Methods of diagnosing and treating diseases of the dental pulp and the periradicular tissues (around the root)

Background
Endodontics is the field of dentistry dealing with the study, treatment and prevention of diseases of the dental pulp, and pathological processes originating in pulpal tissue. The pulp may be damaged in various ways. Among the common causes are deep caries, cracks, dental fillings and trauma to the teeth. The first stage is inflammation of the pulp, which is sometimes very painful and can cause severe toothache. However, the inflammation is  also frequently quite symptomless. A characteristic of pulpitis (pulpal inflammation) is that it can rapidly involve the entire pulp, leading to death of the tissue and so-called pulpal necrosis. The necrotic tissue is susceptible to infection and eventually oral bacteria invade the partially empty pulp cavity and grow on the pulp tissue remnants. The bacteria and their metabolites then seep out from the pulp cavity into surrounding tissues and cause inflammation of the tooth's attachment apparatus. This spread of infection usually occurs at the root apex, and the condition is then referred to as an apical granuloma. The tooth may become sore and give rise to pain and aching, and there may be some swelling of the jaw due to suppuration (pus formation). Such processes are generally quite localized, but on occasion particularly aggressive infections can arise, and spread to other organs, and even lead to life-threatening conditions.

Objectives
To describe the state of research in the area. To evaluate methods of assessing pulpal status  associated with various types of tooth damage. Are there effective, conservative  methods of treating reversible pulpal damage associated with deep caries lesions, tooth cracks, or pulpal exposure due to trauma or other causes? Are there effective methods of treating the irreversibly damaged pulp? Are there effective measures of restoring an endodontically treated tooth for long-term survival? What follow-up time is required? Is there a risk of disease in other organs in connection with acute or chronic pathological processes emanating from the pulp? What are the side effects and risks? Are the methods cost-effective? The SBU report will serve as background data for Sweden's national dental care guidelines.