Pathogenesis and Characteristics - Pulp polyps develop as an overgrowth of pulpal tissue resulting in a hyperplastic mass. - Factors contributing to the development of pulp polyps include a persistent balance between the irritant and tissue resistance, continuous low-grade inflammation, well vascularised pulpal tissue with good tissue reactivity, an open carious cavity, and young patients with a good immune system. - Wide apical foramen of the affected tooth prevents pulpal strangulation and necrosis in response to inflammation. - Pulp polyps are characterised by the overgrowth of pulp tissue outside the boundary of a tooth's pulp chamber. - They can be found in open carious lesions, fractured teeth, or cavities with missing dental restorations. - Lack of intrapulpal pressure in an open lesion prevents pulp necrosis. - Pulp polyps require a good vascular supply and immune resistance for development, commonly seen in molar teeth of children and young adults. - Clinically, pulp polyps present as small, pink-red, lobulated masses protruding from the pulp chamber and filling or encompassing the open cavity.

Management - Management options for teeth with pulp polyps depend on the amount of sound tooth tissue remaining. - Extraction is usually the only option for teeth with a large carious cavity and little sound tooth tissue. - Restorable teeth can be treated with root surface debridement, endodontic therapy, crown lengthening, and/or fixed prosthodontics measures. - Endodontic therapy options include pulpotomy or root canal treatment, depending on factors such as tooth proximity to root completion, extent of pulpal involvement, and whether it is a primary or permanent tooth.

References - Anilkumar K, Lingeswaran S, Ari G, Thyagarajan R, Logaranjani A (January 2016). Management of Chronic Hyperplastic Pulpitis in Mandibular Molars of Middle Aged Adults- A Multidisciplinary Approach. - Suresh K, Bajaj N, Nayak A, Chapi D, Patil S, Rani A (January 2015). Pulp polyp-A periapical lesion: Radiographic observational study. - Purkait SK (2011). Essentials of oral pathology. - Chandra S, Chandra S, Chandra G, Kamala R (2007). Oral medicine. - Ingle JI, Bakland LK (2002). Endodontics.

Additional Information - Pulp polyps occur either as chronic lesions from the onset or as a chronic stage of acute pulpitis. - Majority of pulp polyps are symptomless, but discomfort may occur during mastication. - Pulp polyps may change appearance to an ulcerated, dark red mass if involved in mastication. - Pulp polyps usually show no radiographic apical lesions, but chronic apical periodontitis may develop in long-standing or extensively involved polyps. - Differentiating from a polyp of gingival origin can be done by lifting the pulp polyp from the walls of the cavity, revealing the presence of the pedicle.