Pulpitis is inflammation of the dental pulp or tissue in the center of a tooth. The dental pulp comprises soft connective tissue, nerves, and the blood supply for the tooth.
Inside the innermost part of each tooth is an area called the pulp. The pulp contains the blood, supply, and nerves for the tooth. Pulpitis is a condition that causes painful inflammation of the pulp. It can occur in one or more teeth and is caused by bacteria that invade the tooth’s pulp, causing it to swell.
There are two forms of pulpitis: reversible and irreversible. Reversible pulpitis refers to instances where the inflammation is mild and the tooth pulp remains healthy enough to save. Irreversible pulpitis occurs when inflammation and other symptoms, such as pain, are severe, and the pulp cannot be saved.
Irreversible pulpitis may lead to a type of infection called a periapical abscess. This infection develops at the root of the tooth, where it causes a pocket of pus to form. If not treated, this infection can spread to other parts of the body, such as the sinuses, jaw, or brain.
What is pulpitis?
Pulpitis is inflammation of the dental pulp. It is how a dentist might describe ‘toothache.’
The pulp inside a tooth consists of vascular tissues, blood supply, nerves, and connective tissue. When the pulp is inflamed, a person may experience pain from the tooth’s nerve.
Pulpitis can be reversible or irreversible.
What are the two forms of pulpitis?
There are two forms of pulpitis, namely, reversible and irreversible pulpitis. The latter is further classified into symptomatic and asymptomatic pulpitis.
Based on the clinical findings, if the pulp tissue fails to repair and is painful, the condition is referred to as symptomatic irreversible pulpitis. Some of the specific features of this disorder include excruciating pain on contact with hot stimuli, which persists for 30 seconds or more. The pain can also begin spontaneously and may spread to other parts. It has also been observed that the pain may be aggravated by a change in body position. Usually, teeth affected by irreversible pulpitis are challenging to diagnose primarily because the infection has not reached the bottom portion of the tooth structure, referred to as the periapical region.
Asymptomatic irreversible pulpitis is also diagnosed based on the clinical examination. Here there is no pain or discomfort at the time of testing, and the affected teeth are detected by thermal testing.
Reversible pulpitis is the condition in which the dental pulp is inflamed, but reverts to normal upon the removal of the offending factors. The inflammation of the pulp tissue in reversible pulpitis is generally mild to moderate. For instance, one may experience discomfort in the consumption of cold or sweet foods. However, the pain is relieved upon removal of the stimulus. In general, reversible pulpitis is quick to heal with the correction of the root cause, that is, once the underlying condition is treated. Nonetheless, periodic evaluation is necessary to ensure the complete healing of the condition.
In reversible pulpitis, there is typically mild inflammation in the pulp, and people have short-lived pain.
If a person is experiencing reversible pulpitis, a tooth may have a cavity, but it is not deep yet, and so bacteria are absent in the pulp.
With the reversible form of pulpitis, eating something sweet or cold may cause pain, but this pain goes away once the stimulant is gone.
The tooth pulp is typically healthy and, with treatment, it is possible to save the tooth and for the nerve to heal.
Irreversible pulpitis is one of the most frequent reasons for a person to seek emergency dental treatment.
Irreversible pulpitis occurs when bacteria spread to the nerve, and there is significant inflammation of the pulp.
Irreversible pulpitis typically causes intense pain that may be spontaneous, lingering, and radiating. Irreversible pulpitis pain may be so severe that it wakes a person up at night.
Someone with irreversible pulpitis may have difficulty pinpointing the exact location of the pain. However, 40% of teeth with irreversible pulpitis may also be painless.
Irreversible pulpitis can lead to an infection at the end of the tooth if the bacteria in the pulp cause the nerve to die. This is called pulp necrosis, or pulp death.
If necrosis occurs, a pocket of pus may form at the end of the tooth’s root, known as a periapical abscess, or dental abscess. It can cause severe pain, especially when biting.
Left untreated, the infection can spread to other parts of the body, including the brain.
What are the symptoms?
Both types of pulpitis cause pain, though the pain caused by reversible pulpitis may be milder and occur only while eating. The pain associated with irreversible pulpitis may be more severe and occur throughout the day and night.
Other symptoms of both forms of pulpitis include:
- sensitivity to hot and cold food
- sensitivity to very sweet food
- pain, which may be sharp or throbbing
Irreversible pulpitis may include additional symptoms of infection, such as:
- running a fever
- swollen lymph nodes
- bad breath
- bad taste in the mouth
Signs and symptoms of infection may also accompany irreversible pulpitis if the inflammation progresses, and may include:
- a fever
- an unpleasant taste in the mouth
- difficulty eating
- swelling in the face or cheek
- swollen lymph nodes
What are the various causes of pulpitis?
The causes of pulpitis are broadly classified into physical, chemical, and bacterial causes.
- Physical causes such as mechanical injury and thermal injury: pulpitis due to mechanical injury is often due to dental trauma, more commonly in children. Some habits like bruxism (gritting of teeth at night), nail-biting or manipulating hairpins with the teeth are among the causes of tooth trauma. Some dental procedures may also lead to tooth trauma. This is, for instance, when inadvertent exposure of the pulp tissue occurs during tooth restoration procedures performed to remove caries; during the use of dental pins for adhering tooth restorations; or as a result of the application of excessive force on teeth during orthodontic procedures.
Pulpitis due to thermal causes occurs in situations such as excessive liberation of heat during dental procedures like cavity preparation during the treatment of caries, or because of the heat produced during the polishing of a tooth filling.
Other physical causes include cracked tooth syndrome, barodontalgia, and tooth attrition. Cracked tooth syndrome is the result of partial fractures on the tooth surface. This may lead to pain especially after the release of biting pressure.
Barodontalgia is the phenomenon in which tooth pain occurs at high altitudes due to the low atmospheric pressure. Chronic pulpitis may be symptomless at the lower levels; however, such teeth may become painful at higher altitudes above 5,000-10,000 feet.
Tooth attrition refers to the pathological wearing down of dental hard structures. Attrition eventually leads to the exposure of dental pulp tissue, thus causing inflammation and pulpitis.
- Chemical causes of pulpitis include the overuse of desensitizing paste and pulp reaction to components like arsenic present in silicate tooth restoration.
- Bacterial causes of pulpitis include infection with streptococci, staphylococci, and anaerobes. Streptococci and staphylococci are the most common bacteria recovered from vital pulp tissue.
hat are the risk factors?
Anything that increases the risk of tooth decay, such as living in an area without fluoridated water or having certain medical conditions, such as diabetes, may increase the risk of pulpitis.
Children and older adults may also be at increased risk, but this is largely determined by the quality of dental care and oral hygiene habits.
Lifestyle habits may also increase the risk of pulpitis, including:
- poor oral hygiene habits, such as not brushing teeth after meals and not seeing a dentist for regular checkups
- eating a diet high in sugar, or consuming foods and drinks which promote tooth decay, such as refined carbohydrates
- having a profession or hobby that increases your risk of impact to the mouth, such as boxing or hockey
- chronic bruxism
How is it diagnosed?
Pulpitis is typically diagnosed by a dentist. Your dentist will examine your teeth. They may take one or more X-rays to determine the extent of tooth decay and inflammation.
A sensitivity test may be done to see if you experience pain or discomfort when the tooth comes in contact with heat, cold, or sweet stimuli. The extent and duration of your reaction to the stimuli can help your dentist decide if all, or only part, of the pulp, has been affected.
An additional tooth tap test, which uses a lightweight, blunt instrument to gently tap on the affected tooth, can help your dentist determine the extent of the inflammation.
Your dentist may also analyze how much of the tooth’s pulp is damaged with an electric pulp tester. This tool delivers a tiny, electrical charge to the tooth’s pulp. If you’re able to feel this charge, your tooth’s pulp is still considered viable, and the pulpitis is most likely reversible.
How is it treated?
Treatment methods vary depending on whether your pulpitis is reversible or irreversible.
If you have reversible pulpitis, treating the cause of the inflammation should resolve your symptoms. For example, if you have a cavity, removing the decayed area and restoring it with a filling should relieve your pain.
If you have irreversible pulpitis, your dentist may recommend you see a specialist, such as an endodontist. If possible, your tooth may be saved through a procedure called a pulpectomy. This is the first part of a root canal. During a pulpectomy, the pulp is removed but the rest of the tooth is left intact. After the pulp is removed, the hollow area inside of the tooth is disinfected, filled, and sealed.
In some instances, your entire tooth will need to be removed. This is known as tooth extraction. Tooth extraction may be recommended if your tooth has died and cannot be saved.
After a pulpectomy or tooth extraction, let your surgeon know if you experience any of these symptoms:
- severe pain, or pain which intensifies
- swelling inside or outside of the mouth
- feelings of pressure
- a recurrence or continuation of your original symptoms
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Dr. Seif received an award in Aesthetic Dentistry and an Advanced Standing Achievement Certificate and held a position as a part-time clinical instructor.
Dr. Seif has more than 15 years of experience as a dentist and has obtained two dental degrees. Dr. Seif earned his first degree in dentistry in Syria in 1998 and practiced general dentistry until coming to the US to advance his education by earning a second dental degree from Loma Linda University School of Dentistry, a world-renown dental institute. While at Loma Linda, Dr. Seif received an award in Aesthetic Dentistry and an Advanced Standing Achievement Certificate and held a position as a part-time clinical instructor.
Dr. Seif’s compassion and friendly nature is evident to his patients. He believes that every individual should be treated in a kind, caring and respectful manner. Dr. Seif is dedicated to life-long learning and enjoys participating in post-graduate courses that enable him to provide his patients and community with the excellent dental care he believes every person deserves.
Moving from the Dallas-Fort Worth area in 2014, Dr. Seif now calls Baytown his home. Along with cooking, friends, family and his dog, Sophie, he enjoys southern culture. He is enthralled by the friendliness and hospitality he finds in Texas, saying, “This is exactly the kind of community I want to live and practice in!”