Radiographic assessment of the prevalence of pulp stones in Malaysians

Radiographic evaluation of teeth with pulp stones and pulp canal obliteration: characteristics, and associations with dental parameters

The study aimed to radiographically assess the characteristics of pulp stones (PS) and pulp canal obliteration (PCO) in teeth and examined their associations with various dental parameters such as caries, restorations, periodontal status, and age. This cross-sectional observational study was conducted at the Faculty of Dentistry, King Abdulaziz University between September 2022, and May 2023, involved 101 patients exhibiting 402 teeth with PS or PCO. Data were collected from periapical and bitewing radiographs, and analyzed by two calibrated dentists. Multiple dental parameters were assessed, including caries level, presence and level of restorations, periodontal condition, and age of the patient. The study population consisted of 62 females and 39 males, with an age range of 18-65 years. Inter- and intra-examiner reliability were high (Kappa = 0.88 and 0.98 respectively). PS were more commonly found in molars (81.2%), while PCO were presented in only 115 teeth (23%). Age significantly affected the type of calcification (p < 0.001), with PS more common in the 20-30 age group and PCO more common in individuals over 40. Presence of caries was significantly associated with the type of calcification (p = 0.013), but restoration was not. The majority of teeth with PS (76%) or PCO (93%) had healthy periodontium. Around 40% of teeth with PCO showed signs of periapical changes, a finding significantly different from those with PS (p < 0.001). Pulp calcifications were significantly associated with various dental parameters, including caries presence, age, and periodontal status. The findings provide crucial insights into the epidemiology and aetiology of pulp calcifications.

Pulp stones: any relevance with the levels of serum calcium, parathyroid hormone, vitamin D and uric acid

Objectives

This study evaluated the effect of serum calcium, parathyroid hormone (PTH), vitamin D, and uric acid levels on pulp stone formation.

Materials and Methods

Patients who were admitted to the Muğla Sıtkı Koçman University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology for dental complaints were registered. Among these patients, individuals who had routine biochemical tests at the same period in the Outpatient Clinics of Muğla Sıtkı Koçman University Training and Research Hospital were included in the study. The patients with at least 1 pulp stone on panoramic radiographs recorded as the "pulp stone group" while patients without any pulp stones were the "control group". Demographic data and serum levels of calcium, PTH, vitamin D, and uric acid were retrospectively evaluated in both groups. Student t-test or Mann-Whitney U test was used to evaluate the differences between the groups.

Results

Among 151 patients, dental pulp stone was detected in 53.6% of patients, and 82.7% of these patients were female. Female sex and pulp stone formation were significantly associated (p = 0.001). The mean age of the pulp stone group was 43.9, while it was 39.9 in the control group, without any significant correlation between age and pulp stone (p > 0.05). Similarly, there were no significant differences in serum levels of PTH, vitamin D, uric acid and calcium between groups (p > 0.05).

Conclusions

According to the present study, the effect of dental factors rather than systemic factors should be considered primarily in pulp stone formation.

Prevalence and Association of Calcified Pulp Stones with Periodontitis: A Cone-Beam Computed Tomography Study in Saudi Arabian Population

This study aimed to identify the prevalence and association of periodontitis and pulp stone (PS) along with the clinical variables. This study assessed the cone-beam computed tomography (CBCT) records to identify the presence of PS and clinical periodontitis records were used to determine the stages of periodontitis. The Chi-square test was used to evaluate the relationship between study parameters. Logistic regression was used to determine the association between PS and periodontitis. A total of 228 CBCT records were conveniently selected for this study based on the inclusion and exclusion criteria. Cohen's kappa analysis showed near to perfect scores for both examiners. The Chi-square test showed that CBCT records from the age range 41-50 years, male patients, and stage II of periodontitis prevalently showed pulp stones; however, there were no significant differences observed between the PS and clinical variables. However, gender, involvement of tooth, and stages of periodontitis showed significant distribution of the PS. Logistic regression showed that the stages of periodontitis showed no significant association with PS in patients with periodontitis. Moreover, multivariate odds ratio adjustment did not alter the outcome. Periodontitis is not associated with the presence of PS in the current population.

Prevalence of Pulp Stones in the Population of Rajasthan: A Cross-Sectional Study in a Tertiary Care Hospital

Introduction This study aimed to use radiography to determine the prevalence of pulp stones in the population of Rajasthan and to evaluate the relationship between pulp stones and tooth status, type, age, and gender. Methods The radiograph data record files collected from the Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, from September 2018 to October 2019, had a total of 9918 diagnostic quality intraoral periapical radiographs. One examiner examined all the radiographs to identify pulp stones and associated factors. Pearson chi-square test of significance was used for statistical analysis. Results On screening, a total of 889 intraoral periapical radiographs were found to have pulp stones. The presence of pulp stones was significantly higher in mandibular molars (68%) and was more common in the age group of 31-45 years (37%), followed by 13-29 years (35%). Maximum of pulp stones were of attached type (64%) than free pulp stones. Conclusion The prevalence of pulp stones in the population of Rajasthan studied is 8.9%, which is much lower than the reported prevalence in the literature. Pulp stones are predominantly attached and found significantly more often in mandibular molars in the age group of 31-44 years.

Cone-Beam Computed Tomography-Based Investigation of the Prevalence and Distribution of Pulp Stones and Their Relation to Local and Systemic Factors in the Makkah Population: A Cross-Sectional Study

Objectives This study aimed to assess the prevalence and distribution of dental pulp stones and evaluated their possible associations with local and systemic factors in the Makkah population in Saudi Arabia. Materials and methods Archived cone-beam computed tomography (CBCT) images for 390 patients, from the electronic health records (EHR) in the Dental Teaching Hospital, Umm Al-Qura University, were used. Images were examined in all planes (coronal, sagittal, and axial) for a discrete radiopaque mass in the pulp of all teeth, in both arches. The teeth conditions (the presence of caries, restoration, the periodontal condition, and the presence of pulp stones) were recorded. Additional patient information, including age, gender, and medical condition, was obtained from the patients' archived files. The collected data were statistically analyzed using the Statistical Package for Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY) software; a p-value of ≤ 0.05 is considered statistically significant. Results Pulp stone prevalence was 78.97% of the subjects (308 out of 390) and 15.92% of the examined teeth (1644 out of 10326). There were statistically significant differences regarding nationality (p=0.043) and age (p=0.023) but no significant difference between males and females (p=0.876), maxillary and mandibular teeth (p=0.392), and right and left sides (p=0.222) in pulp stone prevalence. Significant differences were found between pulp stone prevalence of sound versus and carious and restored teeth and between periodontally affected teeth and periodontally healthy teeth (p=0.031). Conclusion The prevalence of pulp stones in the Makkah population is high. A positive association was found between nationality, age, tooth restorations, caries, periodontal diseases, and pulp stone prevalence, but no correlation was found with patients' health or gender. The molars were the most affected teeth, while the incisors were the least.

A New Landscape of Human Dental Aging: Causes, Consequences, and Intervention Avenues

Aging is accompanied by physical dysfunction and physiologic degeneration that occurs over an individual's lifetime. Human teeth, like many other organs, inevitably undergo chronological aging and age-related changes throughout the lifespan, resulting in a substantial need for preventive, restorative as well as periodontal dental care. This is particularly the case for seniors at 65 years of age and those older but economically disadvantaged. Dental aging not only interferes with normal chewing and digestion, but also affects daily appearance and interpersonal communications. Further dental aging can incur the case of multiple disorders such as oral cancer, encephalitis, and other systemic diseases. In the next decades or even hundreds of years, the proportion of the elderly in the global population will continue to rise, a tendency that attracts increasing attention across multiple scientific and medical disciplines. Dental aging will bring a variety of problems to the elderly themselves and poses serious challenges to the medical profession and social system. A reduced, but functional dentition comprising 20 teeth in occlusion has been proposed as a measurement index of successful dental aging. Healthy dental aging is critical to healthy aging, from both medical and social perspectives. To date, biomedical research on the causes, processes and regulatory mechanisms of dental aging is still in its infancy. In this article, updated insights into typical manifestations, associated pathologies, preventive strategies and molecular changes of dental aging are provided, with future research directions largely projected.

The prevalence of pulp stones in a Turkish paediatric cohort from the Isparta district: an 8-year retrospective radiographic study

PURPOSE

To evaluate the prevalence of pulp stones in a Turkish paediatric cohort from the Isparta district using panoramic radiographs.

METHODS

Panoramic radiographs of 19,857 children and adolescents between the ages of 9 and 18 years were retrospectively analysed to determine the prevalence and distribution of pulp stones. Teeth with pulp stones were classified in terms of dentition, location, dental status and complete or incomplete root formation. Statistical analysis was carried out by applying Chi‑square and Mann-Whitney U. Univariate logistic regression analysis was applied to determine the factors affecting pulp stone status. Differences were considered as significant when p < 0.05.

RESULTS

Out of a total of 19,857 patients, pulp stones were identified in 6.5%. Among the 548,415 teeth examined, 0.96% had pulp stones. The incidence of pulp stones in girls (7.4%) was higher than in boys (5.7%) (p < 0.001). The prevalence of pulp stones increased with age and was significantly higher in molar teeth. A significant difference existed in the incidence of pulp stones according to the jaws (p < 0.001). In both jaws, no statistically significant difference was observed in terms of teeth with pulp stones being on the right and left (p = 0.834). Of molars with pulp stones, 91.8% had completed root formation. The majority of patients (37.7%) had pulp stones in four teeth.

CONCLUSION

Knowing the incidence of pulp stones in paediatric patients by dentists, endodontists, and paediatric dentists will help prevent complications that may occur during applications by facilitating the determination of appropriate methods, especially during endodontic procedures.

Morphology of pulpal mineralizations: A scoping review

OBJECTIVE

The aim of this scoping review was to summarize and discuss the morphological features and associated factors of pulpal mineralizations (PMs) as described within the literature.

DATA

The study protocol was registered on the Open Science Framework platform and is available at the following link: https://osf.io/hfqwe. This scoping review was developed according to the PRISMA-ScR guidelines.

SOURCES

A literature search of four electronic databases was performed in SCOPUS, MEDLINE (PubMed), EMBASE and Word of Science, with the last search on May 29, 2023. Study selection was completed by two reviewers independently. Data was extracted regarding study characteristics, types, and features of PM and associated factors.

STUDY SELECTION

Of 1016 studies initially identified ten which qualified were included in this scoping review. Systemic and local factors that result in pulpal insult can contribute to the development of PMs. Three forms of PM have been reported, pulp stones, diffuse mineralizations, and mineralized ectopic connective tissue, with discrete and diffuse mineralization being the two clinically relevant forms. The different forms of PMs exhibit dissimilar morphological features.

CONCLUSION

Pulpal mineralizations exist in two clinically relevant forms: diffuse and discrete mineralizations and are likely associated with a pulpal insult.

CLINICAL SIGNIFICANCE

Understanding the morphology of dental pulp mineralization is the first step to expanding the knowledge of pulp mineralization and could result in improved diagnosis of endodontic pathosis.

A systematic review assessing the dental pulp stone prevalence in the Saudi Arabian population

This Systematic Review (SR) was to report on the prevalence of pulp stones in the Saudi Arabian (KSA) population. The electronic databases were searched for scientific research articles during May 2021. The data search was performed in electronic search engines like PubMed, Scopus, Web of science, and Saudi Digital Library, and 6 original research articles which fulfilled the eligibility criteria were assessed for qualitative data. The prevalence of pulp stones among the KSA population ranged from 4.6% to 50.93% among the study participants and it ranged between 10.2%-13.34% in the teeth assessed. The pulp stones were more frequently reported in decayed teeth, periodontal diseases, attrition, teeth with dental restorations, and higher in the molar teeth in comparison with the premolar teeth. The data on the prevalence of pulp stones among the Saudi population will be helpful for clinicians in planning endodontic procedures.

Three-dimensional analysis for detection of pulp stones in a Saudi population using cone beam computed tomography

PURPOSE

To assess the prevalence and distribution of pulp stones in a Saudi population.

METHODS

A cone beam computed tomography (CBCT) analysis of 150 upper and 150 lower dental arches was performed. The relationships between pulp stones and age, sex, tooth type, dental arch, orthodontic treatment, caries, and restoration were statistically examined (P < 0.05).

RESULTS

A total of 295 dental arches (98.3%) had at least one pulp stone, and the prevalence was higher in the maxillary teeth (56.2%) than in the mandibular teeth (48.1%) (P = 0.0003). Men were more likely to have pulp stones than women (P = 0.011 for the maxilla, P < 0.0001 for the mandible). Furthermore, age and orthodontic treatment had no significant effects on the incidence of pulp stones (P > 0.05). A higher occurrence of pulp stones was observed in the first molars (>91%), and in carious and restored teeth when compared to intact teeth (P < 0.05).

CONCLUSION

Pulp stones were more prevalent in the upper dental arches, first molars, and carious and restored teeth, as well as in the male population, and were not associated with age or orthodontic treatment.

Assessment of Pulp Stones Among Western Saudi Populations: A Cross-Sectional Study

BACKGROUND

The term "pulp stones" refers to conditions of calcification that can appear in any area of the dental pulp. This study aims to assess the prevalence of pulp stones and examine whether there is any connection between their occurrence and factors such as patient age, gender, tooth location, presence of decay, or dental restorations in a western Saudi subpopulation based on cone-beam computed tomography (CBCT).

METHODOLOGY

500 patients were randomly selected from the College of Dentistry, Taibah University, Madinah, Saudi Arabia, database. The study involved evaluating 2998 teeth in coronal, axial, and sagittal planes by four dental peer examiners observing and recording data (sequentially and simultaneously) that included whether pulp stones were present or absent, the teeth group (anterior, premolars, and molars), tooth location (maxillary or mandibular), presence or absence of restoration, presence or absence of caries, and the patient's gender. Chi-square tests were utilized for statistical analysis, and a significance level of p-value ≤0.05 was established.

RESULTS

Out of 500 individuals (250 females and 250 males), only 130 individuals (26%) and 278 teeth out of 2998 (9.2%) had pulp stones, with no significant statistical correlation identified between the presence of pulp stones and gender. (P = 0.459). Molars exhibited the greatest incidence of pulp stones (238; 85.6%), followed by anterior teeth (30; 10.8%), and premolars had the lowest prevalence (10; 3.6%). Teeth that showed a higher occurrence of pulp stones were associated with caries (74; 26.6%) and restorations (58; 20.9%). The association between pulpal stone and periodontal involvement was seldom significant (0.7%). A significant association was found between the presence of pulp stones and nonintact teeth (P<0.001). There was a statistically significant difference in the distribution of pulp stones between females and males in the maxillary and mandibular (74.7% and 57.3%, respectively) (P = 0.002). Additionally, the frequency of pulp stones was statistically significant when comparing the left and right sides (P<0.001) (48.9% and 51.1%, respectively).

CONCLUSION

Understanding the prevalence and distribution of pulp stones is crucial for dentists and endodontists, as it assists practitioners in devising an appropriate treatment plan for affected teeth that require root canal therapy. One-fourth of the Madinah population was confirmed to have pulp stones, with a higher incidence in molars, caries, and restored teeth. No difference was found between its occurrence and gender. The high prevalence is exhibited in individuals between 45 and 54 years old. However, further studies with equal patient distribution are needed to confirm this observation.

Effects of Orthodontic Treatment on Pulp Stone Formation: A Retrospective Study

Objective

This retrospective study was aimed at determining the incidence of dental pulp stone formation during fixed orthodontic treatment.

Materials and Methods

A total of 100 patients who received fixed orthodontic treatment were included in this study. Pre- and posttreatment panoramic radiographs of the patients were examined to identify pulp stones. The data were analyzed using McNemar's and Pearson's chi-square tests to investigate the correlations between having a dental pulp stone and gender, age, treatment type, and duration.

Results

Dental pulp stones were detected in 17% of patients on pretreatment panoramic radiographs and 35% of patients on posttreatment panoramic radiographs. The incidence of pulp stones sharply increased in the pre- and posttreatment radiographs (38%) (P < 0.001). In addition, there were associations between age, treatment duration, and the incidence of pulp stones (P < 0.05). Nevertheless, no associations were found between treatment type, gender, and the presence of pulp stones. Dental pulp stones were most frequently observed in first molars (62%), followed by second molars (36%).

Conclusion

Fixed orthodontic treatment may trigger pulp irritation and calcification, resulting in the formation of pulp stones. Although pulp stones have no serious consequences, an orthodontist must consider the probability of pulp stone formation because it can cause difficulties in endodontic treatment.

Cone beam computed tomography assessment of the prevalence and association of pulp calcification with periodontitis

Periodontitis has a known association with pathological calcification in the cardiovascular system. Considering the close anatomic and circulatory association between dental pulp and the periodontium, this study aimed to evaluate the prevalence of pulp calcification (PC) under different periodontal conditions, as well as the associations of PC with the degree of periodontal damage, via cone beam computed tomography (CBCT) examination. In this study, 55 patients were categorized into three groups according to periodontal condition: group 1 (healthy controls), group 2 (periodontitis stage I-II), and group 3 (periodontitis stage III-IV). PC and radiographic bone loss (RBL) was assessed by CBCT in sagittal, axial, and coronal views, and statistical analyses were conducted. PC was identified in 378 of 1170 teeth (32.3%). The prevalence significantly differed among the three groups (P < 0.001). Group 2 had a 2.43-fold (P < 0.001, 95% confidence interval [CI] 1.64-3.61) higher risk of PC than group 1; and the risk of PC was 3.04-fold (P < 0.001, 95% CI 2.06-4.48) higher in group 3 than group 1. Teeth with more severe RBL exhibited a higher prevalence of PC (P < 0.001). Molar teeth had a higher risk of PC than incisors and premolars. In conclusion, the occurrence of PC is related to the periodontal state, and the prevalence of PC is higher in teeth with periodontitis; tooth type and periodontitis status are important risk factors for PC.

Association between Periodontitis and Pulp Calcifications: Radiological Study

Objective

The presence of intrapulpal calcifications is one of the effects reported as a consequence of periodontal pathology. Although the impact of the pulp pathology on the periodontium is obvious, the contrary remains unclear and controversial. This study was conducted in order to better understand this fact and establish a potential association between periodontitis and intrapulpal calcifications and then to determine the factors associated with their occurrence.

Materials and Methods

To investigate the issue, a retrospective radiological study using periapical preoperative radiographics assessed 332 teeth taken from the records of 79 patients who received treatment for periodontitis. In the second part of the study, 81 of the sample with intact dental crowns presenting an attachment loss were compared to their contralateral with intact dental crowns without any attachment loss. The study of the association between periodontitis and intrapulpal calcifications and the factors associated with their occurrence was performed by the Chi squared and Fisher's exact tests. The significance level was set at 0.05.

Results

The results indicated that 251 (75.6%) teeth had an attachment loss while 102 (30.7%) had intrapulpal calcification. Among the 206 (62%) teeth with intact crown, only 6 (1.8%) showed calcification in the pulp cavity and 20 (6%) showed calcification in the root canals, with a statistically significant difference (p < 0.005) compared to teeth with restorations and caries. For the 32 (19.7%) teeth with coronary calcification, 18 (22.2%) presented an attachment loss versus 14 (17.2%) without attachment loss; the difference was not statistically significant (p=0.6). Similarly, only 13 (16%) of a total of 22 (13.5%) teeth with root canal calcification had attachment loss versus 9 (11.1%) without attachment loss. This difference was not statistically significant (p=0.5).

Conclusion

This radiographic study revealed no association between the presence of periodontitis and the occurrence of intrapulpal calcifications. Although intrapulpal calcifications were present in some teeth with loss of attachment, they were not necessarily the consequence of periodontal disease.

A comparison of dietary isotopes in pulp stones and incremental dentine from Early Neolithic individuals of the Whitwell Long Cairn, England

Objectives

This study investigates if palaeodietary information can be obtained from pulp stones through stable isotope analysis, presents a method for their extraction from tooth samples, and assesses their utility as a source of paleodietary information when coupled with the incremental dentine method.

Materials and Methods

Six tooth samples (2 per individual), four of which contained pulp stones, were selected from three Early Neolithic (3720–3650 cal BC) individuals from the Whitwell Long Cairn in Derbyshire, England. After demineralization, each tooth was divided into 1 mm increments. Stable isotope analysis of collagen was conducted on each dentine increment and a portion of each pulp stone.

Results

All samples met the quality control criteria for well‐preserved collagen. Excluding the pulp stones, the mean δ¹³C value of the teeth sampled was −21.5 ± 0.2‰ and the mean δ¹⁵N value was 9.9 ± 0.5‰, suggesting these individuals had a terrestrial‐based diet. The pulp stones produced similar δ¹³C values between −21.6 and −21.4‰ and δ¹⁵N values between 9.1 and 9.8‰.

Discussion

The results demonstrate that paleodietary information can be obtained from pulp stones through stable isotope analysis. There are, however, significant challenges in interpreting this data, particularly as to inferring the timing and duration of their formation. The pulp stone results were compared with the incremental dentine profiles for each person to further investigate when they might have formed. For two individuals, the pulp stones appear to reflect diet from a time period after childhood and adolescence. For the third individual, it could not be determined if the pulp stones reflect a contemporary or later time period than the incremental dentine series. All teeth with pulp stones have moderate to severe wear on the occlusal surface, which could have been a contributing factor to their development.

Detecting calcified pulp stones in patients with periodontal diseases using digital panoramic and periapical radiographies

Background/purpose

Pulp stones are discrete calcified masses appearing in the dental pulp of healthy, disease and unerupted teeth. They are presented freely within the pulp tissue or attached and embedded in any part of coronal and radicular dentin. Here, the purposes of this study were to identify the presence of pulp stones in periodontal patients using digital panoramic and periapical radiographies, and to determine the association with gender, age, tooth type and dental arch.

Materials and methods

This is a retrospective study on selected records of 465 dental samples obtained between January and December, 2020. Data were collected from patients diagnosed with generalized chronic periodontitis and accepted the full periodontal treatment covered by the Government's Periodontal Health Care Program. Their digital panoramic (DPR) examination and full mouth periapical radiographic (DPA) examination (including 12 periapical and 4 bitewing images) were performed at the Outpatient Clinics of the Department of Stomatology, Taichung Veterans General Hospital. Patients were segregated into various groups according to their age, gender and tooth locations. All radiographic images were examined by a dental radiologist and two dentists to identify the presence of pulp stone calcifications and their associated factors using the Sirona applications software. Records were analyzed using SPSS version 22.0 based on tests of Pearson Chi-square and McNemar correlation.

Results

From 271 males and 194 females, a total of 465 DPR and 7440 DPA radiographs were studied. Pulp stone calcifications were identified in 270 (58.0%) subjects in DPR images and 348 (74.8%) subjects in DPA images (for 1 or more teeth per subject). We detected calcified opacities in 1031 teeth with DPR images and in 1326 teeth with DPA images from a total of 12,407 teeth. The incidence of pulp stones was similar across genders, but different in tooth locations and dental arch sextant. Moreover, pulp stones were detected more often on maxillary molars and subjects of old ages (>40 years). Digital panoramic and periapical radiography showed significant differences in the detection of pulp stone calcifications (P < 0.05), and detected better with digital periapical radiography examination.

Conclusion

We found 58.0% (n = 645) of our patients with pulp stones using digital panoramic radiography, and 74.8% using digital periapical radiography. Regarding individual teeth, only 8.5% of pulp stones were observed in digital panoramic radiography and 10.6% in digital periapical radiography. Pulp stones were more often seen in maxillary molar teeth and old patients of ages >40 years old using periapical radiography examination especially in those patients with periodontally condition. As a two-dimensional imaging system, digital periapical radiography is recommended for a definitive and routine assessment in patients suspected of hard tissue abnormality and pulp calcification formation.

The Pulp Stones: Morphological Analysis in Scanning Electron Microscopy and Spectroscopic Chemical Quantification

Background and objectives: Pulp stones are hard tissue structures formed in the pulp of permanent and deciduous teeth. Few studies have evaluated their morphology and chemical composition. However, their formation, composition, configuration and role played in overall health status are still unclear. Clinically, they may be symptomatic; technically, they impede access during endodontic therapy, increasing the risk of treatment errors. Thus, this study aimed to morphologically analyze pulp stones and present their chemical quantification, identifying their main chemical elements. It also correlates the results with their possible induction mechanisms. Materials and Methods: Seven pulp nodules were collected from molar teeth needing endodontic treatment. The morphology of the stones was analyzed by scanning electron microscopy (SEM), and their chemical composition was determined by X-ray dispersive energy spectroscopy (EDX). Results: These structures varied considerably in shape, size and topography. The site of the stones in the pulp cavity was the factor that most affected the morphology. The majority of the stones found in the pulp chambers presented nodular morphology, while those in the root canals presented a diffuse shape, resembling root canal anatomy. The topography of the nodules showed heterogeneous relief, revealing smooth and compact areas contrasting with the rugged and porous ones. The chemical composition varied depending on the location of the nodule in the pulp cavity and the relief of the analyzed area. Radicular stones presented considerably lower calcium and phosphorus content than coronary nodules. Conclusions: The high cellularity rate of the coronal pulp predisposes this region to nodular mineralizations around injured cells. The presence of larger caliber vascular bundles and higher collagen fiber content in radicular pulp determines a diffuse morphological pattern in this region. Understanding the morphology and chemical composition of the pulp stones allows future translational pathways towards the prevention or treatment of such conditions.

Evaluation of the relation between the pulp stones and direct restorations using cone beam computed tomography in a Turkish subpopulation

Objectives

This study aimed to assess the presence of pulp stones through an examination of cone beam computed tomography images and correlate their prevalence with age, sex, dental arch and side, tooth type, and restoration type and depth.

Materials and Methods

Cone beam computed tomography images obtained from 673 patients and archival data on 11,494 teeth were evaluated. The associations of pulp stones with age, sex, dental arch and side, tooth type, and restoration type and depth were noted. All the measurements were subjected to a χ² test and one sample χ² test (p < 0.05).

Results

In the study group, 163 (24.2%) patients and 379 (3.3%) teeth had at least one pulp stone. The pulp stone frequency in those aged 30–39 years was significantly greater than in those aged 18–29 and ≥ 60 years, and the frequency was higher in females than in males (p < 0.05). The highest prevalence of pulp stones was found in maxillary dental arches and molar teeth (p < 0.05). Pulp stones were significantly more common in medium-depth restorations (p < 0.05).

Conclusions

Maxillary molar teeth, medium-depth restorations, individuals aged 30–39 years and females had a greater percentage of pulp stones.

Micro-CT assessment of radicular pulp calcifications in extracted maxillary first molar teeth

OBJECTIVES

The present study aimed to evaluate the frequency, position, and length of radicular pulp calcifications in three-rooted maxillary first molars using micro-computed tomography.

MATERIALS AND METHODS

Two hundred three-rooted maxillary first molars were scanned at a pixel size of 10 µm and reconstructed using similar parameters. Three-dimensional models of the mesiobuccal (MB1, MB2, MB3), distobuccal (DB), and palatal (P) canals were qualitatively evaluated for discontinuity in the canal path. Transaxial and sagittal cross-sectional images of the roots were further screened, and the complete obliteration of the canal lumen by pulp calcification was identified when the canal had similar radiodensity to the surrounding dentine. Then, the number, position, and length of the calcifications were recorded for each root. Intra-observer agreement was performed using Cohen's kappa test, while one-way ANOVA and Duncan tests compared the lengths of calcifications among the canals, with α = 5%.

RESULTS

Intra-observer agreement was perfect for identification of pulp calcifications (ĸ = 1.0; p = 0.000). MB2 and MB3 canals accounted for the highest percentage frequency of calcifications distributed throughout the canal path. In the MB1, DB, and P canals, they occurred mainly at the apical third. Lengths of calcifications were greater in the MB3 (0.89 ± 0.81 mm) and MB2 (0.82 ± 0.93 mm) canals than in the MB1 (0.39 ± 0.32 mm), DB (0.34 ± 0.22 mm), and P (0.28 ± 0.22 mm) canals (p < 0.05).

CONCLUSION

MB2 and MB3 canals accounted for the highest frequency and length of radicular pulp calcifications. In the MB1, DB, and P canals, calcifications occurred mostly at the apical third, while in the MB2 and MB3, most of calcifications were observed at the orifice level and along the canal path.

CLINICAL RELEVANCE

In maxillary first molars, radicular pulp calcifications are mainly located at the apical third of the MB1, DB, and P canals, while in the MB2 and MB3 canals, most of them are at the orifice level or along the canal path.

Dental pulp calcifications in prehistoric and historical skeletal remains

BACKGROUND

The prevalence of hard tissue formations in the dental pulp varies considerably. Beside ageing processes and irritations of the dental pulp, etiological associations with cardiovascular disease and dietary habits have been discussed, which are of particular research interest. The aim of this pilot study is to provide new insights on structural and etiological factors involved in the development of pulp calcifications by investigating skeletal remains from different (pre)historic periods.

METHODS

The jaws of 46 skeletons excavated in central Germany, were examined for the presence of pulp stones using digital volume tomography (DVT). A total of 1122 teeth were examined with all tooth types considered. To obtain information about the three-dimensional structure of pulp calcifications, micro-CT images were taken. Thin sections of three molars were histologically analysed. Potential dietary effects were studied by analysing stable isotope ratios of nitrogen (δ¹⁵N) in bone samples collected from each individual.

RESULTS

The analysis indicates that pulp stones affect molars in particular and increase slightly with age and dental wear. The micro-CT scans and the histological analysis show that the structures are much more complex than presumed on the basis of DVT imaging. Individuals with lower δ¹⁵N-isotope values and thus with a potentially lower proportion of animal protein in their diet appear to be less affected by pulp stones.

CONCLUSION

When comparing between archaeological and recent data, DVT analysis provides qualitatively comparable results. Micro-CT and histological images illustrate the excellent preservation of pulp calcifications and their complex structure. Differences in prevalence rates and δ¹⁵N-isotope values of Neolithic and historical individuals support the assumption that dietary habits and living conditions could have an influence on the development of pulp calcifications. Due to the small sample size these results require further validation.

Nestin and dental pulp stones - a case report-driven hypothesis

The dental pulp stem cells (DPSCs) are mesenchymal stem/stromal cells (MSCs) with multilineage potential of differentiation. Different studies investigated dental pulp stones (PS), the calcified masses in the dental pulp, in regard to their prevalence, topography and structure. The etiology of PS is still unclear and, to our knowledge, the DPSCs were not attributed yet specific roles in PS formation. We report here an immunohistochemical study of a PS-embedding dental pulp from an impacted third mandibular molar of an adult patient, in which we used antibodies against CD34, Ki67, glial fibrillary acidic protein (GFAP), α-smooth muscle actin (α-SMA) and nestin. While endothelial cells expressed CD34 and pericytes or vascular smooth muscle cells expressed α-SMA, DPSCs and the osteoblasts coating the PS were exclusively labeled with nestin antibody. Stromal networks of nestin-expressing DPSCs were regarded as in situ providers of osteogenic progenitors involved in PS formation. Further experimental studies, with larger lots of tissue samples, as well as extended panels of markers, are needed in order to elucidate the DPSC hypothesis in the PS etiology.

Analysis on the predictive value of different variables in pulp stones appearance frequency and its pulpal response to cold stimuli

This study evaluated the presence of pulp stones in a Seville population, correlating their presence and size with state of the crown and pulp response to cold stimuli, encompassing variables such as age, gender, location (arch and teeth group). The study included 1090 teeth corresponding to 146 patients. Each patient underwent a visual examination, periapical radiographs and sensibility tests. The SPSS 25 software (SSPS, Chicago, USA) was used to carry out the statistical analysis, doing logistic regression to compare variables and Chi-square with a significance level p < 0.001. Of 1090 teeth studied, 524 were molars and 566 premolars. Of the molars, 316 showed calcifications and of the 566 premolars only 6 showed pulp stones (p < 0.001). Due to the low prevalence of premolar pulp calcifications, our study included only molars. These calcifications were significantly more common in women than in men (71.5% vs. 28.5%) and in people over 40 years. Significant differences were identified between the state of the crown and the pulp response with the presence of pulp stones, although size did not influence this association. The set of independent variables has a statistically significant effect on the criterion variable (χ² = 260.25, p < 0.001). There was a significant association between the state of the crown and the type of pulp response with the presence of pulp stones, but not with the size of the calcification. In conclusion, the highest probability to find pulpal calcification was observed in women over 40 years old in upper molars, and though the pulpal reaction of teeth with pulpal calcification varies, frequently there is an immediate response to a cold stimulus. There is no correlation between the size of pulp stones and the condition of the crown, just as the sensitivity of the pulp did not correlate with the size of pulp stones.

Prevalence of pulp stones: A systematic review and meta-analysis

OBJECTIVE

During the last years, different prevalences of dental pulps had been reported from different parts of the world. Combining these original estimates will provide useful information for policymaking in the field of health, treatment and research. This study aims to estimate the global prevalence of pulp stones.

METHODS

Electronic databanks such as PubMed, Scopus, Science direct, Cochrane, and also Google scholar motor engine were searched by 2 researchers using related keywords. The heterogeneity between the results was assessed using Cochrane and I² indices. The initial estimates were represented by forest plot and were combined according to random effects models. Factors responsible for heterogeneity were investigated using meta-regression models, and studies responsible for heterogeneity were assessed following sensitivity analysis.

RESULTS

Prevalence of pulp stones had been reported in 16 studies including 14 093 subjects. The pooled prevalence (95% confidence interval) of pulp stones among the total population, men and women were estimated as of 36.53% (27.17-45.88), 32.58% (24-41.15), and 39.23% (28.73-49.73), respectively. In addition, of 193 687 teeth investigated during the primary studies, 9.57% (95% confidence interval: 7.05-12.08) were affected by pulp stones.

CONCLUSION

Our meta-analysis shows a considerable prevalence of pulp stones, especially among women.

Evaluation of the relationship between sleep bruxism and pulpal calcifications in young women: A clinico-radiological study

PURPOSE

This study was performed to investigate the relationship between sleep bruxism (SB) and pulpal calcifications in young women.

MATERIALS AND METHODS

A total of 100 female participants between 20 and 31 years of age who were referred to our radiology clinic for a dental check-up, including 59 SB and 41 non-SB patients, were sampled for the analysis. SB was diagnosed based on the American Academy of Sleep Medicine criteria. All teeth were evaluated on digital panoramic radiographs to detect pulpal calcifications, except third molars, teeth with root canal treatment, and teeth with root resorption. Binary logistic regression analysis was used to determine the risk factors for pulpal calcifications. The Spearman correlation coefficient was applied and the Pearson chi-square test was used for categorical variables. To test intra-examiner reproducibility, Cohen kappa analysis was applied. P values <.05 were considered to indicate statistical significance.

RESULTS

A total of 2800 teeth were evaluated (1652 teeth from SB patients and 1148 from non-SB patients), and 61% of patients had at least 1 dental pulpal calcification. No statistically significant relationship was found between SB and pulpal calcifications (P>0.05). In SB patients, the total number of pulpal calcifications was 129, while in non-SB patients, it was 84. Binary logistic analysis showed that SB was not a risk factor for the presence of pulpal calcifications (odds ratio, 1.19; 95% CI, 0.52-2.69, P>.05).

CONCLUSION

No relationship was found between SB and pulpal calcifications.

A comparative study of cone-beam computed tomography and digital panoramic radiography for detecting pulp stones

PURPOSE

The aim of this study was to compare cone-beam computed tomography (CBCT) and digital panoramic radiography (DPR) for the detection of pulp stones.

MATERIALS AND METHODS

DPR and CBCT images of 202 patients were randomly selected from the database of our department. All teeth were evaluated in sagittal, axial, and coronal sections in CBCT images. The systemic condition of patients, the presence of pulp stones, the location of the tooth, the group of teeth, and the presence and depth of caries and restorations were recorded. The presence of pulp stones in molar teeth was compared between DPR and CBCT images.

RESULTS

Pulp stones were identified in 105 (52.0%) of the 202 subjects and in 434 (7.7%) of the 5,656 teeth examined. The prevalence of pulp stones was similar between the sexes and across various tooth locations and groups of teeth (P>.05). A positive correlation was observed between age and the number of pulp stones (ρ=0.277, P<.01). Pulp stones were found significantly more often in restored or carious teeth (P<.001). CBCT and DPR showed a significant difference in the detection of pulp stones (P<.001), which were seen more often on DPR than on CBCT.

CONCLUSION

DPR, as a 2D imaging system, has inherent limitations leading to the misinterpretation of pulp stones. Restored and carious teeth should be carefully examined for the presence of pulp stones. CBCT imaging is recommended for a definitive assessment in cases where there is a suspicion of a pulp stone on DPR.

Pulp Stones, Prevalence and Distribution in an Iranian Population

AIM

This study determined the prevalence and distribution of pulp stones in the permanent dentition of an adult population using their periapical radiographs.

MATERIALS AND METHODS

The study followed a cross-sectional design. A total of 800 periapical radiographs collected from 412 patients attending dental clinics in Kerman, Islamic Republic of Iran, were examined using magnification.

RESULTS

Pulp stones were present in 9.6% of all permanent teeth examined, being most common in maxillary first and second molars, followed by mandibular first and second molars. They were present in 31.5% of all adult patients, with a significantly increased prevalence in females compared with males (40.5 vs 23.9%, chi-squared test p < 0.001). There was also an increased prevalence with age.

CONCLUSION

Based on the results of this study, clinicians should expect to encounter pulp stones most commonly in the pulp chambers of maxillary first and second molars, particularly in older female patients.

CLINICAL SIGNIFICANCE

Pulp stones depending on their size and location can pose challenges to endodontic treatment. They obstruct access to the canal orifices and thus complicate endodontic treatment. Knowing where and when pulp stones are likely to occur improves the quality of root canal treatments.

The prevalence and distribution of radiopaque, calcified pulp stones: A cone-beam computed tomography study in a northern Taiwanese population

Background/purpose

Presence of pulp stones increase the difficulty of locating canal orifice during endodontic treatment. This study aims to determine the prevalence of pulp stones in a northern Taiwanese population through analysis of cone beam computed tomography (CBCT).

Materials and methods

A total of 144 patients and 2554 teeth were used in the present study which were collected from a CBCT image archive. To determine the presence of pulp stones, images of pulp chamber and root canals were analyzed in the sagittal, axial and coronal planes and from the occlusal to apical direction. Correlations between pulp stones and gender, age, tooth type, dental arch or side were also examined.

Results

Of the 144 patients, 120 patients (83.3%) and 800 (31.3%) teeth were found to have one or more pulp stones through CBCT examination. Prevalence of pulp stones between dental arches and tooth types were significantly different (P < 0.001). Pulp stones were found to be the most prevalent in first molars (50.0%) and most scarce in first premolars (18.8%). There was no significant correlation between pulp stones and gender, increasing age, or dental sides.

Conclusion

Pulp stones are more frequent in maxillary teeth compared to mandibular teeth. Pulp stones in molar teeth were significantly more common than premolars and incisors. CBCT could be a sensitive tool to detect pulp stones, especially simplifying identification of pulp stones in radicular pulp. Knowledge of pulp stones distribution can aid dentists in clinical endodontic treatment.

Radiographic Assessment of the Prevalence of Pulp Stones in a Yemeni Population Sample

Objective:

To determine the prevalence and distribution of pulp stones in the posterior teeth of a sample of adult Yemeni dental patients using digital panoramic radiographs.

Methods:

In total, 913 panoramic radiographs from patients attending the hospital dental clinics of at University of Sciences and Technology, Sana’a, Yemen, from January 2013 to December 2014 were examined. The occurrence of pulp stones in the posterior teeth of adult subjects was recorded. Associations between pulp stones and gender, age, arch, side and tooth type were studied.

Results:

The overall prevalence of pulp stones was 18.6% for individuals (170 out of 913 subjects) and 3.99% for examined teeth (351 out of 8802 teeth). The pulp stone occurrence was significantly higher in the maxilla than in the mandible for each tooth type and location (P<0.001). Pulp stones occurred more often on the right side (P<0.001). First molars represented 71% of the affected teeth with the maxillary right first molar showing the highest occurrence. Fifty-six percent of the affected subjects had pulp stones in more than one tooth. No significant difference in the occurrence of pulp stones was detected between genders or among age groups (P>0.05).

Conclusion:

The prevalence of pulp stones is different among populations. Pulp stones were found in approximately one-fifth of subjects in the Yemeni population, where up to 90% of the population have a Qat-chewing habit. This habit usually causes mechanical and chemical irritation and results in pulp calcification.

Assessing pulp stones by cone-beam computed tomography

OBJECTIVES

The aim of this study was to evaluate the occurrence of pulp stones by cone-beam computed tomography (CBCT) and to correlate their prevalence with patient's gender, location of tooth (right or left of maxillary or mandibular arch), group of teeth, and restorations.

MATERIALS AND METHODS

CBCT images of 382 patients randomly selected from the database of the University Oral Radiology Department were retrospectively examined. A total of 2833 tooth images obtained using the i-CAT 3D Imaging System were evaluated. Image analysis was performed with the i-CAT software, and all teeth were evaluated in sagittal, axial, and coronal views. All the measurements were subjected to chi square test, odds ratio, and Fisher's exact tests (p < 0.05).

RESULTS

The prevalence of pulp stones was similar between patient's genders and tooth locations. Pulp stones were detected in 31.9% of patients and 9.5% of teeth. Maxillary and mandibular molars were the groups of teeth with the highest frequency of pulp stones. The presence of restorations increased the chance of occurrence of pulp stones by 2.1 times in all teeth examined (p < 0.0001) and by 4.7 times in maxillary teeth (p < 0.0001).

CONCLUSIONS

Pulp stones had a high prevalence with molar teeth showing the highest prevalence. The presence of restorations increased the chance of occurrence of these calcifications, specifically in maxillary teeth.

CLINICAL RELEVANCE

CBCT provides accurate anatomical details in three dimensions, offering the possibility to view an individual tooth in axial, sagittal, and coronal views. This study performed an investigation of the occurrence of pulp stones by CBCT.

Comparative Physicochemical Analysis of Pulp Stone and Dentin

INTRODUCTION

Odontoblasts are responsible for the synthesis of dentin throughout the life of the tooth. Tooth pulp tissue may undergo a pathologic process of mineralization, resulting in formation of pulp stones. Although the prevalence of pulp stones in dental caries is significant, their development and histopathology are poorly understood, and their precise composition has never been established. The aim of the present study was to investigate the physicochemical properties of the mineralized tissues of teeth to elucidate the pathologic origin of pulp stones.

METHODS

Areas of carious and healthy dentin of 8 decayed teeth intended for extraction were analyzed and compared. In addition, 6 pulp stones were recovered from 5 teeth requiring root canal treatment. The samples were embedded in resin, sectioned, and observed by scanning electron microscopy and energy-dispersive spectroscopy. X-ray diffraction was performed to identify phases and crystallinity. X-ray fluorescence provided information on the elemental composition of the samples.

RESULTS

Pulp stones showed heterogeneous structure and chemical composition. X-ray diffraction revealed partially carbonated apatite. X-ray fluorescence identified P, Ca, Cu, Zn, and Sr within dentin and pulp stones. Zn and Cu concentrations were higher in pulp stones and carious dentin compared with healthy dentin.

CONCLUSIONS

Pulpal cells produce unstructured apatitic mineralizations containing abnormally high Zn and Cu levels.