1989-1-2-65-66-full - Saudi Dental Journal

ISSN (Print) 1013-9052
EISSN 1658-3558

The Saudi Dental Journal,
P.O. Box 52500,
Riyadh 11563,
Kingdom of Saudi Arabia

Tel.	966-1-467-7328
Fax.	933-1-467-7308 / 966-1-467-7534
Email	saudidj@ksu.edu.sa

Pulp Stones and Dental Pain

Mukhtar H. Abdel Wahab, BDS, PhD
Riyadh Dental Center, P.O.Box 1584, Riyadh 11441, Saudi Arabia.

Abstract

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.

Introduction

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).

Discussion

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.

References

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.

Tables

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