Pulp Polyp

The pulp polyp, also known as chronic hyperplastic pulpitis or proliferative pulpitis, is an uncommon and specific type of inflammatory hyperplasia that is associated with a nonvital tooth.

Pulpal diseases are broadly divided into reversible and irreversible pulpitis and are based on the ability of the inflamed dental pulp to return to a healthy state once the noxious stimulus has been removed. In the case of the pulp polyp, the disease process is irreversible. In contrast to most cases of irreversible pulpitis, the pulp polyp is usually an incidental finding that occasionally mimics reactive and neoplastic diseases of the gingiva and adjacent periodontium.

Medical Care

• Treatment of a pulp polyp in a permanent tooth includes either root canal therapy or extraction of the tooth.
• The more conservative pulpotomy treatment has been successful in selected cases when only the coronal pulp is affected.
• In immature teeth with incomplete root development, placement of an apical barrier and strengthening of the thin root with composite resin may be indicated prior to root canal treatment.
• Pulp revascularization of an immature permanent tooth is another new treatment approach that results in the formation of vital pulpal tissue.
• The tooth requires a full-coverage crown following endodontic therapy.
• Prior to extensive restorative treatment, the risks and benefits of this treatment, including the long-term prognosis of the affected tooth in a young child, needs to be thoroughly explained.

Surgical Care

• The affected tooth is extracted when primary teeth are involved or when minimal tooth structure in permanent teeth is available for restoration or the alveolar bone support is unfavorable.
• A surgical crown lengthening procedure may be needed to prepare a tooth for a full-coverage crown.
• Healing is uneventful in most cases.

Medication Summary

Systemic medications are not recommended for the management of this lesion. Antibiotics are not prescribed for the treatment of the pulp polyp, despite a bacterial component. However, an antibiotic paste mixture is used within the canals of the infected tooth when the revascularization process is performed for the treatment of the nonvital tooth.

Further Outpatient Care

• Periodic dental examinations are recommended to monitor the success of the root canal therapy or to intercept problems associated with the premature loss of a tooth.
• Orthodontic treatment may be needed to restore the occlusion.
• If a tooth is extracted, either a dental implant or fixed dental prosthesis (bridge) is a treatment option to restore function and aesthetics.

Complications

• Space discrepancy from crown destruction or premature loss of a tooth may result in a crowded malocclusion, supereruption of an opposing tooth, or the impaction of a succedaneous tooth.
• Without definitive treatment, some of these long-standing, nonvital teeth may progress to symptomatic disease, including periapical inflammatory disease and (rarely) cellulitis and osteomyelitis of the jaws.

Prognosis

• The prognosis is excellent. No risk for recurrence exists once definitive treatment has been rendered.

Patient Education

• Reinforce the importance of routine oral health care to prevent the development of deep carious lesions that may cause inflammatory pulpal disease and more serious sequelae.