Authors: Rubach WC, Mitchell DF.
Title: Periodontal Disease, Age, and Pulp Status.
Journal: Oral Surg Oral Med Oral Pathol
Date: Apr 1965
Citation: 19:482-93
Category: Endodontic-Periodontal Relationships
Evidence-based Ranking: 4
Purpose/Objectives: To clarify conflicting findings and opinions concerning earlier reports on periodontal disease and its effect on the pulp.

Materials and Methods: 20 patients, ages 23-67 were used for a total of 127 teeth with various degrees of periodontal disease. Electric vitality tests were done on each tooth along with controls. Caries, attrition, restorations, and periodontal findings were also noted. 74 of the 127 teeth were immediately fixed with formalin after extraction. Microscopic examination was done along with recording the tooth, age, EPT, amount of fibrosis, presence of pulp stones and calcifications, amounts of secondary dentin, inflammation, vacuolization, condition of vessels, and miscellaneous information.

Results: Calcification- Calcifications were seen in 82 percent of the specimens. There was no consistent difference in the amount of diffuse calcifications and pulp stones in the moderate-severe group and the normal group. In 9 of 11 cases with pulp exposure to periodontal contamination via auxillary canals, an increase was apparent. Age was not a consistent factor. Fibrosis- it was very difficult to judge, but it appeared that age and periodontal disease were not factors. EPT- calcifications and fibrosis did not seem to influence, and the amount of periodontal disease also did not affect the recordings. The amount of secondary dentin did result in higher responses. Artifact- is a huge factor in evaluating pulp microscopically. Most occur from the preparation process. Vacuoles that are mistaken as signs of abscesses and atrophy might actually be tearing by the microtome. Odontoblasts cut in cross section often appear as inflammatory cells.

AuthorÂ’s Conclusions: 1. Diffuse calcifications occured in 82%. 2. Denticles were not correlated with periodontal disease, except if pulpitis was due to exposure of periodontitis through auxillary canals. 3. Calcifications were not associated with highe EPT, but large amounts of coronal secondary dentin were. 4. EPT did not vary with age or bone loss. 5. Variation was not great with EPT, however teeth with more thickness, suvh as molars. 6. Artifacts due to preparations have been misinterpeted, and there is little support for metamorphosis, fibrosis, vacuolization, and venous/passive/active/generalized hyperemia.

ReviewerÂ’s Comments: Considering the time frame, a good study which critically looked at possible misinterpreations of microscopic investigations. In regards to their work, negative controls with no evidence of periodontal disease should of been used for comparision.