Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pulp Polyp

  • Author: Catherine M Flaitz, DDS, MS; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Apr 30, 2014
 

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.

Pulp polyps involving the primary, first, and seco Pulp polyps involving the primary, first, and second mandibular molars in a young child with extensive dental caries.
Next

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 in part because of this lack of significant intrapulpal pressure. In young teeth in which 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.

The possible role of a type 1 hypersensitivity reaction has been hypothesized because of an increased presence and concentration of immunoglobulin E (IgE), histamine, and interleukin-4 (IL-4) within the pulp polyps when compared with healthy pulpal tissues.[1]

Previous
Next

Epidemiology

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 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. In a Brazilian clinical study of traumatized primary teeth, the occurrence of pulp polyps was 2.3% in young children.[2]

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. When trauma is the causative factor in primary anterior teeth, most examples are observed in children aged 2 years or younger.

Previous
 
 
Contributor Information and Disclosures
Author

Catherine M Flaitz, DDS, MS Distinguished Teaching Professor of Oral and Maxillofacial Pathology and Pediatric Dentistry, Department of Diagnostic and Biomedical Sciences, University of Texas Health Sciences Center at Houston School of Dentistry

Catherine M Flaitz, DDS, MS is a member of the following medical societies: American Academy of Oral Medicine, International Association of Oral Pathologists, American Academy of Pediatric Dentistry, American Academy of Oral and Maxillofacial Pathology, American Dental Association, International Association for Dental Research

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Academy of Pediatric Dentistry Board of Trustees; Commissioner of Dental Accreditation; Chief of Dentistry Nationwide Children's Hospital<br/>Serve(d) as a speaker or a member of a speakers bureau for: American Academy of Pediatric Dentistry Speakers Bureau<br/>Received research grant from: Trimira LLC; GC America; C3-Jian; others<br/>Travel Grant from GC America; American Academy of Pediatric Dentistry for Continuing Education Presenter for: Multiple speaking engagements for dental meetings.

Coauthor(s)

M John Hicks, DDS, MD, PhD, MS Professor with Tenure, Department of Pathology and Immunology, Baylor College of Medicine; Medical Director of Ultrastructural Pathology, Department of Pathology, Texas Children's Hospital; Professor of Pediatrics, Baylor College of Medicine; Adjunct Professor, Department of Pediatric Dentistry, School of Dentistry, University of Texs Health Science Center at Houston

M John Hicks, DDS, MD, PhD, MS 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, International Association of Oral Pathologists

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, 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, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

Gregory J Raugi, MD, PhD Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle School of Medicine; 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.

References
  1. Sattari M, Haghighi AK, Tamijani HD. The relationship of pulp polyp with the presence and concentration of immunoglobulin E, histamine, interleukin-4 and interleukin-12. Aust Endod J. 2009 Dec. 35(3):164-8. [Medline].

  2. Abdel Jabbar NS, Aldrigui JM, Braga MM, Wanderley MT. Pulp polyp in traumatized primary teeth--a case-control study. Dent Traumatol. 2013 Oct. 29(5):360-4. [Medline].

  3. Raslan N, Wetzel WE. Exposed human pulp caused by trauma and/or caries in primary dentition: a histological evaluation. Dent Traumatol. 2006 Jun. 22(3):145-53. [Medline].

  4. Vergotine RJ, Hodgson B, Lambert L. Pulp polyp associated with a natal tooth: case report. J Clin Pediatr Dent. 2009 Winter. 34(2):161-3. [Medline].

  5. Trope M. Treatment of the immature tooth with a non-vital pulp and apical periodontitis. Dent Clin N Am. Apr 2010. 54(2):313-324. [Medline].

  6. Caliskan MK. Success of pulpotomy in the management of hyperplastic pulpitis. Int Endod J. 1993 Mar. 26(2):142-8. [Medline].

  7. Caliskan MK, Oztop F, Caliskan G. Histological evaluation of teeth with hyperplastic pulpitis caused by trauma or caries: case reports. Int Endod J. 2003 Jan. 36(1):64-70. [Medline].

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

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

  10. Nair RG, Samaranayake LP, Philipsen HP, Graham RG, Itthagarun A. Prevalence of oral lesions in a selected Vietnamese population. Int Dent J. 1996 Feb. 46(1):48-51. [Medline].

  11. Neuhaus KW. Teeth: malignant neoplasms in the dental pulp?. Lancet Oncol. 2007 Jan. 8(1):75-8. [Medline].

  12. Neville B, Damm D, Allen C, Bouquot J. Pulpal and periapical disease. Oral and Maxillofacial Pathology. 3rd ed. St. Louis, Mo: WB Saunders; 2009. 120-53.

  13. Piskin B, Aktener BO, Karakisi H. Neural changes in ulcerative and hyperplastic pulpitis: a transmission electron microscopic study. Int Endod J. 1993 Jul. 26(4):234-40. [Medline].

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

  15. Southam JC, Hodson JJ. Neurohistology of human dental pulp polyps. Arch Oral Biol. 1973 Oct. 18(10):1255-60. [Medline].

  16. 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. 1974 Apr. 37(4):546-55. [Medline].

  17. 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. 1999 Feb. 87(2):233-7. [Medline].

 
Previous
Next
 
Pulp polyps involving the primary, first, and second mandibular molars in a young child with extensive dental caries.
Picture 2. Pulp polyp involving the permanent second mandibular molar in a young adult with multiple carious teeth.
Fibrosed pyogenic granuloma of the mandibular gingiva that partially surrounds a carious molar with crown destruction. Reactive gingival lesions that extend into a large carious lesion of an adjacent tooth may resemble a pulp polyp.
Low-power photomicrograph of a pulp polyp demonstrating inflamed fibrovascular tissue that is lined by stratified squamous epithelium (hematoxylin and eosin, original magnification X40).
Intermediate-power photomicrograph of a pulp polyp with superficial bacteria and exogenous, pigmented material overlying the surface epithelium (hematoxylin and eosin, original magnification X100).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.