Pulpal Necrosis

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Pathway of entry for microorganisms into the root canal
How to indentify of endodontic microorganisms
Etiological factors of pulp diseases :
- Most changes in the pulp are caused by irritation.
-The main irritants to the pulp belong to two groups :
Group I : living irritants (microbial )
Group II : non-living irritants (non-microbial )
1) physical : mechanical , thermal , electrical , aeronautical & irradiation.
2) chemical : acids , alkalies & poisons.
I- living irritants (microbial irritation )
The principal pathways by which microorganisms may gain enterance into
the pulp or periodontal areas are :
a) through an open cavity that may be caused by trauma , operative dental
procedures or dental caries.
b) Via the gingival cervice & by invasion along the periodontal ligament in
several forms of periodontal disease.
c) By extension of periapical infection from adjacent infected teeth.
d) Through the blood stream during bacteraemia or septicemia
( hematogenous infection)
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II- Non-living irritants ( non-microbial irritation)
A)Mechanical irritaion such :
1- Accidental
2- Odontoiatrogenic ( dentist induced pulpitis).
B) Thermal irritation such as :
1- odontogenic
2- large metallic filling without an efficient lining .
3- prologed cooling of teeth.
4- rapid olishing of teeth or restorations.
5- prolonged contact of thermal pulp testers , whether hot or cold .
6- using of Laser for tissue ablation.
C) Electrical irritation :
When metal fillings of different electromotive potential (gold vs amalgam) are placed
so that they occasionally come in contact with each other , an intermittent electrical
current may be set up which is of sufficient intensity to irritate the pulp.
D) Aeronautical irritation :
- Aeronautical odontalgia (Aerodontalgia) denoting toothach occuring to persons of air
crews when flying at high altitudes or when entering the low pressure chamber

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 -This condition may occur in a vital pulp with caries or a filling .
-This pain has been attributed to the formation of nitrogen bubbles in the
pulp tissues or vessels. It may due to fat emboli from altered lipoprotein &
platelet thrombi.
-Aerodontalgia is a marker of inadequate pulp protection from the
atmosphere & this usually means caries.
-So it is not a direct cause of pulpitis , rather than an exacerbation factor.
-This condition is also seen in divers subjected to rapid decomposition
following deep sea diving.
2) Chemical irritation :
Irritant substances may be applied directly to an exposed pulp or may diffuse
through the dentine after the insertion of a restorative material.

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