eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Oral Medicine

Pulp Polyp: Differential Diagnoses & Workup

Author: Catherine M Flaitz, DDS, MS, Professor of Oral and Maxillofacial Pathology and Pediatric Dentistry, Department of Diagnostic Sciences, University of Texas Health Sciences Center at Houston, Dental Branch
Coauthor(s): M John Hicks, DDS, MS, PhD, MD, Professor, Department of Pathology, Baylor College of Medicine; Medical Director of Ultrastructural Pathology, Medical Director of Cytogenetics and Molecular Cytogenetics, Department of Pathology, Texas Children's Hospital
Contributor Information and Disclosures

Updated: Nov 5, 2009

Differential Diagnoses

Pyogenic Granuloma (Lobular Capillary Hemangioma)

Other Problems to Be Considered

Irritation fibroma (focal fibrous hyperplasia)
Peripheral ossifying fibroma
Peripheral giant cell granuloma
Epulis granulomatosum
Parulis (soft tissue abscess)
Pericoronitis
Neoplastic disease of the jaws with soft tissue extension
Child neglect: Pulp polyps along with other carious teeth found in children or adolescents may indicate child neglect.

Workup

Imaging Studies

  • 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.

Other Tests

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.

Procedures

Affected teeth and pulpal tissue are occasionally submitted for gross and histopathologic examination. This examination is most important when the pulp polyp is diagnosed in multiple teeth and when the cause for this uncommon pulpal response is not obvious at clinical examination.

Histologic Findings

Microscopic findings reveal a mass of granulation tissue protruding from the crown of a fractured or carious tooth that resembles a pyogenic granuloma. The fibrovascular stroma contains numerous small, delicate vascular channels and a prominent inflammatory infiltrate composed of primarily lymphocytes, plasma cells, and neutrophils. Although the surface may be ulcerated, it is covered by stratified squamous epithelium that resembles oral mucosa in approximately 50% of these inflammatory hyperplastic lesions. The source of this epithelium appears to be from the engraftment of desquamated oral epithelial cells or the migration of the epithelium from the adjacent gingival tissues. In more mature lesions that are covered with squamous epithelium, the granulation tissue is replaced by fibrous connective tissue with minimal inflammation and foci of dystrophic calcification.

Bacteria (primarily gram positive) are found on the surface of the polyp and within the carious lesion. In many cases, the histopathologic changes are limited to the coronal pulp tissue with the apical tissue exhibiting only mild vasodilation and minimal chronic inflammation.

Ultrastructural examination of nerve fibers associated with the pulp polyp exhibits variable findings within the same tooth, ranging from normal to moderate or severe degeneration of both myelinated nerve fibers and unmyelinated nerve fibers.

More on Pulp Polyp

Overview: Pulp Polyp
Differential Diagnoses & Workup: Pulp Polyp
Treatment & Medication: Pulp Polyp
Follow-up: Pulp Polyp
Multimedia: Pulp Polyp
References
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References

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  4. Caliskan MK, Turkun M, Oztop F. Histological evaluation of a tooth with hyperplastic pulpitis and periapical osteosclerosis. Int Endod J. Sep 1997;30(5):347-51. [Medline].

  5. Camp JH. Diagnosis dilemmas in vital pulp therapy: treatment for the toothache is changing, especially in young, immature teeth. Pediatr Dent. May-Jun 2008;30(3):197-205. [Medline].

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  10. Smulson MH, Sieraski SM. Histopathology and diseases of the dental pulp. In: Weine FS. Endodontic Therapy. 5th ed. St. Louis: Mo: Mosby; 1996:84-165.

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  12. Southam JC, Hodson JJ. The growth of epithelium, melanocytes, and Langerhans cells on human and experimental dental pulp polyps. Oral Surg Oral Med Oral Pathol. Apr 1974;37(4):546-55. [Medline].

  13. Whitaker SB, Singh BB, Weller RN, Bath KR, Loushine RJ. Sex hormone receptor status of the dental pulp and lesions of pulpal origin. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Feb 1999;87(2):233-7. [Medline].

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Further Reading

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Keywords

pulp polyp, pulp polyps, pulpal diseases, chronic hyperplastic pulpitis, proliferative pulpitis, inflammatory hyperplasia, dental caries, reactive pulpal disease, irreversible pulpitis

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Contributor Information and Disclosures

Author

Catherine M Flaitz, DDS, MS, Professor of Oral and Maxillofacial Pathology and Pediatric Dentistry, Department of Diagnostic Sciences, University of Texas Health Sciences Center at Houston, Dental Branch
Catherine M Flaitz, DDS, MS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Academy of Oral Medicine, American Academy of Pediatric Dentistry, American Dental Association, International Association for Dental Research, and International Association of Oral Pathologists
Disclosure: Nothing to disclose.

Coauthor(s)

M John Hicks, DDS, MS, PhD, MD, Professor, Department of Pathology, Baylor College of Medicine; Medical Director of Ultrastructural Pathology, Medical Director of Cytogenetics and Molecular Cytogenetics, Department of Pathology, Texas Children's Hospital
M John Hicks, DDS, MS, PhD, MD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Society for Clinical Pathology, College of American Pathologists, International Academy of Pathology, and International Association of Oral Pathologists
Disclosure: Nothing to disclose.

Medical Editor

Gregory J Raugi, MD, PhD, Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle
Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Drore Eisen, MD, DDS, Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati
Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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