Small Bump Within the Tooth: An Overview

Introduction

Pulp polyp or chronic hyperplastic pulpitis is a pulpal inflammation due to extensive carious exposure to young pulp or any mechanical irritation. It is characterized by granulation tissue development, covered by epithelium due to long-standing low-grade infection.

What Are the Causes of Small Bumps Within the Tooth?

Some of the most common causes of small bumps within the tooth are listed below:

• Due to slow, progressive carious exposure of the pulp.

• For the pulp polyp formation, there should be a large, open cavity.

• A young, resistant pulp.

• A chronic, low-grade stimulus is necessary.

• Mechanical irritation from chewing and bacterial infection also provides stimulation.

• Loss or fracture of the dental restoration or filling leading to pulpal exposure.

• Fracture of the tooth due to trauma leads to pulpal exposure.

• Due to hormonal influence (estrogen and progesterone-female reproductive hormones).

• Hypersensitivity reaction: Type 1 hypersensitivity reaction is hypothesized due to an increased presence and concentration of the immunoglobulin E (IgE), histamine, and interleukin-4 (IL-4) within the pulp polyps in comparison with healthy pulpal tissues

What Are the Symptoms of Bump Within the Tooth?

Usually, no symptoms are seen, and the patient may feel discomfort during chewing due to pressure caused by the food bolus.

However, some clinical features of small bumps within the tooth are as follows:

• Generally, these can be seen only in children's and young adult's teeth.

• It has a specific characteristic appearance and can be seen as a fleshy, reddish pulpal mass that fills the cavity or extends beyond the tooth surface. The pulpal mass may be so big it may interfere with the comfortable closure of the mouth.

• At the early stage, it appears in the size of a small pin.

• Pulp polyp is less sensitive than normal pulp, but more sensitive than gingival tissue.

• If the pulp polyp is cut no pain is seen, but pressure may get transmitted to the apical end (tip of the tooth’s root) of the pulp and cause pain.

• It will bleed easily due to its rich blood vessels and it can only be stopped by applying pressure.

• It may also appear as though gum tissue is growing into the tooth cavity.

How to Diagnose a Bump Within the Tooth?

• X-ray shows a large, open cavity with direct access to the pulp chamber.

• It responds poorly or not at all to the thermal test.

• It may respond to extreme cold as from ethyl chloride spray.

• More current is used by the electric pulp tester to elicit a response than that of the normal tooth.

What Is the Histopathology of Bump Within the Tooth?

The stratified squamous epithelium covers the surface of the pulp polyp. The pulp polyp in the deciduous teeth has a higher chance of having stratified squamous epithelium on its surface than the pulp polyp in the permanent tooth. Such epithelium is derived from the gingiva (gums) or the freshly desquamated epithelial cells of the mucosa or tongue. The tissue within the pulp chambers often gets transformed into granulation tissue, projecting into the carious lesion from the pulp. The granulation tissue is a young, vascular connective tissue that contains polymorphonuclear neutrophils, lymphocytes, and plasma cells. The pulp tissue is chronically inflamed. Nerve fibers are also found in the epithelial layer.

How to Differentiate Gingival Tissue From Pulp Tissue?

The pulp polyp can be diagnosed easily in the clinical examination as it has a characteristic appearance. The pulp tissue may extend beyond the tooth cavity and give the appearance of the gum tissue. To differentiate the pulp polyp from the gingival tissue, one should raise it and trace the stalk of the tissue to its origin in the cavity. Also, the gingival tissue is less sensitive than the pulpal tissue.

What Is the Treatment for a Small Bump Within the Tooth?

• The main objective of the treatment should be towards the elimination of the polypoid tissue followed by extirpation of the pulp (removal of the pulp), done only if the tooth is restorable.

• The hyperplastic pulpal mass has to be removed with a periodontal curette or spoon excavator.

• After removal bleeding is seen due to its rich vascular supply, it can be controlled with pressure.

• The pulp tissue of the chamber is then removed completely.

• A temporary dressing is placed in contact with the radicular pulp tissue (root pulp).

• The radicular pulp is removed at a later visit.

• If there is enough time the entire pulpectomy (removal of both coronal and radicular pulp) procedure is done in a single visit.

• After the root canal treatment, a prosthetic crown is given.

• The type of endodontic treatment depends on the stages of tooth development or whether it is a permanent or primary tooth.

• Depending on the root development either only pulpotomy- removal of the coronal pulp on incomplete root development or pulpectomy - removal of both coronal and radicular pulp is performed.

• When the tooth is not restorable with a large carious cavity and little sound tooth tissue extraction is preferred.

• A combination of other treatments is used to save a restorable tooth. They are:

  • Root surface debridement.

  • Endodontic therapy.

  • Crown lengthening procedure.

  • Fixed prosthodontics treatment.

What Is the Prognosis of the Small Bump Within the Tooth?

If left untreated, the prognosis for the pulp is unfavorable. Thus long-standing, nonvital teeth may lead to symptomatic diseases, such as:

• Periapical inflammatory disease (range of conditions affecting the tissues surrounding the apex of a tooth's root).

• Cellulitis (common, potentially serious bacterial skin infection) (rare).

• Osteomyelitis of the jaw (infection of the jawbone).

If there is crown destruction due to caries or premature loss of teeth it causes space discrepancies. Such space discrepancies especially during the transitional stages from the primary to permanent tooth eruption period lead to, crowded malocclusion, supereruption of the opposing tooth, mesial inclination (movement of the tooth towards the midline) of the tooth toward the space produced due to crown destruction, and the impaction of the succedaneous tooth. It becomes favorable after the endodontic treatment and prosthetic rehabilitation.

What Patient Education Is Done for Bumps Within the Tooth?

• The patient is recommended to perform the oral hygiene practices below to prevent the development of deep carious lesions that may cause pulpal inflammatory disease and further serious complications.

• Brush twice regularly for two minutes.

• Replace the toothbrush once every three months.

• The modified bass technique is recommended for effective cleaning of both teeth and gingival area.

• Fluoridated toothpaste is recommended to prevent caries.

• Use dental floss to clean between the teeth.

• Water flossers are easier to use than dental floss.

• Use a tongue scraper to clean the tongue and prevent any bad breath.

• The patient is advised to avoid frequent intake of sweets or sticky foods.

• Avoid food or snack intake in between meals.

• Avoid intake of sweet drinks like tea, and coffee, frequently.

• The patient is recommended to get scaling (cleaning) of the teeth every six months.

• Thus, the dentist can check whether the patient has developed any new cavities, as it can be managed in its earliest stage.

Conclusion

When a painless tissue growth is seen within a carious tooth, it should be treated early to its restorable form and prevent the further progress of dental caries. Management of pulp polyps typically involves addressing the causative factors, such as restoring or extracting the affected tooth, to prevent further complications. Understanding the etiology, clinical presentation, and treatment options for pulp polyps is crucial for dental practitioners in providing effective and timely care, thereby preserving oral health and preventing potential progression to more severe conditions. Regular dental check-ups and prompt treatment of carious lesions can significantly reduce the incidence of pulp polyps and enhance overall dental health.