A rare occurence of Pulp Polyp in premolar.

[Ritika Bhat]

A pulp polyp (chronic hyperplastic pulpitis ) occurs almost exclusively in children and young adults who possess a high degree of tissue resistance and reactivity and readily respond to proliferative lesions.

It usually involves teeth with large open carious lesions.

Clinical feature: pinkish red globule of tissue protruding from the pulp chamber and not only fills the caries defect but also extends beyond.

The teeth most commonly involved by this phenomenon are deciduous molars and first permanent molars.

this is because they have excellent blood supply because of large root opening and this coupled with the high tissue resistance and reactivity in young persons accounts for unusual
proliferative property of the pulp tissue.

But this pulp polyp was seen in a young adult in a maxillary premolar..something very rare to be seen.

        

[drmithila]

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.

 

        

[drmithila]

Diagnosis and determination of the most appropriate treatment options are based on adjunctive tests, including response to percussion, thermal stimuli, and electric pulp testing. In most cases, the results of these adjunctive tests are similar to those obtained for healthy teeth, which is in contrast to most teeth that exhibit irreversible pulpitis. The normal responses should not confuse the practitioner that the pulpal tissue is healthy and therefore requires only conservative treatment. In addition, these tests help to differentiate a true pulp polyp from hyperplastic gingivitis that is overlying a cavitation from a nonvital tooth.Intraoral radiographs, in particular periapical and bite-wing film views, are needed to confirm this diagnosis and to determine the extent of tooth destruction and if the inflammatory lesion involves the surrounding alveolar bone.
Radiographic findings demonstrate a large coronal radiolucency that extends to the pulpal chamber with focal loss of tooth structure, while the root apices may be either open or closed.
Although no bony changes are usually observed, the surrounding alveolar bone may reveal either an incipient periapical radiolucency that is consistent with chronic apical periodontitis or a localized radiopacity that is referred to as focal sclerosing osteomyelitis (condensing osteitis). In addition, vertical alveolar bone height may be decreased surrounding the involved tooth, which is indicative of periodontitis.
Radiographic imaging is required to determine the most appropriate treatment for the involved tooth.

 

        

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