PULPAL NECROSIS AND GANGRENE


Both necrosis and gangrene are terms that define dental pulp death. Most often, under the action of caries-producing micro-organisms, continuity solutions are created between the septic environment and the pulp chamber, with bacteria penetrating deep and gradually altering the layers of the tooth.

A dental pulp of a young, healthy patient with no other associated general disease will react with marked inflammation, coupled with pain.

If treatment is not instituted when caries is detected or when it causes painful sensitivity, the dental pulp will undergo a continuous process of alteration and lose its nutrition, leading to mortification.

The difference between necrosis and gangrene is the bacterial factor. It is assumed that necrosis causes pulp mortification but there is no bacterial factor. In this respect, repeated small trauma, substances such as acids or large and sudden temperature variations are blamed. These cause blood flow to the pulp to stop and the pulp to die.

Gangrene, on the other hand, is the septic mortification of the pulp of temporary and permanent teeth caused by bacteria.

As it can affect the whole pulp of a tooth or only part of it, gangrene can be total or partial.

The causes of gangrene are as follows:

Deep decay- as mentioned above, bacterial infiltration of the dental pulp can cause pulpal mortification if the body’s defense mechanisms are overcome by the harmful ones.

Trauma – especially in the front teeth there is a risk of trauma, especially at a young age. Of the traumas, those that have opened the pulp chamber further allow bacteria from the oral cavity into the pulp space.

Deep marginal periodontitis – Inflammation of the marginal periodontium is the suffering of the structures that hold the tooth in its normal position in the dental arch. The promoter of periodontal disease is untreated gingivitis which, through evolution, produces bone resorption and periodontal pockets. These periodontal pockets contain increased amounts of bacteria and if they border the dental apex, they can cause pulpal morphosis.

Symptomatology of pulpal necrosis and gangrene

The tooth, through the septic mortification in gangrene and aseptic mortification found in necrosis, loses all reaction to surrounding stimuli. The following signs and symptoms may characterize pulpal mortification:

The existence of deep, untreated caries, which in evolution has opened the pulp chamber.

Removal of the carious deposit is painless.

Bleeding is absent.

Both the patient and the doctor may smell a foul odor from rotting food in the cavity created by the carious process.

The tooth affected by gangrene or necrosis may show changes in color. Thus, it loses its translucency, becomes duller compared to healthy teeth.

The mucous membrane in front of the tooth is more purplish and thinner. In the event of a complication, abscesses may also occur, materialized by a purulent collection of mucous membrane.

Vitality tests of the tooth in question are negative.

Treatment

Treatment of necrosis and gangrene is carried out by pulpal extirpation, drug treatment and sealing of the canals with filling materials to prevent further bacterial infiltration.