Alimentary System

Tooth - Necrosis

Narrative
Comment:
Bacterial infection and other injuries in the tooth pulp induce an inflammatory response, but similar to the brain’s enclosure within the calvarium, the tooth pulp’s enclosure within the dentin limits the amount of swelling. The swelling that occurs with inflammation can result in markedly increased pressure in the tooth pulp, which inhibits blood flow. Additionally, the intrapulpal formation of collateral blood vessels is inhibited because the apex of the tooth is the sole entry point for blood vessels. The decreased blood flow due to increased intrapulpal pressure or vascular occlusion (e.g., thrombosis) generally results in ischemic necrosis of the pulp and death of the tooth.
Recommendations:
Necrosis of the teeth should be diagnosed and graded if the majority of a tooth is affected and multiple tissues within the tooth are necrotic. If 1 or 2 particular sites in the tooth are affected (e.g., ameloblast, odontoblast, pulp), and the majority of the tooth is unaffected, then the site(s) should be included in the diagnosis. Any associated inflammation should be diagnosed only if it is considered to be unrelated to the necrosis (i.e., is a primary lesion) or if it is severe enough to warrant a separate diagnosis.
References:

Long PH, Leininger JR. 1999. Teeth. In: Pathology of the Mouse (Maronpot RR, ed). Cache River Press, St Louis, MO, 13-28.

Abstract: http://www.cacheriverpress.com/books/pathmouse.htm

Nyska A, Maronpot RR, Long PH, Roycroft JH, Hailey JR, Travlos GS, Ghanayem BI. 1999. Disseminated thrombosis and bone infarction in female rats following inhalation exposure to 2-butoxyethanol. Toxicol Pathol 27:287-294.

Abstract: https://www.ncbi.nlm.nih.gov/pubmed/10356705

Zbinden G, Grimm L. 1985. Thrombosis effects of xenobiotics. Arch Toxicol 8(suppl):131-141.

Abstract: https://www.ncbi.nlm.nih.gov/pubmed/3006632
  • Image of necrosis in the tooth from a male B6C3F1 mouse in a chronic study

    Tooth - Necrosis in a male B6C3F1 mouse from a chronic study. There is necrosis of most components of the tooth, including the 2 denticles in the pulp (arrow), and suppurative inflammation of the tooth pulp (arrowhead).

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<p>Tooth - Necrosis in a male B6C3F1 mouse from a chronic study. There is necrosis of most components of the tooth, including the 2 denticles in the pulp (arrow), and suppurative inflammation of the tooth pulp (arrowhead).</p>

Tooth - Necrosis in a male B6C3F1 mouse from a chronic study. There is necrosis of most components of the tooth, including the 2 denticles in the pulp (arrow), and suppurative inflammation of the tooth pulp (arrowhead).
<p>Tooth - Necrosis in a male B6C3F1 mouse from a chronic study (higher magnification of Figure 1). There is necrosis of all components of the tooth, including the 2 denticles in the pulp (arrow), and suppurative inflammation of the tooth pulp (arrowhead).</p>

Tooth - Necrosis in a male B6C3F1 mouse from a chronic study (higher magnification of Figure 1). There is necrosis of all components of the tooth, including the 2 denticles in the pulp (arrow), and suppurative inflammation of the tooth pulp (arrowhead).

Authors:

Linda H. Kooistra, DVM, PhD, DACVP
Pathologist
Charles River Laboratories, Inc.
Research Triangle Park, NC

Abraham Nyska, DVM, Diplomate ECVP, Fellow IATP
Expert in Toxicologic Pathology
Visiting Full Professor of Pathology
Sackler School of Medicine, Tel Aviv University Timrat Israel

Reviewers:

Joel R. Leininger, DVM, PhD
Senior Pathologist
MedImmune
Washington, DC

Amy Brix, DVM, PhD, DACVP
Senior Pathologist
Experimental Pathology Laboratories, Inc.
Research Triangle Park, NC