Authors: Seltzer S, Bender IB, Ziontz M.
Title: The Interrelationship of Pulp and Periodontal Disease.
Journal: Oral Surg Oral Med Oral Pathol
Date: Dec 1963
Citation: 16:1474-90
Category: Endodontic-Periodontal Relationships
Evidence-based Ranking: 4
Purpose/Objective: To make a more accurate assessment of the status of pulps from teeth with periodontal lesions.

Materials and methods: 85 teeth that have evidence of periodontal disease such as deep pockets, interradicular bone resorptions, lateral root resorptions and mobility were evaluated. Prior to extraction, subjective symptoms were recorded. The presence of periodontal involvement was confirmed by histologic examination of the periodontal membranes attached to the teeth following extraction.

Results and discussion: 1) When the nutrition of the pulp was interfered with involvement of foramina from lateral canals by periodontal disease, small regions of necrosis or infarction occurred within the pulp, causing pulp-tissue breakdown, fatty degeneration and calcification. 2) Periodontal lesions can cause the pulp to atrophy as periodontal lesions produce a degenerative effect on the dental pulp by means of dystrophic calcifications discovered throughout the pulp tissue that often almost obliterate the coronal portions of the pulp and reparative dentin deposition along the dentinal walls. 3) Teeth subjected to a combination of pulp and periodontal irritants had a greater incidence of inflammatory reaction than those subjected to operative procedures alone. 4) Resorptions of the sides of the roots were frequently found subjacent to the granulation tissue overlying the roots. 5) Extensive pulp lesions cause periodontal changes through lateral and accessory foramina and also through the crestal extension of the granulomatous lesions. In those instances, periodontal treatment alone could not be effective in eliminating the lesion. Only effective endodontic treatment could result in eradication.

Conclusions: Periodontal lesions produced a degenerative effect on the pulps of the involved teeth. Pulps subjected to a combination of pulpal and periodontal irritants showed a greater incidence of inflammatory reactions than those subjected to operative procedures alone. Pulp lesions were found to have an effect on the severity of the periodontal lesion. Thus, retention of these teeth could be accomplished only through combined endodontic and periodontal therapy.

ReviewerÂ’s comments: The authors believe unequivocably that pulpal lesions have an effect on the severity of periodontal lesions AND periodontal lesions produced a degenerative effect on the pulp. Some of the samples used had fractures and caries; this may have somehow skewed the results.