Pulp Stones and Dental Pain
Mukhtar H. Abdel Wahab, BDS, PhD
Riyadh Dental Center, P.O.Box 1584, Riyadh 11441, Saudi Arabia.
A case is
reported of a 42 year-old female who presented with the painful upper left
first molar. Comprehensive clinical examination did not reveal the cause of the
pain which got progressively worse. The tooth was extracted on the insistence
of the patient. Microscopic examination of multiple sections of the decalcified
tooth showed a large freestone which occupied most of the pulp chamber and was
closely related to a nerve bundle. The finding tended to support the view that
pulp stones in an apparently healthy tooth may cause toothache.
Pulp stones are aggregations of calcium phosphate, calcium carbonate, and
magnesium phosphate formed in the pulp chamber or the root canals and may be
attached to the dentinal wail or lie freely within the pulp.1-24 Shafer's" classified pulp stones into true
denticles, which resemble dentine because of their tubular structure, and false
denti cles, which are composed of localized masses of calcified material and
do not show dentinal tubules.
According to Cook2, pulp stones
can be found in normal teeth with healthy pulps as well as in cari ous teeth
and periodontally involved teeth. Bergman,' however, stated that stones occur
mainly in teeth with pathologic pulps where the pulp is dead or dying. Both
authors reported that pulp stones may cause discomfort and pain,though they may
be present without clinical symptoms.
Case History
A female
patient, aged 42 years, complained of a painful upper left first molar. The
tooth had a
mesio-occlusal-distal amalgam restoration which was more than ten years old and
at the time of examination, appeared clinically satisfactory. The pain started
about one month previously and was spontaneous, moderate, and pulsating. The
attack usually lasted about four hours and became more frequent and more
intense prior to presentation in the clinic.
Clinical examination of
the tooth revealed no abnormality other than mild tenderness to precision. The
tooth responded to cold and electrical stimulation at the same level as the
control tooth. The tooth was electively extracted according to the patient's
wish and microscopic examination of multiple sections of the tooth, showed no
inflam matory process in the pulp. However, a large free pulp stone occupying
most of the pulp chamber was present (Fig. 1) and in some sections was shown to
be closely related to a nerve bundle (Fig. 2).
It is evident that the precise cause of pain incases such as this may not be
clear. Nevertheless, this finding supports the view that teeth with pulp stones
could be painful and because the stone may compress the nerve bundle to which
it is closely opposed.
The patient
stated that the pain increased in intensity, conceivably as the pulp stone
enlarged, causing greater compression on the nerve bundle.
Some authors consider
pulp stones to be a form of dystrophic or pathological calcification1
although in this case, there was no histological evidence of inflammation.
There may well have been some other disturbances, which are not demonstrable by
routine histological means. These pathological changes could have caused the
release of pain causing substances, like 5-hydroxytrytamine and potassium ions
from blood platelets and red blood cells.3
In conclusion, this case
tended to support the view that pulp stones can cause toothache.
- Bergman S. Simulated
minor trifacial neuralgia caused by pulp
stones: Report of a case.
J Am Dent Assoc 1943;30:701-703.
- Cook WA. Pulp stones and head
pains. Dent RadiogPhotog 1961;34:80-82.
- Mumford JM. Tooth ache and related pain. London:Churchill Livingstone, 1972.
- Shafer WG, Hine, MK, Levy BM. A textbook of oral pathology. Philadelphia: Saunders,
1963.
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