Pulp stones: a review

Abstract

Pulp stones are a frequent finding on bitewing and periapical radiographs but receive relatively little attention in textbooks. A review of the literature was therefore performed, initially using the PubMed database and beginning the search with 'pulp calcifications' and 'pulp stones'. Each term provided more than 400 references, many of which related to pulp calcification in general rather than pulp stones, and focussed largely on the problems these changes presented to clinicians. A manual search using references from this source was carried out. Contemporary textbooks in endodontology were also consulted, and an historic perspective gained from a number of older books and references. The factors involved in the development of the pulp stones are largely unknown. Further research may determine the reasons for their formation, but with current endodontic instruments and techniques this is unlikely to alter their relevance to clinicians.

Evaluation of Pulp Stones in a Subpopulation of Northeast Turkey

“…However, the true prevalence is likely to be higher because pulp stones with a diameter less than 200 µm cannot appear on radiographs. 2,5 To determine the prevalence of pulp stones, Baghdady et al 15 and Colak et al 1 used bitewing radiographs, al-Hadi Hamasha and Darwazeh 16 used periapical and bitewing radiographs, and Satheeshkumar et al, 17 Syrynska et al, 18 and Turkal et al 19 used panoramic radiographs in their study. Panoramic radiographs show the entire mouth area, and panoramic images are excellent for screening for pulpal calcifications, as all teeth can be examined using the same image.…”

“…12 True pulp stones contain dentin and are lined by odontoblast, whereas false pulp stones are composed of degenerative cells of the pulp that have been mineralized. 2,5 This morphological distinction is based alone on histological analyses. 12 Pulp stones are diagnosed by radiographic imaging and histological slides.…”

“…Pulp stones occur in all tooth types but most frequently in molars. 2,3,12 The prevalence of pulp stones varies from 8% to 90%, depending on the study design, type, and radiographic technique employed. 1,5 Pulp stones can cause endodontic problems by hindering access to root canals and their subsequent shaping.…”

“…11 Despite a number of microscobic and histochemical works, the exact cause of pulp calcifications remains largely unknown. 2 Pulp stones may be classified as true or false. 12 True pulp stones contain dentin and are lined by odontoblast, whereas false pulp stones are composed of degenerative cells of the pulp that have been mineralized.…”

“…A single tooth may have from 1 to 12 or even more stones with different sizes. [2][3][4] The etiology of pulp stones is controversial. Whereas some etiological factors include pulp degeneration, inductive interactions between epithelium and pulp tissue, 5 age, 6 circulatory disturbances in pulp, 7 orthodontic tooth movement, 8 idiopathic factors, 9 and genetic predisposition, 10 other etiological factors link pathological calcification with nanobacteria and/or bacterial toxin penetration.…”