Histopathological Assessement of Dental Pulp Condition in Patients With Periodontitis and Pathological Tooth Mobility: A Pilot Study

Introduction Periodontitis is frequently associated with pathological tooth mobility (1). Conventionally, teeth exhibiting severe periodontal pathology and increased mobility were regarded as having poor prognosis. However, several studies (2-5) have demonstrated that root canal treatment of asymptomatic teeth with periodontal disease can potentially reduce tooth mobility. This finding implies that, despite the absence of clinical symptoms, there may still be pathological changes occuring within the pulp of mobile teeth, which could influence the overall prognosis of dental treatment. Aim To assess the histopathological alterations in dental pulp of patients with periodontitis exhibiting increased pathological tooth mobility. Methods Patients from the KK Department of Dental and Oral Pathology with periodontal pathology and intact teeth scheduled for extraction were clinically examined. All patients were diagnosed with stage III periodontitis (6), and mobility grade was assessed using Miller's classification (7). Intact third molars served as a control group. Following extraction, longitudinal incisions were made and the tooth was split along the axis. The pulp was separated from the hard tissues and underwent histological preparation protocol (8). The samples were stained with hematoxylineosin and analyzed with the assistance of experienced histopathologist using a light microscope. The examination focused on the presence of alterations such as inflammatory infiltrate, calcifications, fibrosis, edema, necrosis, and loss of blood vessels integrity along the coronal, middle, and apical thirds of the pulp, which were evaluated qualitatively. Results Out of the 11 specimens processed, only 6 pulps were acceptable for detailed histological analysis. All examined teeth demonstrated alterations in the dental pulp to varying degrees, with a tendency for these to be more pronounced in teeth exhibiting mobility grade III. The most prevalent pathological findings in the pulp of the teeth with mobility grades I and II included changes in the integrity of blood vessels and the presence of fibrosis; however none of these pulps exhibited edema. Calcification was observed solely in the coronal third of the pulp of the tooth categorized with mobility grade I. Infiltration of inflammatory cells were displayed in the apical thirds of two teeth with mobility grades II and III. Notably, two teeth with grade III mobility exhibited necrotic pulp in the coronal and middle thirds of the root, whereas no necrosis was observed in teeth with lower mobility grades. Conclusions This pilot study indicated a tendency for more pronounced alterations in the dental pulp of teeth exhibiting grade III mobility compared to those with lower mobility grades in patients diagnosed with periodontitis. Based on this finding, pathological tooth mobility may potentially serve as a clinical indicator of pulp status in individuals with periodontal disease.