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Pulp Polyp Treatment & Management

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

Medical Care

See the list below:

  • Treatment of a pulp polyp in a permanent tooth includes either root canal therapy or extraction of the tooth.
  • The more conservative pulpotomy treatment has been successful in selected cases when only the coronal pulp is affected.
  • In immature teeth with incomplete root development, placement of an apical barrier and strengthening of the thin root with composite resin may be indicated prior to root canal treatment.
  • Pulp revascularization of an immature permanent tooth is another new treatment approach that results in the formation of vital pulpal tissue.[5]
  • The tooth requires a full-coverage crown following endodontic therapy.
  • Prior to extensive restorative treatment, the risks and benefits of this treatment, including the long-term prognosis of the affected tooth in a young child, needs to be thoroughly explained.
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Surgical Care

See the list below:

  • The affected tooth is extracted when primary teeth are involved or when minimal tooth structure in permanent teeth is available for restoration or the alveolar bone support is unfavorable.
  • A surgical crown lengthening procedure may be needed to prepare a tooth for a full-coverage crown.
  • Healing is uneventful in most cases.
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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].

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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).
 
 
 
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