Pulpless canals will always be infected. There will be
no pain from the tooth itself when it has a pulpless
canal, although some patients may give a history of
occasional vague discomfort over a period of time.
However, pain may arise from the periradicular tissues
that become inflamed because of the presence of
bacteria in the pulp space. The only clinical sign
suggesting the condition may be the lack of response to
pulp sensibility tests. No significant changes can be
detected on the radiograph in the early stages of this
condition but within 2–10 months there will be a
radiolucency suggesting periapical involvement.
As there is the potential for erroneous pulp sensibility test
responses, corroborating the clinical findings, radio-graphs
and patient information is necessary for a
definitive diagnosis.
Clinically, it is not possible to distinguish whether a
tooth has a “necrotic pulp without infection”, the early
stage of a “necrotic pulp with infection” or the early
stage of a “pulpless, infected root canal system”. These
disease entities can only be differentially diagnosed
when a periapical radiolucency develops or if there are
other clinical signs of periapical involvement. A
“necrotic pulp without infection” will not have apical
periodontitis but a “necrotic pulp with infection” will
have apical periodontitis, as will a “pulpless infected
root canal system”. If a tooth has a “necrotic pulp with
infection”, this implies that it is in the early stage of the
infection process since the necrotic tissue has yet to be
ingested by the bacteria. Hence, it is more likely that
there will be no periapical radiolucencies evident.
The periapical changes (i.e., bone resorption) take 2–10
months to be evident even though the necrotic pulp
remnants are removed by the bacteria within 1–3
months after invasion.
Hence, a tooth with periapical
radiolucency is extremely likely to have a “pulpless,
infected root canal system” (Figs 5 and 6).
Tenderness to biting pressure and/or percussion is a
typical classical sign of apical periodontitis and this
may be present before the radiolucency is evident if the
periapical response is rapid. Hence, such tenderness
without a radiolucency would indicate either a “necrotic
pulp with infection” or the early stages of a tooth with
a “pulpless, infected root canal system”.
no pain from the tooth itself when it has a pulpless
canal, although some patients may give a history of
occasional vague discomfort over a period of time.
However, pain may arise from the periradicular tissues
that become inflamed because of the presence of
bacteria in the pulp space. The only clinical sign
suggesting the condition may be the lack of response to
pulp sensibility tests. No significant changes can be
detected on the radiograph in the early stages of this
condition but within 2–10 months there will be a
radiolucency suggesting periapical involvement.
As there is the potential for erroneous pulp sensibility test
responses, corroborating the clinical findings, radio-graphs
and patient information is necessary for a
definitive diagnosis.
Clinically, it is not possible to distinguish whether a
stage of a “necrotic pulp with infection” or the early
stage of a “pulpless, infected root canal system”. These
disease entities can only be differentially diagnosed
when a periapical radiolucency develops or if there are
other clinical signs of periapical involvement. A
“necrotic pulp without infection” will not have apical
periodontitis but a “necrotic pulp with infection” will
have apical periodontitis, as will a “pulpless infected
root canal system”. If a tooth has a “necrotic pulp with
infection”, this implies that it is in the early stage of the
infection process since the necrotic tissue has yet to be
ingested by the bacteria. Hence, it is more likely that
there will be no periapical radiolucencies evident.
The periapical changes (i.e., bone resorption) take 2–10
months to be evident even though the necrotic pulpremnants are removed by the bacteria within 1–3
months after invasion.
Hence, a tooth with periapical
radiolucency is extremely likely to have a “pulpless,
infected root canal system” (Figs 5 and 6).
Tenderness to biting pressure and/or percussion is a
typical classical sign of apical periodontitis and this
may be present before the radiolucency is evident if the
periapical response is rapid. Hence, such tenderness
without a radiolucency would indicate either a “necrotic
pulp with infection” or the early stages of a tooth with
a “pulpless, infected root canal system”.