Chronic hyperplastic pulpitis, commonly referred to as a pulp polyp, is a non-neoplastic, benign proliferation of pulpal tissue. It is often observed in children and adolescents, attributed to their rich pulpal vascularity and strong immune response.
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✅ Etiology
Pulp polyps arise primarily due to:
➤ Advanced Dental Caries: The most common cause, where prolonged exposure leads to bacterial infiltration and chronic inflammation (Seltzer & Bender, 2002).
➤ Dental Trauma: Fractured teeth or open pulp chambers expose the tissue to irritation.
➤ Open Apex or Immature Roots: In children, an open apex allows for vascular proliferation and granulation tissue growth (Brito et al., 2018).
➤ Poor Oral Hygiene: Facilitates microbial colonization and chronic irritation.
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° Appears as a red or pink soft tissue mass arising from a large carious lesion or a fractured tooth.
° Painless in most cases due to lack of nerve innervation in the granulation tissue.
° No bleeding on manipulation or mild bleeding only.
° Most commonly seen in molars of children and adolescents.
° May interfere with occlusion or become traumatized during chewing.
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Diagnosis is primarily clinical, but may be supported by:
➤ Radiographs: To evaluate the extent of decay and assess root development or periapical pathology.
➤ Pulp Vitality Testing: Usually not necessary, but may help in borderline cases.
➤ Histopathology: Shows fibrovascular granulation tissue with chronic inflammatory cells (Ricucci & Siqueira, 2010).
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° Gingival polyps
° Papillary hyperplasia
° Peripheral giant cell granuloma
° Inflammatory fibrous hyperplasia
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Treatment depends on the tooth’s vitality, restorability, and root development stage:
1. Pulpotomy
Indicated in vital teeth with no periapical pathology. The coronal pulp is removed and the radicular pulp preserved, often using materials like MTA or Biodentine (El Meligy et al., 2019).
2. Pulpectomy
Complete removal of pulp tissue, ideal for non-vital primary teeth. Root canals are filled with resorbable materials like ZOE or iodoform-based pastes.
3. Extraction
Indicated in non-restorable teeth, teeth with excessive root resorption, or when endodontic treatment is contraindicated. Placement of a space maintainer may be necessary.
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With appropriate intervention, the prognosis is excellent. Follow-up is essential to monitor eruption of permanent teeth and prevent space loss.
💬 Discussion
Pulp polyps are often misunderstood as aggressive lesions, but they are a benign response to chronic irritation in young, healthy pulp tissue. Pediatric patients’ immune and reparative capacities allow this type of response, unlike in adults. Early detection through routine exams can prevent complications. Advances in biocompatible materials and minimally invasive dentistry have improved outcomes for pulp therapy in children.
💡 Conclusion
Pulp polyps in children are a clear indicator of neglected dental caries or trauma. Prompt recognition and appropriate treatment—whether pulp therapy or extraction—are critical for preserving oral health and preventing long-term complications in developing dentition.
📚 References
✔ Brito, F. C., de Sousa, C. M., & Maia, L. C. (2018). Pediatric endodontic treatment: A systematic review. International Journal of Paediatric Dentistry, 28(6), 525–539. https://doi.org/10.1111/ipd.12406
✔ El Meligy, O. A., Allazzam, S. M., & Alamoudi, N. M. (2019). Clinical and radiographic success of MTA pulpotomy in primary molars: A 24-month follow-up. European Archives of Paediatric Dentistry, 20(3), 225–230. https://doi.org/10.1007/s40368-019-00414-3
✔ Ricucci, D., & Siqueira, J. F. (2010). Biofilms and apical periodontitis: Study of prevalence and association with clinical and histopathologic findings. Journal of Endodontics, 36(8), 1277–1288. https://doi.org/10.1016/j.joen.2010.04.007
✔ Seltzer, S., & Bender, I. B. (2002). The dental pulp: Biology, pathology, and regenerative therapies. Quintessence Publishing.
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