Photograph showing Pulpal hyperaemia. While bacteria are still some distance from the pulp, acid permeating along the dentinal tubules gives rise to dilation of the blood vessels, oedema and a light cellular inflammatory infiltrate in the pulp 
What is Pulpitis?
|Photograph showing Pulpal hyperaemia. While bacteria are still some distance from the pulp, acid permeating along the dentinal tubules gives rise to dilation of the blood vessels, oedema and a light cellular inflammatory infiltrate in the pulp |
Pulpitis is the inflammation of the pulp. It is the most common cause of pain in young persons.
It is of two types.
Irreversible pulpitis has been divided into further two types
Causes of Pulpitis
Traumatic exposure of the pulp
Thermal or Chemical irritation/injury
Fracture of a crown or cusp
The pulps of individual teeth are not precisely perceived on the sensory cortex in the brain. Therefore, pulpal pain is poorly localised by the patient and may be felt in any of the teeth of the upper or lower jaw of the affected side. Sometimes, pain may be referred to a more distant site, for example, the ear. Pulp pain can not be provoked by pressure on the tooth as it is not transferred to pulp tissues. The patient can chew in comfortably unless there is a large open cavity allowing food to distort or stimulate the dentin.
Pain-short and sharp stabs.
Stimulated by hot, cold or sweet.
Pain subsides in seconds or few minutes (2-5 Minutes) after removal of
Constant throbbing pain with sharp exacerbation.
It may exacerbate spontaneously, with hot & cold or sweet.
In late stage, cold may relieve the pain.
Pain persists minutes or hours after stimulus removal.
In the early stages the tooth is hypersensitive to very cold or hot food. They may cause a burst of pain that stops as soon as the irritant is removed. As the inflammation progresses, pain lasts longer after the stimulus removal. There may be prolonged attacks of toothache. The pain may start spontaneously, usually when the patient is trying to get to sleep.
The Mechanism Behind the Pain
The pain is due to two reasons1. It is partly due to the pressure on the irritated nerve endings being exerted by the
Chronic pulpitis may develop without episodes of acute pulpitis, but usually it follows
acute pulpitis, if not treated at an early stage. In other instances, many pulp dies
painlessly under large carious painlessly.
The first indication of chronic pulpitis is the development of periapical periodontitis,
either with pain or seen by chance in a radiograph. In other cases, there are bouts
of dull pain, brought on by hot or cold stimuli or occurring spontaneously. There are
often prolonged remissions, and recurrent acute exacerbations.
Table: Symptoms and signs of pulpitis in Nutshell
|Symptoms||Acute pulpitis||Chronic Pulpitis||Reversible Pulpitis||Irreversible Pulpitis|
|Nonspecific Pain||Intense, throbbing||Low, dull ache||Moderate||Intense, throbbing|
|Sensitivity of tooth||Very painful||Short & sharp||Pain resolves after stimulus removed in seconds or few minutes||Last for several minutes or hours after stimulus|
|Swelling near tooth||Present||Rarely||Rarely||Present|
|Increase in pain while lying down||Present||Absent||Absent||Present|
|Fever||Present||Very rare||Very rare||Present|
Management of Pulpitis
The chances of the survival of an inflamed are poor are poor, and we do not have many treatment options. As mentioned previously, the concept of irreversible pulpitis is considered useful for treatment planning, but criteria are poorly defined. Open pulpitis is usually associated with gross cavity formation, and it is rarely possible to save the tooth, despite the vitality of the pulp. Following are the treatment options for pulpitis:
If the tooth is fractured or cracked, stabilised the fracture and seal the pulp temporarily
Removal of caries, obtundent or steroid dressing for acute pulpitis if one feels that the pulp vitality can be preserved
Removal of caries and pulp capping, if the caries is near pulp
Pulpotomy of deciduous tooth, to maintain arch integrity
Endodontic treatment-for irreversible pulpitis
Extractions-for pulp open pulpitis with large carious lesion