Pulp polyp – chronic hyperplastic pulpitis
In deciduous or recently erupted permanent teeth with wide-open carious cavities and a good apical blood supply, pulpitis may be associated with a hyperplastic response characterised by the production of exuberant granulation tissue. This is seen most frequently in deciduous molars and first permanent molars. The wide-open pulpitis prevents build-up of tissue pressure compromising pulpal blood flow, and the good apical blood supply facilitates pulpal defence and repair. The hyperplastic granulation tissue protrudes beyond the boundaries of the pulp chamber to form a pulp polyp and such lesions are described as chronic hyperplastic pulpitis (Figs.).
The polyp may become epithelialized by the spontaneous grafting of oral epithelial cells present in the saliva ( Fig.). The origin of these epithelial cells is unknown. Most of the desquamated cells in saliva are degenerate superficial squames, incapable of further division. For the polyp to become epithelialized the grafted cells must be capable of division and subsequent differentiation into stratified squamous epithelium. Such cells must come from the region of the basal cell layer and might be released from trauma to the oral mucosa or from the gingival sulcus.
- an ulcerated pulp polyp presents as a dark red, yellow-flecked (because of the fibrinous exudate) fleshy mass protruding from the pulp chamber
- Bleeds readily on probing
- In contrast, an epithelialized polyp is firmer, pinkish-white in colour, and does not bleed readily.
- They are both usually devoid of sensation on gentle probing.
- few odontoblast present
- pulp tissue replaced by granulation tissue
- covered by stratified squamous epithelium later this granulation tissue is replaced by fibrous tissue
- removal of polyp
- pulpectomy followed by RCT
- in grossly destructed tooth – extraction