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Understanding about the classification of pulp inflammation

Trijoedani	Widodo
Department of Conservative Dentistry
Faculty of Dentistry Airlangga University
Surabaya - Indonesia

abstract

Since most authors use the reversible pulpitis and irreversible pulpitis classification, however, many dentists still do not 
implement these new classifications. Research was made using a descriptive method by proposing questionnaire to dentists 
from various dental clinics. The numbers of the dentists participating in this research are 22 dentists. All respondents use 
the diagnosis sheet during their examinations on patients. Nonetheless, it can't be known what diagnosis card used and 
most of the dentists are still using the old classification. Concerning responses given towards the new classification: a) 
the new classification had been heard, however, it was not clear (36.3%); b) the new classification has never been heard 
at all (63.6%). Then, responses concerning whether a new development is important to be followed-up or not: a) there 
are those who think that information concerning new development is very important (27.2%); b) those who feel that it is 
important to have new information (68.3%); c) those who think that new information is not important (8%). It concluded 
that information concerning the development of classification of pulp inflammation did not reach the dentists.

Key	words:	Classification, Reversible pulpitis, Irreversible pulpitis 

Correspondence: Trojoedani Widodo, c/o: Bagian Konservasi Gigi, Fakultas Kedokteran Gigi Universitas Airlangga. Jln. Mayjend. 
Prof. Dr. Moestopo 47 Surabaya 60132, Indonesia.

introduction

The classification of a type of diseases is really needed 
to decide the treatment indication easily. The classification 
is also important for pulp disease, nonetheless, the exactly 
classification of pulp inflammation or pulpitis has never 
been found.1 It is mentioned that a challenge faced by 
dentists in classifying right on pulp diseases is due to the 
other symptoms often accompanying especially during the 
transitional period of the pulp diseases. In dentists’ office 
or in the dental clinics, the dentist use various classification 
of pulp inflammation and indication of treatment.

Previously some classifications have already been 
made, those were classifications made by Bence 2 and Knap3 

at 1976 , Grossman4 at 1981, and Shafer et al.5 at 1983. 
Smulson6 at 1984 stated that it is very important to assume 
the inflammation level happened in order to classify the 
pulp inflammation. We should distinguish the pulp tissues 
condition that could be kept under pulp capping treatment 
and the pulp tissues that need pulpectomy because it could 
not be maintained anymore. He classified the pulpitis into 
reversible pulpitis and irreversible pulpitis. Reversible 
pulpitis is mild to medium pulp inflammation caused by 
stimulation and the defense system of the pulp tissue is 
still able to recover. While irreversible pulpitis is severe 
pulp inflammation caused by a type of stimulation and the 
defense system of the pulp tissue cannot overcome it longer, 
and this cannot be recovered or healed. Other authors 
followed up this classification later on, for examples: 

Grossman et al. 7 at 1988; Wiene8 at 1989; Simon et al.9 

at 1994; Walton and Torabinejad10 at 1996; Mount and 
Hume11 at 1998, Beer et al.12 at 2000, Stock et al.13 and Pitt 
Ford14 at 2004. Widodo15 at 1997 in her research classified 
the pulpitis into reversible pulpitis and irreversible pulpitis 
to express the immunopathological change happened in the 
pulp inflammation using immunopatological concept and 
morfofunctional on inflammation of pulp tissues. 

Most authors using the reversible pulpitis and 
irreversible pulpitis classification, however, many dentists 
still do not implement these new classifications. Based 
on this phenomena, there is a problem about is there a 
difference to determine the diagnosis of pulp inflammation 
and why the new classification is not been adopted by 
dentists in clinics.

Therefore, a research was made using a descriptive 
research method,16 by proposing questionnaires to dentists 
from various dental clinics covering: dental clinics in 
government hospitals, dental clinics in private hospitals, 
dental clinics in government hospitals in public health 
centers, and laboratory clinics in the area of Faculty of 
Dentistry Airlangga University. Then an analysis was made 
on the collected questionnaires, to know whether there was 
any change in the diagnostic techniques implemented to 
find the pulpitis classification, and some responses over the 
new classification. It is through this practice that the cause 
of not using the new classification method is found and how 
the effort should be made to get the same understanding 
about the pulpitis classification. 



�7Widodo: Understanding about the classification of pulp

material and method

The purpose of this research is to find an explanation 
concerning an objective situation, how the dentists-in-
clinics diagnosed in determining the classification of a 
disease and its treatment plan implemented. The data is 
collected from the dentists, and the method used in this 
research is descriptive research method.16

The	population of this research were the dentists. Some 
of the samples were the dentists at Surabaya, working at 
the dental clinics in private hospitals, government hospitals, 
dental clinics in government hospitals in public health 
centers, and laboratory clinics in the area of Faculty of 
Dentistry Airlangga University. While the analysis unit is 
the answer given through the questionaires. 

The questionnaires sheet is used as a supporting 
instrument for data collection. The questionnaires were 
distributed among the 22 dentists, consist of two dentists 
from two dental laboratories in the area of Faculty of 
Dentistry, Airlangga University, two dentists from the 
public health center at Surabaya, some dentists of the 
private hospital at Surabaya, and some dentists who are 
participating a training in the Hospital of Dr. Soetomo, 
Surabaya. The questionnaires sheets were presented by 
giving some explanations that it will not go far beyond the 
expectation of the researchers. 

A descriptive analysis was made upon the collected 
data. The diagnosis performed to understanding concerning 
classification of pulp inflammation, their knowledge about 
the development of new classification; reversible pulpitis 
and irreversible pulpitis. Moreover, it was also observed 
their responses towards the current development of dental 
sciences especially dental conservation.

result 

The number of the dentists participating in this research 
is 22. They consisted of two dentists from dental laboratory 
in the area of Faculty of Dentistry, Airlangga University, 
two dentists from the public health center at Surabaya, five 

dentists of the private hospital at Surabaya, two dentists 
from Navy Department i.e., from the dental laboratory of 
Navy (LADOKGI YOS SUDARSO) in Ujung Pandang, 
dentist of the dental clinic of the Hospital of Tk.III Kasdam 
V Brawijaya Surabaya, and ten dentists coming from 
various hospitals participating a training in Dr. Sutomo 
Hospital. The result of the questionnaire can be seen as 
shown in Table 1.

The questionnaire proposed to the dentists is 
accompanied by giving some explanations about how 
to fill the forms. All respondents use the diagnosis sheet 
during their examinations on patients as seen in Table 1. 
Nonetheless, it cannot be known the diagnosis card that 
the dentists used and most of the dentists were used old 
classification. Concerning responses given towards the 
new classification: a) the new classification has ever been 
heard, but not clearly, responded by eight (8) dentists 
(36.3%); b) the new classification has never been heard 
at all, responded by fourteen (14) dentists (63.6%). The 
response of the dentists about whether a new development 
is important to be followed-up or not: a) the information 
about new development is very important, was responded 
by six dentists (27.2%); b) those who feel that it is important 
to have new information was responsed by fifteen dentists 
(68.3%); c) those who think that new information is not 
important was responded only by one person (8%).

discussion

The purpose of this research is to examine the 
understanding of classification of pulp inflammation among 
the dentists. The data obtained through the questionnaires 
and this research was the descriptive research. The dentists 
involved in the research were the dentists who live in 
Surabaya, both as permanent residents or as graduate 
students who are studying in Surabaya. It is expected that 
the information collected was more widespread and varies. 
Each institution has their own standards, demands, or 
regulations to determine the diagnosis of a disease related 
to the classification of the disease. The classification is 

Table	1.	 The result of questionnaire from 22 dentists about diagnostic techniques, classification reversible pulpitis and irreversible 
pulpitis 

Diagnostic 
Techniques

Using 
Classification

Given toward 
new Classification

Need new 
information

Using the Diagnostic Card 22 (100%)
Not Using the Diagnostic Card 0
Using old classification 22 (100%)
Using new classificatin 0
Has already known 0
Has ever heard but not very clear 8 (36.3% )
Has never heard at all 14 (63.3% )
Very Important 6 (27.2%)
Important 15 (68.3%)
Not important 1 (8%)



�� Dent. J. (Maj. Ked. Gigi), Vol. 40. No. 1 January-March 2007: 46–48

important as the basic steps to determine any indication 
of treatment.

The dentists from two laboratories (Oral Surgery and 
Pedodontic) of Faculty of Dentistry, Airlangga University 
are chosen. In Oral Surgery laboratory, diagnosis of all the 
teeth are performed although extraction is the first priority, 
moreover, for the Pedodontic Laboratory, they perform 
diagnosis all of the teeth in detail. Some data were also 
collected from the dentists from the Private Hospital at 
Surabaya and the district hospital from various places, who 
are training in the Hospital of Dr. Soetomo. By doing this, 
a better understanding can be obtained. The purposes of the 
research are to observe whether classification of pulpitis is 
well understood, to know whether there is any difference in 
the diagnostic techniques, and determine the factor causing 
the new classification of pulpitis is not implemented yet.

Concerning the diagnostic techniques implemented in 
the pulpitis, the dentists have already used the diagnostic 
card. However, this action does not guarantee that a good 
understanding concerning the pulpitis is alike. Therefore, 
it is important to socialize the diagnostic techniques 
and the use of right diagnostic sheet. The basics of right 
choise of diagnosis implemented in local clinics given 
during studying seriously affect the understanding of the 
dentists concerning the classification of the pulpitis. It 
can be concluded that, it is very important for the dentists 
continuously follow the new development or techniques in 
the science of dental clinics.

The classification of pulpitis has already developed 
year to year, moreover in the understanding of hyperemia. 
According to the old concept hyperemia was not a disease 
but a coincidence before inflammation.2,3,4 Hyperemia 
is signed by the vasodilatation of the blood cells, it is a 
preliminary phase of an inflammation process that Shafer 
et al.5 at 1983 started to change hyperemia term into focal 
reversible pulpitis, then it was emphasized by Smulson6 
at 1984 using new term the reversible pulpitis. Reversible 
pulpitis as a mild to medium inflammation caused by a 
stimulation and the defense system of the pulp tissue is still 
able to overcome it that it can also be recovered. While the 
irreversible pulpitis is a severe inflammation which can't 
overcome it, so, it can't be recovered.6,7

The classification of the pulpitis turned to the reversible 
pulpitis and the irreversible pulpitis finally followed up by 
the other authors like: Grossman et al.7 at 1988, Weine8 at 
1989; Simon et al.9 at 1994; Walton and Torabinejad 10 at 
1996; Mount and Hume 11 at 1998, Beer et al.12 at 2000, 
Stock et al.13 and Pitt Ford at 2004. Although this new 
classification started to be used in conservative dentistry 
textbooks since 1984, most of the dentists still use the old 
classification, especially the use of hyperemia pulpae. 

Actually, the good understanding concerning the hyperemia 
pulpae was not applicable and it is important to correct it 
by using the right term, the reversible pulpitis as it means 
that it can be cured for the defense system of the pulp tissue 
is still able to overcome it. It was said that focal reversible 
pulpitis is a science term for hyperemia pulpae.17

It concluded that information concerning the 
development of classification of pulp inflammation did 
not reach the dentists. However, some of them, especially 
the dentists who work in town or suburb, try to get a new 
information about conservative dentistry through seminars. 
There is only one dentist who expressed that knowing new 
development of pulpitis diagnosis is not important, the 
reason is that he has a lot of patients in his clinic and most 
of the patient prefer to pull the tooth out.

references

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15. Widodo T. Analisis perubahan imunopatologik pada pulpitis 
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