Pulp stone
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The study investigates the prevalence of pulp stones in Malaysians, revealing a 44.9% occurrence rate, particularly in molars and non-intact teeth. Notably, the study found no significant association with sex, age, or ethnicity, despite higher rates among older individuals and specific racial groups. The findings suggest that further research is necessary to explore the implications of pulp stones in dental health and forensic identification.
Pulp stone
- 1. Radiographic Assessment of the Prevalence of Pulp Stones in Malaysians Kannan et al. JOE — Volume 41, Number 3, March 2015 GUIDED BY: DR.RAHUL MARIA PRESENTED BY: DR. ANUBHUTI Conservative Dentistry & Endodontics
- 3. INTRODUCTION Pulp stones are discrete calcified bodies found in the dental pulp. They have calcium phosphorous ratios similar to dentin and can be seen in healthy, diseased, or even unerupted teeth JOE -Vol 41,No 3,March 2015 3
- 4. These pulp stones, also known as denticles, may exist freely within the pulp tissue or be attached or embedded in the dentin. They are found more frequently at the orifice of the pulp chamber or within the root canal. JOE -Vol 41,No 3,March 2015 4
- 5. A tooth may have pulp stones of varying sizes, from minute particles to large masses, which can occlude the pulp space. They are seen in all tooth types but occur most commonly in molars JOE -Vol 41,No 3,March 2015 5
- 6. Size Radiographic examinations are not likely to detect pulp stones less than 200μm in diameter 6 Radiographic assessment of the prevalence of pulp stones in Australians 2008.Australian Dental Journal 2002;47:(1):36-40
- 7. Radiographically, pulp stones appear as radiopaque structures in the pulp space that frequently act as an impediment during endodontic treatment JOE -Vol 41,No 3,March 2015 7
- 8. 8 Pulp stones were histologically classified by Kronfeld Radiographic assessment of the prevalence of pulp stones in Australians 2008.Australian Dental Journal 2002;47:(1):36-40
- 9. PULP STONES True pulp stones False pulp stones JOE -Vol 41,No 3,March 2015 9
- 10. PULP STONES Asymptomatic unless they impinge on nerves (or) blood vessels. Goga, R.; N. P. Chandler & A. O. Oginni (2008). "Pulp stones: a review". International Endodontic Journal 41: 457–468. CLASSIFICATION True denticles False denticles Diffused calcifications 10
- 11. Based on location Embedded Adherent free JOE -Vol 41,No 3,March 2015 11
- 12. They rare and contain dentin with distinct dentinal tubules lined by odontoblasts. it contains a concentric layers of mineralized tissue formed by surface accretion around blood thrombi, dying or dead cells, or collagen fibers JOE -Vol 41,No 3,March 2015 12 True pulp stones False pulp stones
- 13. Found mostly in radicular portion. It arise as a result of epithelial mesenchymal interactions Found mostly in coronal portion It arise from degenerating cells of the pulp that eventually get mineralized JOE -Vol 41,No 3,March 2015 13 True pulp stones False pulp stones
- 14. Increasing age Circulatory disturbances in the pulp Orthodontic tooth movement Transplantat ion of teeth Trauma Other etiologic factors JOE -Vol 41,No 3,March 2015 14
- 15. Pulp stones have been associated with systemic problems Cardiovascular disease Systemic sclerosis A genetic predisposition Idiopathic . JOE -Vol 41,No 3,March 2015, A radiographic correlation between systemic disorders and pulp stones.Nayak, et al.Indian J Dent Res, 21(3), 2010 15
- 16. Genetic disorders Dentin dysplasia Dentinogenesis Imperfecta Van der Woude syndrome JOE -Vol 41,No 3,March 2015 16
- 17. Pulpal calcifications can develop throughout life, and studies have reported prevalence rates from 8%–90% JOE -Vol 41,No 3,March 2015 17
- 18. The prevalence of pulp stones in teeth based on radiographic examinations has been reported to be around 20%–25% whereas histologic examinations yield higher prevalences JOE -Vol 41,No 3,March 2015 18
- 19. The purpose of this study was to determine the prevalence of pulp stones in Malaysians using radiographs and to investigate any association between the occurrence of pulp stones with sex, age, tooth type, dental arch, and tooth status. JOE -Vol 41,No 3,March 2015 19
- 20. In Malaysia, the population is largely composed of 3 major ethnic backgrounds (Malays, Chinese, and Indians), which further permitted to compare the occurrence of pulp stones among racial groups. JOE -Vol 41,No 3,March 2015 20
- 21. Materials and Methods Records of patients between the ages of 10 and 70 years, which contained intraoral periapical radiographs of diagnostic quality, were included in the study. A random sample of 1000 dental records of patients who were treated at the AIMST Dental Centre, Faculty of Dentistry, AIMST University, Kedah, Malaysia, were reviewed. JOE -Vol 41,No 3,March 2015 21
- 22. A total of 1779 teeth were examined from these radiographs; only permanent teeth with complete roots were analyzed All radiographs were taken in the oral radiology department using the parallel cone technique. The final sample consisted of 361 patient records that had 507 intraoral periapical radiographs of diagnostic quality. JOE -Vol 41,No 3,March 2015 22
- 23. The data were recorded in a detailed spreadsheet prepared for the study JOE -Vol 41,No 3,March 2015 23
- 24. The data were statistically analyzed using the Pearson chi-square test of significance to report any association of pulp stone occurrence with sex, age, race, tooth type, dental arch, and tooth status. JOE -Vol 41,No 3,March 2015 24
- 25. Results A total of 60 (38.5%) male and 102 (49.8%) female subjects exhibited pulp stones Among the total 361 subjects, 162 (44.9%) had pulp stones in 1 or more teeth. Overall Prevalence of Pulp Stones and Distribution between Sexes Of the 361 subjects examined, 156 were males and 205 were females. JOE -Vol 41,No 3,March 2015 25
- 26. Pulp Stone Distribution among Age Groups There was a higher prevalence in patients 50–59 years of age (56.8%) when compared with the other age groups. JOE -Vol 41,No 3,March 2015 26
- 27. Pulp Stone Distribution among the 3 Races in Malaysia Among the ethnic groups (Malays, Chinese, and Indians), the Indian population (52.6%) had more pulp stones as reflected JOE -Vol 41,No 3,March 2015 27
- 28. Pulp Stone Occurrence in Tooth Types and Dental Arches The occurrence of pulp stones in the mandibular (15.5%) and maxillary (15.9%) arches were almost equal. JOE -Vol 41,No 3,March 2015 28
- 29. Of the teeth exhibiting pulp stones, the maxillary left second molar showed the highest occurrence (36.5%) followed by the mandibular right second molar (30.4%). A relatively low frequency was seen in mandibular incisors followed by maxillary left first premolars (3.2%), which were the least affected teeth JOE -Vol 41,No 3,March 2015 29
- 30. Pulp Stones and Tooth Status pulp stones were not associated with any other tooth abnormalities (both developmental and acquired). JOE -Vol 41,No 3,March 2015 30
- 31. Discussion The true prevalence is likely to be higher in microscopic examinations of teeth than figures from radiographic studies , the latter is the only noninvasive technique available for evaluating pulp stones in clinical investigations JOE -Vol 41,No 3,March 2015 31
- 32. However, Tamse et al stated that bitewing and periapical radiographs showed no significant difference in the identification of pulp stones. Bitewing radiographs do not show the complete radicular pulp, so we examined only periapical radiographs to avoid underreporting of pulp stones. JOE -Vol 41,No 3,March 2015 32
- 33. The prevalence of pulp stones was higher in females compared with males. JOE -Vol 41,No 3,March 2015 33
- 34. The prevalence was high in patients older than 30 years; however, there was no significant difference between the various age groups The maximum number of pulp stones was seen in a 34-year-old female patient who exhibited more than single pulp stones in several teeth. In the study, the youngest individual was a 12-year-old female who exhibited a single pulp stone in her maxillary left first molar tooth. JOE -Vol 41,No 3,March 2015 34
- 35. Hamasha and Darwazeh stated that molars, being the largest teeth in the arch, have a better supply of blood to the pulp tissues, leading to more precipitation of calcifications. JOE -Vol 41,No 3,March 2015 35
- 36. Recent researches have incriminated as a factor which initiates these calcium depositsa small bacteria – Nanobacterium sanguineum – which has the possibility to form around itself, a real “mineral carcass 36 Radiographic assessment of the prevalence of pulp stones in Australians 2008.Australian Dental Journal 2002;47:(1):36-40
- 37. The tendency for the occurrence of pulp stones was high in teeth that were not intact This may be caused by chronic pulpal irritation in both carious and restored teeth. JOE -Vol 41,No 3,March 2015 37
- 38. Hamasha and Darwazeh noted a high incidence of pulp stones associated with Dilacerations, impactions, Taurodontism, and enamel pearls. JOE -Vol 41,No 3,March 2015 38
- 39. JOE -Vol 41,No 3,March 2015 39
- 40. Use of magnification and trans illumination as well as careful examination of colour changes and pulp chamber spaces ,can help the clinician safely locate the canals Clinician should search for root canal orifices only after completely preparing the pulp chamber and cleaning and drying its floor(95% denatured ethanol ) 40 Pathways of cohen 13th edition page no 171
- 41. A fiber optic light directed towards through the CEJ can reveal subtle landmarks and colour changes that may not otherwise be visible Pathways of cohen 13th edition.pg 171 41
- 42. Clinician must be aware of these colour changes and must keep in mind that orifices are located at the angles formed by the floor and walls at the end of the developmental grooves 42 Pathways of cohen 13th edition.pg 171
- 43. Additional aid Staining the pulp chamber floor with 1% methylene blue dye Sodium hypochlorite ‘champagne bubble test’ and searching for canal bleeding points JOE -Vol 41,No 3,March 2015 43
- 44. Clinician should use a long shank #2 or #4 round bur to remove dentin, attempting to locate calcified canals 44 Pathways of cohen 13th edition.pg 173
- 45. An endodontic explorer,DG 16 is used to probe the pulp floor. A straight ultrasonic tip may be used to remove the dentin 45 Pathways of cohen 13th edition.pg 173
- 46. 46 Pathways of cohen 13th edition.pg 173
- 47. As the first indication of a canal space, the smallest instrument (#.06#.08 file) should be introduced in the canal . Gentle passive movement, both apical and rotational, often produces some penetration. A slight pull, signaling resistance, usually is an indication that the canal has been located this should be confirmed by radiographs 47 Pathways of cohen 13th edition.pg 173
- 48. A small hand K- file negotiates the canal to its terminus .a radiograph is used to confirm the file’s position 48 Pathways of cohen 13th edition.pg 173
- 49. The file should not be removed until some canal enlargements has occurred. 49 Pathways of cohen 13th edition.pg 173
- 50. The wise clinician stops excavating dentin if a canal orifice cannot be found to avoid weakening the tooth structure. Serious errors can arise from overzealous or inappropriate attempts to locate canals. Root wall or furcation perforations can occur even with the most careful search 50 Pathways of cohen 9th edition.pg 185
- 51. Conclusion The prevalence of pulp stones in the Malaysian population studied was 44.9%. Stones were found significantly more often in molars and in teeth that were not intact (either restored or carious). Pulp stones occurred predominantly in restored teeth. The occurrence of pulp stones had no significant association with sex, age, or the different Malaysian ethnic races. However, these findings require further investigation. The size, shape, location, and number of pulp stones on radiographs can be used as an adjunctive feature for forensic identification.JOE -Vol 41,No 3,March 2015 51
- 52. REFERENCES A radiographic assessment of the prevalence of pulp stones in a group of Turkish dental patients. Gulsahi et al.International Endodontic Journal, 42, 735–739, 2009 A radiographic correlation between systemic disorders and pulp stones.Nayak, et al.Indian J Dent Res, 21(3), 2010 Radiological and microscopic aspects of the denticles. Romanian Journal of Morphology and Embryology 2006, 47(3):263–268 Pilot Study of Correlation of Pulp Stones with Cardiovascular Disease. Edds et al.JOE—Volume 31, Number 7, July 2005 Correlation of pulp stone prevalence with dietary habits - A pilot study Health Sciences 2012;1(3):JS003C JOE -Vol 41,No 3,March 2015 52
- 53. REFERENCES Association between dental pulp stones and calcifying nano particles. Zeng et al .International Journal of Nanomedicine 2011:6 Pulp stones: a review. Goga et al.International Endodontic Journal, 41, 457–468, A Radiographic assessment of the prevalence of pulp stones in Australians 2008.Australian Dental Journal 2002;47:(1):36-40 Ingle’s 6th edition Pathways of cohen 8th ,9th,13th edition Grossman’s 13th edition Textbook of endodontics by anil kohli JOE -Vol 41,No 3,March 2015 53