eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Pulp Polyp

Author: Catherine M Flaitz, DDS, MS, Dean and Co-director of Oral and Maxillofacial Pathology Laboratory, 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 with Tenure, Department of Pathology, Baylor College of Medicine; Medical Director of Surgical Pathology, Department of Pathology, Texas Children's Hospital
Contributor Information and Disclosures

Updated: Feb 7, 2007

Introduction

Background

The pulp polyp, also known as chronic hyperplastic pulpitis or proliferative pulpitis, is an uncommon and specific type of inflammatory hyperplasia that is associated with a nonvital tooth.

Pulpal diseases are broadly divided into reversible and irreversible pulpitis and are based on the ability of the inflamed dental pulp to return to a healthy state once the noxious stimulus has been removed. In the case of the pulp polyp, the disease process is irreversible. In contrast to most cases of irreversible pulpitis, the pulp polyp is usually an incidental finding that occasionally mimics reactive and neoplastic diseases of the gingiva and adjacent periodontium.

Pathophysiology

The pulp polyp is the result of both mechanical irritation and bacterial invasion into the pulp of a tooth that exhibits significant crown destruction due to trauma or caries. The mechanical causes that may stimulate this response include a tooth fracture with pulpal exposure or loss of a dental restoration. Usually, the entire dentinal roof is exposed with the crown of a carious tooth. The large exposure of pulpal tissue to the oral environment and bacterial invasion results in a chronic inflammatory response that stimulates an exuberant granulation tissue reaction.

The hyperplastic tissue reaction occurs because the young dental pulp has a rich blood supply and favorable immune response that is more resistant to bacterial infection. Furthermore, because the tooth is open to the oral cavity, transudates and exudates from the inflamed pulpal tissue drain freely and do not accumulate within the restricted and rigid confines of the tooth. Tissue necrosis with destruction of the microcirculation that usually accompanies irreversible pulpitis does not occur due, in part, to this lack of significant intrapulpal pressure. In young teeth where the apex of the root is open, the risk of pulpal necrosis secondary to venous congestion is decreased. The presence of a rich vascular network in the young pulpal tissue is an important protective mechanism against the inflammatory response that significantly decreases with age.

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 recent 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.

Clinical

History

• Pulp polyps are usually asymptomatic.
• Direct pressure during mastication may cause mild-to-moderate tenderness.
• Localized bleeding may occur when the soft tissue is manipulated or traumatized.
• All lesions are associated with a history of a long-standing carious lesion or a fractured tooth.
• Pulp polyps reach a maximum size within a couple of months and then remain static.
• Mobility of the tooth and sensitivity to percussion are usually absent.
• Drainage of a purulent exudate is not a characteristic finding.

Physical

• A spongy, soft tissue nodule extrudes from the cavitated or fractured surface of a tooth.
• The surface varies from pink and smooth to red and white and granular.
• Polyps typically enlarge to fill the entire cavitated area or pulpal chamber of the tooth.
• Soft tissue may merge with the adjacent attached gingiva.
• Polyps usually develop in carious primary molars and first permanent molars because anatomically in young persons, these teeth have large pulp chambers.
• A pulp polyp is a single lesion, but multiple teeth may be affected.
• Teeth with open or incomplete apexification of the root apices are the most susceptible.

Causes

Causes of a pulp polyp include the following:

• Carious tooth with significant loss of tooth structure
• Loss of a dental restoration that results in pulpal exposure
• Fractured tooth due to trauma with a pulpal exposure
• Pulpal tissue with access to a good blood supply
• Possible hormonal (estrogen and progesterone) influence

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