Aging’s Effects on the Pulpal Chamber

Amy Dukoff, D.M.D.
Aging’s Effects on the Pulpal Chamber

Amy Dukoff

S OUR PATIENT population ages, the dental pulp’s morphology may change. Age-related changes affect the pulpal chamber and the canal. Noticing age-related changes, such as the narrowing of the pulpal space, is important during treatment.
    The calcifying process reduces the size of the pulpal chamber and narrows the canal. If total obliteration of pulpal tissue ensues, it hinders the practitioner’s treatment of the symptomatic tooth while providing patient care. Many times, the patient is asymptomatic while the chamber and canal are calcifying. Also, the practitioner may be unaware that the tooth is undergoing age-related changes that would result in a necrotic tooth with a periapical rarefaction in the future. Calcifying pulpal chambers signal that age-related pulpal changes are taking place in the dental pulp tissue.
    The narrowing of the pulpal chamber and canal space creates a clinical challenge for the practitioner. Locating the orifice of the canal space becomes difficult. Pulp stones block the access to the root canal space and the orifices may become recessed. Furthermore, removing all dystrophic calcifications and pulp stones from the pulp chamber is a tedious process. Yet, removing all of the calcifications from within the chamber is a prerequisite to removing all pulp tissue. Moreover, negotiating a “tight” canal can be a perilous procedure. Care must be taken to prevent instrument separation, the creation of false canals, and perforation.
    Aging in the pulp chamber can make diagnosis of patient’s vague symptoms difficult. Many times a patient reports non-specific pain in a general area, but can’t identify the offending tooth with certainty. When a patient reports inconsistent pain, which is unpredictable in onset, the practitioner should suspect a degenerating pulp that hasn’t presented with a radiographic rarefaction. Furthermore, at the office visit the patient’s offending tooth may be free of caries, rarefaction, and reproducible symptoms. The patient becomes frustrated from the lack of definitive action taken by the dentist to alleviate the fleeting pain. Narrowing of the pulpal chamber and canal should be a ‘red flag’ to the practitioner that a pulpal problem exists.
    The dental pulp is a complex tissue that responds to our body’s biological clock. The age-related pulpal changes need close examination during diagnosis, treatment planning, and debridement. Narrowing of the pulpal space is a characteristic found in the growing aging population.

October - December 2009

Noticing age-related changes is important during treatment.

Remember to make sure to get a reliable, accurate, and repeatable reference point when taking your measurement control. Sometimes it may be necessary to flatten a cusp tip rather then use the cusp slope when measuring. You can use an indelible marker to make a small mark on a crown surface to give yourself further accuracy and repeatability during the visit. Also remember to re-measure as you instrument because canal straightening ultimately can shorten your measurement control by .5 mm to as much as 1 mm.

Doug Kase

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