Overview
Chronic pulpitis represents a persistent, low-grade inflammatory state of the dental pulp, often evolving from incompletely resolved acute inflammation or developing insidiously from slowly advancing caries with gradual bacterial antigen exposure. Unlike acute pulpitis, it is frequently asymptomatic or minimally symptomatic, making it a diagnostic challenge that often goes undetected until significant pulp damage has occurred.
The chronically inflamed pulp mounts an ongoing but insufficient immune response, characterized by lymphocytes, plasma cells, and macrophage infiltration rather than the neutrophil predominance of acute disease. Fibrous tissue replaces inflamed pulp areas, calcifications may develop, and tertiary (reparative) dentin is deposited as a defensive reaction.
Chronic pulpitis is classified as open (communicating with the oral environment through a carious exposure) or closed (no exposure, bacteria enter via tubules or lateral canals). Hyperplastic pulpitis (pulp polyp) represents an exuberant proliferative response in open chronic pulpitis in young patients with rich vascular supply.