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 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 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
Irreversible pulpitis may include additional symptoms of infection, such as:
How does dental caries result in pulpitis?
The oral cavity naturally contains a host of bacteria. These bacterial counts flare up in the presence of foods containing high sugar and starch content. In the presence of high sugar, these bacteria produce acids which eat away the tooth coverings, resulting in tooth decay or caries. Once caries advances to the deepest layer of the tooth (pulp), it results in inflammation of the pulp which is referred to as pulpitis.
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.
A dentist can diagnose pulpitis from a person’s symptoms, an examination of the teeth, and possibly X-rays.
In some cases, the dentist may perform other 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.
These tests can help the dentist to determine the extent of the damage, and possibly save the pulp.
The treatment will depend on whether the pulpitis is reversible or irreversible.
If the pulpitis is reversible, the pain and discomfort should resolve once the person treats the underlying cause of the inflammation.
If damage to the tooth, such as with a cavity or a fracture, is causing the pulpitis, a dentist may repair the tooth to protect the pulp.
The pulp should heal and return to its normal, healthy state once a dentist has removed the source of the irritation.
Irreversible pulpitis means that something has damaged the nerve beyond repair, and the inflammation in the pulp cannot be reversed.
The dentist will typically perform a root canal treatment to remove the dying pulp.
Alternatively, a dentist may remove the entire tooth, although this is not typically the first line of treatment if they can save the tooth.
A dentist will not recommend systemic antibiotics as a treatment for irreversible pulpitis. This is because antibiotics will not alleviate the pain and heal the nerve inside the tooth.
To prevent pulpitis, people can ensure that they practice good oral hygiene to remove unhealthy bacteria from their mouth and teeth.
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 who have bruxism, which occurs when a person grinds or clench their teeth in their sleep, may want to consider wearing a mouth guard at night.
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