The prevalence of occlusal pulpar exposure in cheek teeth with apical infections and idiopathic fractures

Abstract

Hundred and ten cheek teeth that were extracted (1993 - 2008) because of apical infection (n=79; mean dental age 3.5 years) or idiopathic cheek teeth fractures (n= 31; median dental age 8.5 years) were examined, including analyses of transverse and longitudinal sections and CAT scan images of these teeth. Computerised axial tomography was useful to determine pulp chamber anatomy and could identify pulp horns suspicious of pulpitis and exposure. The apical infections were mainly (68%) due to anachoresis (blood or lymph born infection), with the residual cases caused by descending periodontal disease (23%), infundibular caries (4%), fissure fractures (3%) and dysplasia (3%). The idiopathic fracture patterns were similar to previously described patterns. Occlusal pulpar exposure was found in 32% of apically infected cheek teeth, including exposure of multiple pulps in 27% and a single pulp in 5%. This finding re-enforces the value of detailed intra-oral examination of suspect apical infection cases. However, 10% of apically infected cheek teeth had changes to the occlusal secondary dentine termed occlusal pitting, but did not have exposure of the underlying pulp. The term occlusal defect would therefore be more appropriate to use in live patients. Multiple pulpar exposures occurred in some cheek teeth with apical infections, and the pulp involvement reflects the anatomic relationships of these pulps. A higher proportion (42%) of cheek teeth extracted because idiopathic fractures had pulpar exposure (26% multiple, 16% single pulps), especially with midline sagittal maxillary and miscellaneous pattern mandibular cheek teeth fractures, but only 3% had occlusal pitting.