagnosis with acute myelitis.

An abscess around the apex level: heaviest

As a result of advanced periosteal inflammation in a progressive tooth on a tooth that has already had necrosis of the pulp, there is purulent and diffuse inflammation.

Severe pain when typing, touching. Progresses rapidly from mild to intense swelling. Systemic manifestations: fever, fatigue, possibly a rash under the chin or under the jaw, swelling in the face.

Inflammation around the chronic apex

A long-lasting, asymptomatic inflammation around the apex. However, it hurts a bit to touch.

Tooth decay, normally no symptoms, painless examination.

A film with a peri-apical lumen (granulomatous, cystic)

The marrow does not respond to electricity.

Inflammation around the chronic apical pus

Similar to inflammation around the chronic apex, but the presence of a fistula indicates pus formation but no symptoms due to discharge of pus through the fistula.

Abscess relapsed

Symptoms resembling peri-apical abuses but occur after a period of chronic peritonitis. Film: has a luminous area.

Bone fibrosis around the apex

Bone mineralization in the region around the apex.