Pulpitis: What you need to know

Pulpitis is dental pulp inflammation, or tissue in the middle of a tooth. The dental pulp contains the tooth’s delicate connective tissue, nerves, and blood supply.

Pulpitis causes discomfort, swelling and sensitivity. A cavity-borne bacterial infection is usually the cause.

This article should look at what it is, along with the options for symptoms, causes, diagnosis and treatment.

What is pulpitis?

A person with pulpitis may have throbbing pain.
A person with pulpitis may have throbbing pain.

Pulpitis is Dental Pulp inflammation. This is how a dentist would explain’ toothache.’

The pulp inside a tooth is made up of vascular tissue, blood supply, nerves, and connective tissue. Upon inflammation of the pulp, a person can feel nerve pain from the tooth.

Pulpitis is theoretically reversible or permanent.

Reversible pulpitis

There’s normally moderate inflammation in the pulp in reversible pulpitis, and people have short-lived discomfort.

If a person has reversible pulpitis, a tooth may have a cavity, but it is not yet deep, and therefore there is a lack of bacteria in the pulp.

Eating something sweet or cold will cause pain with the reversible form of pulpitis but this pain goes away once the stimulant is gone.

The tooth pulp is typically healthy, and the tooth can be saved and the nerve healed with care.

Irreversible pulpitis

Chronic pulpitis is one of a person’s most common reasons to look for emergency dental care.

Irreversible pulpitis occurs when bacteria spread to the nerve, and there is significant inflammation of the pulp.

Usually, chronic pulpitis causes intense pain, which can be sudden, lingering and radiating. Irreversible pain with the pulpitis can be so extreme that a person wakes up at night.

Someone with permanent pulpitis may have trouble figuring out the exact location of the pain. Nonetheless, 40 percent of irreversible pulpitis teeth can also be painless.

If the bacteria in the pulp cause the nerve to die, permanent pulpitis can lead to infection at the end of the dent. This is known as pulp necrosis, or death by pulp.

If necrosis occurs, a pocket of pus, known as a periapical abscess or dental abscess, can develop at the end of the root of the tooth. Especially when biting it can cause severe pain.

The infection, left untreated, can spread to other parts of the body including the brain.

Symptoms

Pulpitis causes:

  • pain, which may be sharp or throbbing
  • sensitivity to sweet, hot, or cold foods and beverages
  • inflammation

The severity of those symptoms depends on the pulpitis type.

Typically, reversible pulpitis causes mild symptoms, such as sensitivity to cold and nonlingering pain.

In contrast, chronic pulpitis may cause extreme pain. For chronic pulpitis, the pain will last long, even after the stimulant has gone away.

Infection signs and symptoms can also accompany permanent pulpitis as the infection progresses, which may include:

  • a fever
  • an unpleasant taste in the mouth
  • bad breath (halitosis)
  • difficulty eating
  • swelling in the face or cheek
  • swollen lymph nodes

Causes

The most common cause of pulpitis according to a systematic analysis in 2016 is when bacteria irritate the dental pulp through a tooth decay area, like dental caries.

Other causes of pulpal inflammation include:

  • trauma or injury to a tooth
  • grinding or clenching the teeth
  • repeated, invasive dental procedures

Usually these irritants cause reversible pulpitis. If the pulp remains inflamed, the pulpitis becomes permanent, which may eventually lead to dying of the pulp.

Diagnosis

A dentist can diagnose pulpitis from a person’s symptoms, teeth inspection, and possibly x-rays.

In certain situations, the dentist can perform additional tests, such as:

  • A sensitivity test: The dentist will check to see if cold or hot stimuli cause pain and discomfort.
  • Tooth tap test: The dentist taps gently on the tooth with a lightweight instrument to check the level of inflammation.
  • Electric pulp test: The dentist may use a tool to deliver a small electrical charge to the pulp. If the person can feel the charge, the pulp is responding normally, and the pulpitis may be reversible.

Such tests may help the dentist assess the extent of the damage, and the pulp may be saved.

Treatment

The treatment will depend on whether the pulpitis is reversible or irreversible.

Reversible pulpitis

If the pulpitis is reversible, once the person treats the underlying cause of the inflammation the pain and discomfort should be resolved.

If pulpitis is caused by damage to the tooth, for example with a cavity or a fracture, a dentist can repair the tooth to protect the pulp.

Once a dentist has removed the cause of the pain, the pulp should recover and return to its normal healthy state.

Irreversible pulpitis

Irreversible pulpitis means that something has weakened the nerve beyond repair, and it can not cure the inflammation in the pulp.

Usually the dentist will do a root canal treatment to remove the dying pulp.

Instead, if they can save the tooth, a dentist can remove the entire tooth, though this is not usually the first line of treatment.

A dentist would not prescribe systemic antibiotics as an irreversible pulpitis procedure. This is because antibiotics won’t ease the pain inside the tooth and repair the nerve.

Prevention

People should ensure good oral hygiene and eradicate harmful bacteria from their mouth and teeth in order to prevent pulpitis.

To help maintain healthy teeth and gums, a person should:

  • see a dentist regularly
  • seek immediate attention for tooth pain or sensitivity
  • brush teeth twice daily
  • floss daily
  • limit or avoid sugary foods

Individuals with bruxism, which happens when a person grinds in their sleep or clench their teeth, may want to consider wearing a mouthguard at night.

Complications

When left untreated, pulpitis may result in a periapical abscess, otherwise known as a dental abscess, which is a localized bone or soft tissue infection. A person may find a pocket of pus next to his tooth.

Once the infection spreads to local tissue spaces and causes widespread swelling, cellulitis can develop.

Symptoms may include:

  • swollen glands and lymph nodes
  • painful rash
  • fever
  • chills
  • difficulty swallowing
  • trismus, or difficulty opening the mouth

If a person develops cellulitis, antibiotics may be taken to treat it.

If a person experiences any of the above symptoms, or sees changes in mental state and has trouble breathing, they should seek emergency medical assistance.

When to see a dentist

People should see their dentist at the first sign of mouth pain, irritation or inflammation.

It is also important to regularly see a dentist for check-ups and cleanings.

Outlook

The pulpitis outlook depends upon the extent of the damage.

Reversible pulpitis can resolve with cause or irritant treatment.

Permanent pulpitis includes procedure of the root canal or tooth removal to relieve the discomfort and sensitivity.

Early intervention will raise the outlook for pulpitis. A dentist can be able to administer a quick care to repair the pulp before the disease is irreversible, such as a filling.

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