EVALUATION OF HISTOPATHOLOGIC CHANGES OF DENTAL PULP IN ADVANCED PERIODONTAL DISEASES

The adverse effects of periodontal disease on dental pulp have been debated for many years. This case-control study was performed to assess the possible effects of advanced periodontal disease on the structure of dental pulp. Fifty-two permanent teeth extracted because of advanced periodontitis with ≥ 5 mm attachment loss and grade III mobility were compared to 52 control teeth, obtained from systemically healthy adults. Two groups were matched for age and teeth types. Inflammation, fibrosis, calcification and necrosis were observed in the 27.8- 40%, 0-59.4%, 0-26.4% and 0-20.9% of the different sections of the study group, and 0%, 9.7-50%, 0-11.6% and 0% of the control group (P < 0.05). Abnormal pulp tissue was observed in the 33.3-88.1% and 12.9-50.5% of different sections of the study and control groups respectively (P < 0.05). Complete necrosis of dental pulp occurred only when depth of adjacent periodontal pocket reached the apical third of the root. There was an increase in frequency of pathologic changes as the depth of periodontal pocket increased (P = 0.00). We conclude that advanced periodontal disease can affect the dental pulp, although not necessarily leading to complete pulp disintegration. Careful consideration of diagnostic and treatment planning in patients with endodontic-periodontal involvement is recommended. Fibrosis and diffuse calcification of dental pulp in teeth with advanced periodontal involvement may endanger root canal therapy, if needed.