Pulpitis refers to inflammation of dental pulp that involves blood vessels and the nerves and is one of the most common reasons of tooth ache. Pulpitis can occur as a result of untreated tooth decay, trauma to the tooth or can occur because of multiple restorations. Gum infection can also lead to pulpitis. Pulpitis is further of 2 types: Reversible Pulpitis and irreversible Pulpitis.   Initially Pulpitis begins as reversible condition and cause of condition is cured to treat it. If the tooth is not treated, then irreversible Pulpitis occurs. In case of irreversible pulpitis, root canal treatment or tooth extraction is done to remove the infection. With clinical examination and with x-rays, diagnosis is made.

Causes of Pulpitis

1. Dental caries which have extended from enamel and dentin into the pulp.
2. Trauma to tooth can lead to pulpitis. Thermal insult as a result of repeated dental procedures can lead to condition.
3. In rare cases, periodontitis may also lead to pulpitis.

In case of injury to the body parts, tissues will become red, swollen and there will be rise in temperature. This process is called as inflammation.  Immunity comes into play in case of injury to the tissues. Inflammation inside teeth is not good.  

In case of injury or irritation to the dental pulp, extra blood and defense cells are sent to dental pulp. Pressure dissipation can occur in other parts of the body but can’t occur in pulpal cavity. Inflamed pulp is surrounded by strong hard tooth structure so with inflammation, pressure build up occurs in the pulp cavity which will further exert pressure on the nerve and the surrounding tissues. Nerves will send signals of pain and patient will experience pain. Depending on severity of inflammation which is present and body’s response, patient will experience mild to severe pain due to pulpitis. Drinking hot drinks and chewing will cause pain to the patient.

With pulpitis, high pressure may be created on tooth nerves that patient may not be able to locate the site of pain and may confuse it with neighboring tooth (Referred pain).  

Pulpitis can be:

1. Reversible Pulpitis and
2. Irreversible Pulpitis 

Reversible Pulpitis: As the name implies, reversible pulpitis can be reversed if timely treated by the dentist. Reversible pulpitis is mild inflammation of pulp.

Causes of Reversible Pulpitis

It can be caused by irritation to the dental pulp which can occur because of cavities which have not involved the dental pulp, tooth wear which has reached the dentin portion of the tooth structure. Fracture of tooth which has caused exposure of dentin, tooth drilling during filling or tooth preparation for dental crown, recent dental cleaning can also lead to irritation to dental pulp and mild inflammation. Placing an amalgam silver filling with metallic gold restoration and excess dehydration of cavity with agents such as alcohol and chloroform can also lead to mild inflammation of dental pulp and reversible pulpitis.

Symptoms of Reversible Pulpitis

In case of reversible pulpitis, pain lasts for less than 5 seconds and occurs when the tooth comes in contact with cold, sweet food stuffs or air blast. Sharp pain occurs on application of stimulus and pain will go after the stimulus is removed.

Diagnosis of Reversible Pulpitis

1. Pain- Pain lasts for a short time period and will disappear after the stimulus is removed.
2. Visual-Dental caries or disturbed occlusion or tooth fracture is there
3. X-rays- Dental caries can be seen in the x-rays. Periapical tissues will appear as normal.
4. Tooth is not tender on percussion
5. Vitality Test- Less current in Electric pulp tester causes pain. Pain will occur on application of cold, sweet foods or air blast and will disappear after stimulus is removed.   

Treatment of Reversible Pulpitis

For treatment of reversible pulpitis, cause of inflammation is cured to treat it. If reversible pulpitis is not fixed in time, then it may progress to irreversible pulpitis.

Irreversible Pulpitis: In case of irreversible pulpitis, whatever damage is done to the pulp, the tooth can’t be repaired. Vitality of tooth can’t be saved in case of irreversible pulpitis. Irreversible pulpitis is severe inflammation of pulp. If reversible pulpitis is not treated, then it may progress and lead to irreversible pulpitis. All the factors which lead to reversible pulpitis also cause irreversible pulpitis.

Irreversible pulpitis is further of 2 types, acute irreversible pulpitis and chronic irreversible pulpitis. In case of acute pulpitis, pulp is abnormally responsive to heat and cold. Chronic irreversible pulpitis can be asymptomatic with exposure to dental pulp, hyperplastic pulpitis.

Causes of Irreversible Pulpitis

In case of large dental filling close to the pulp, trauma to the tooth which can lead to decreased blood supply or removal (As during braces treatment), deep cavities extending deep into the dental pulp, irreversible pulpitis occurs. Gum infections can also lead to irreversible pulpitis.

Symptoms of Irreversible Pulpitis

No pain to severe excruciating pain occurs in case of irreversible pulpitis. Tooth becomes sensitive even to slight change in temperature and pain usually lingers. Patient will experience pain even after the stimulus is removed and will last for several minutes to hours. Sharp, shooting and piercing pain occurs in case of irreversible pulpitis and intensity of the pain will aggravate when the patient lies down. Referred pain to the adjacent tooth or pain in temple region if upper tooth is involved and pain in ear if lower tooth is involved occurs. In later stages, throbbing and gnawing type of pain occurs. With cold water on cold substance, pain relief occurs.

Diagnosis of Irreversible Pulpitis

1. Pain- No pain to severe excruciating pain occurs. Pain is sharp, shooting and piercing and aggravates on lying down. In advanced stage, throbbing or gnawing pain occurs in irreversible pulpitis.
2. Visual- Deep cavity, tooth fracture, large dental cavity can be there(Secondary decay below large dental cavity).
3. X-rays- X-rays will show exposure of dental pulp or secondary caries below filling is seen. Normal periapical area is usually there.
4. Tooth is tender on percussion. Intrapulpal pressure is increased with exudates in pulpal cavity which leads to tenderness on percussion.
5. Heat aggravates the pain and cold provides some pain relief.

Treatment of Irreversible Pulpitis

In case of irreversible pulpitis, root canal treatment or tooth extraction is required to remove the infection from the tooth.   

If systemic sign of infection are also present like fever and swollen lymph nodes, then antibiotics are prescribed to the patient. Amoxicillin 500 mg 8 hourly or clindamycin 150 or 300 mg 6 hourly can be given to the patient.