Dental Pulp Polyps: Symptoms, Causes, Clinical Features, and Treatment

What Are Dental Pulp Polyps?

Pulp polyps are inflammatory and reactive tissue responses of the dental pulp because of long-standing dental infections. Dental pulp polyps are also called chronic hyperplastic pulpitis, which is a common clinical finding. They are especially found in young adults and children.

What Are the Symptoms of Dental Pulp Polyps?

• Chronic hyperplastic pulpitis or pulp polyp is a pulpal disease of the tooth occurring in children and young adults due to untreated endodontic infection.

• The molar tooth of children and young adults are commonly affected by this condition.

• This condition may be a unique one because of its asymptomatic nature.

• The chief complaint of the child or young adult would be discomfort during biting, chewing, or grinding. The patients may complain of pressure and may not notice any changes in response to thermal or electrical stimuli. This may be because of the necrosed pulp.

• When the dental pulp undergoes necrosis or cell death, the tooth which is affected becomes non-vital. These teeth may be insensitive to electric pulp testing and thermal tests.

• During the management of these lesions, if even endodontic treatment (root canal therapy) is not successful, then the tooth might have to be extracted.

What Are the Causes of Dental Pulp Polyps?

Children and young adolescents have good pulpal resistance. This is because the pulp tissue possesses a high resistance against infections and is a good source of blood supply to the tooth. Pulp polyps are caused due to hyperactive overgrowth of pulp tissue of the affected tooth in response to an external stimulus, especially in pulp with good blood supply and open cavitation, leaving the pulp exposed to the environment. This condition rarely affects older age groups and is an uncommon clinical observation in other age groups.

• This condition is mainly characterized by an extensive endodontic or infectious involvement of the tooth pulp.

• Pulp polyp mainly occurs when there are untreated open cavitated or carious lesions. Because the pulp is infected, this is an adverse pulpal reaction or, rather, a pathway to escape the inflammatory or bacterial exudate.

• Other causes of pulp polyps can be because of long-standing tooth fractures, traumatic impact on the tooth leading to pulpal exposure, or more commonly; long-standing fractured tooth restorations.

What Are the Clinical Features of Dental Pulp Polyps?

Mechanical irritation and bacterial invasion are the two main reasons that would result in this chronic inflammation in the dental pulp. Because the dental pulp is a vascularised and richly innervated living tissue, the inflammatory tissue response presents itself as a hyperplastic granulation tissue that extrudes from the chamber as a polyp-shaped mass. The color of tooth pulp may vary in this condition from cherry red (granulation tissue) to an opaque whiteness (moist keratinized epithelium covering).

This inflammatory tissue may also fill up any associated dentinal defects. Because it may even be visible to the dentist, unlike other typical dental lesions, the polyp tissue that projects or rises out of the carious shell of the crown gives it a mushroom appearance. This tissue is thus insensitive and firm to touch or stimulus.

The following features would clinically characterize the moderate or large-sized pulpal polyp lesions:

1. Mostly asymptomatic without any severe pain. If the dental pain exists also, the pain subsides within seconds post removal of the trigger or stimulus.

2. These teeth do not exhibit any sensitivity upon clinical percussion, nor are they mobile.

3. The chronic nature of pulp polyp lesions is due to neglected treatment or tooth warranting endodontic treatment but left open and carious for more than six months.

4. The affected teeth may exhibit continuous trauma from the opposite tooth upon occlusion or biting.

How Are the Dental Pulp Polyps Diagnosed?

Visual diagnosis by the dentist and non-responsiveness of the tooth to electrical pulp testing and thermal tests may be clinically diagnostic of these lesions in accordance with the patient's symptoms. When the pulp involvement is extensive in these reactive polyp lesions, they are revealed clearly on intraoral peri-apical radiographs. These may be associated with chronic apical periodontitis lesions as well. Radiographically, chronic hyperplastic pulpitis will be associated with periapical involvement. These are present as radiolucencies or radiopacities on 2D (2-dimensional) or 3D (3-dimensional) oral radiographic imaging.

How Are Dental Pulp Polyps Treated?

Management of the tooth with chronic hyperplastic pulpitis or pulp polyps is indeed clinically challenging. A multidisciplinary approach would be required for managing pulp polyps in children and young adults. This includes,

• Firstly, endodontic management. After this treatment, surgical crown lengthening would be necessary in some cases.

• Prosthodontic management or rehabilitation of the endodontic treated tooth by a prosthesis, i.e., a tooth crown, would be a standard option.

• When only a minimal amount of tooth structure is left, with increased cavitation and a poor prognosis, the dentist recommends tooth extraction as a final option.

Because the extraction of permanent molars would be detrimental to the individual's oral health, such as a transient or permanent impact on their occlusion, on their tooth aesthetics and functionality as well, dentists widely prefer endodontic treatment as the first option in such cases. The treatment part is more challenging when the pulp polyp is formed in a developing tooth with open apex. Recent studies have concluded that in such cases, pulpotomy procedure can be undertaken, which allows the tooth to remain vital.

Conclusion

To conclude, pulp polyps are inflammatory growths that indicate a good immune response. Though they are common in the younger age groups, they are clinically challenging for the dental surgeon. These lesions need timely management in order to save the tooth. Endodontic treatment should not be neglected by the patient, with tooth extraction being the last option that the dentist considers.