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Thursday, November 8, 2012

Chronic Hyperplastic Pulpitis ( Pulp polyp )

A pulp polyp, also called as Chronic Hyperplastic Pulpitis, is found in an open carious lesion, fractured tooth or when a dental restoration is missing. Due to lack of intrapulpal pressure in an open lesion pulp necrosis does not take place as would have occurred in a closed caries case. Also a good vascular and immune supply is necessary, therefore found in adults. It is a productive pulpal inflammation where the development of granulation tissue is seen.



Causes

Causes of a pulp polyp include the following:
  • Carious tooth with significant loss of tooth structure
  • Loss of a dental restoration that results in pulpal exposure
  • Fractured tooth due to trauma with a pulpal exposure
  • Pulpal tissue with access to a good blood supply
  • Possible hormonal (estrogen and progesterone) influence


Clinical features :

1. Occurs mostly in children and young adults , who possess a high degree of resistance and reactivity.
2.It involves teeth with large,open carious lesions.
3.Pulp appears as a pinkish red globule of tissue protruding from the pulp chamber and not only fills the caries defect but also extends beyond.
4.The teeth most commonly involved by this phenomenon are the deciduous molars and the first permanent molars.


Note : On occasion the gingival tussue adjacent to a broken carious tooth may proliferate into the carious lesion and superficially resemble an example of hyperplastic pulpitis.In such cases , the distinction can be made to determine whether the connection is with pulp or gingiva.  

 Histological features :

1.It is basically a granulation tissue made of delicate connective tissue fibers interspersed with variable numbers of small capillaries.
2. It becomes epithelialized and the origin of these epithelial cells is a matter of controversy.
3.The epithelium is stratified squamous in type and closely resemles the oral muscosa,even to the extent of developing well formed rete ridges.


Epidemiology

Frequency

United States

Pulp polyps are reportedly uncommon in the United States, and no epidemiologic studies specifically document the frequency of this entity. Although this lesion is reported to be uncommon with only isolated references in the literature, the true prevalence of this reactive pulpal disease is likely to be underestimated because it is a well-recognized sequela of extensive dental caries in children.

International

Pulp polyps are uncommon in countries with routine access to dental care, but they are encountered more frequently in developing countries. In a study of Vietnamese refugees who sought dental care, the prevalence of pulp polyps was 6%. This high number of cases is an indication of the severity of dental disease in this impoverished population.

Mortality/Morbidity

Pulp polyps tend to be asymptomatic and are not associated with any significant morbidity or mortality except for gross caries destruction with premature tooth loss in many cases.

Race

No racial predilection is recognized for this sequela of dental caries; however, it is more common in individuals of lower socioeconomic background who have limited access to dental care than in other people.

Sex

No sexual predilection has been documented for this oral lesion.

Age

This pulpal disease occurs almost exclusively in children and young adults, and it can occur in both the primary dentition and the permanent dentition.


Treatment :

Extraction of the tooth or by Pulp extirpation.



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