Authors: Bender IB, Seltzer S.
Title: The effect of periodontal disease on the pulp.
Journal: Oral Surg Oral Med Oral Pathol
Date: Mar 1972
Citation: 33(3):458-74
Category: Endodontic-Periodontal Relationships
Evidence-based Ranking: 5
Purpose/Objectives: To describe the relationship of pulpal disease on the periodontal structure and the relationship of periodontal disease on the pulpal tissue. Also, to describe a new syndrome which is called the pulpodontic-periodontic syndrome and suggest treatment sequences for it.

Materials & Methods: Histologic observations were made on dog teeth, monkey teeth and 178 human teeth. The observations included the presence and size of lateral canals, the inflammatory state of pulpal and periodontal tissues and the relationship they had to each other.

Results: The effect of pulpal disease on periodontal tissues: It was conclusively observed that teeth with chronic inflammation in the root canal space also had areas of chronic inflammation in the periodontal space adjacent to lateral canals. The effect of periodontal disease on the pulp: It was shown with statistical significance that caries and/or restorative procedures can affect the pulps of periodontally involved teeth, and, conversely periodontal disease can affect pulps of teeth with caries and/or restorations. Pulpal – Periodontal syndrome: A syndrome involving inflammation or degeneration of the pulp with a clinical pocket of the same tooth. This can be initiated by either pulpal or periodontal disease. Sequence of treatment: Pain – Presence of acute pain is usually a symptom of endodontic origin. Swelling – Pulpal involvement swelling is usually observed in the mucobuccal fold while periodontal swelling involves the alveolar or palatal mucosa. Pulp testing – Indications of a normal, vital pulp point to periodontal involvement. Clinical pulp status – Lack of caries or large restorations point to periodontal disease. Sinus tracts – Usually of endodontic origin but can be verified by tracing. Radiographic findings – A periapical lesion that does not communicate with the periodontal pocket is of endodontic origin.

Author’s Conclusion: The pulpal and periodontal tissues do indeed effect one another and can lead to a combined lesion known as the pulpodontic – periodontic syndrome.

Validity of Conclusion: Conclusions seem valid due to the high colorations observed in the histologic sections

Reviewer’s Comments: Very good study.