Histopathological and microbiological characterization of pulp tissue in severe (stage IV) periodontitis

Abstract

Objective: To evaluate the morphology of the pulpal connective tissue and bacterial contamination in human teeth with advanced periodontitis. Material and Methods: Twenty-nine healthy teeth with severe periodontitis (stage IV periodontitis) and indication for extraction were collected. After dental extractions and histological preparation, tissue specimens were stained with hematoxylin and eosin, and Giemsa for microscopical analysis of the pulpal morphology and the presence of bacteria, respectively. Results: Several pulp tissue changes were observed in the 29 cases of severe periodontitis: degeneration of the odontoblastic layer (93.1%); dystrophic calcification (44.8%); fibrosis in the root (65.5%) and coronal (31%) regions; necrosis (20.7%), hyperemia (79.3%) and inflammatory infiltrate (82.8%), the latter being present in the root and coronal portions in 62.1% and 65.5% of cases, respectively. With regard to the degree of inflammatory infiltrate intensity, 48.3% had mild inflammatory infiltrate, 31% had moderate inflammatory infiltrate, and 3.4% had intense inflammatory infiltrate. Bacteria were detected in the pulp tissue in 31% of cases. No statistically significant associations were found between the morphological changes presented and the presence of inflammatory infiltrate and/or bacteria in the pulp tissue. Conclusion: Bacterial colonies are not always present in the pulp tissue of teeth with advanced periodontitis; however, this tissue usually presents inflammatory infiltrate, associated with several morphological alterations, of which odontoblast layer degeneration, hyperemia, and fibrosis should be highlighted. These findings underscore the importance of evaluating pulp status in teeth affected by severe periodontitis, supporting accurate diagnosis and interdisciplinary treatment planning in clinical practice.

KEYWORDS

Bacterial infection; Dental pulp; Histology; Inflammatory infiltrate; Periodontal diseases.