Overview

Pulpitis is inflammation of the dental pulp — the soft tissue inside the tooth containing nerves and blood vessels. It is the most common cause of acute toothache and the primary reason root canal treatment is needed. Pulpitis is reversible (pulp can heal if the cause is removed) or irreversible (pulp is too damaged and will die or become infected). Untreated irreversible pulpitis leads to pulp necrosis, abscess, and spread of infection.

Symptoms

• Reversible pulpitis: sharp brief pain from cold that disappears within seconds
• Irreversible pulpitis: spontaneous lingering toothache lasting minutes or hours after stimulus
• Severe throbbing pain, often worse at night and when lying down
• Pain that intensifies with heat and is relieved temporarily by cold
• Referred pain to the ear, temple, or jaw

Causes & Risk Factors

• Deep dental caries reaching the pulp
• Repeated dental procedures on the same tooth
• Cracked or fractured tooth exposing the pulp
• Trauma to the tooth; severe tooth wear eroding close to the pulp
• Periodontal disease with deep pockets reaching the root apex

Complications

• Pulp necrosis (death of the pulp tissue)
• Periapical abscess: infection at the root tip spreading into bone
• Dental abscess and facial swelling; tooth loss if untreated

Diagnosis

Pulpitis is diagnosed through cold and heat testing, electric pulp testing, and percussion. X-rays show the depth of decay and any periapical changes. Distinguishing reversible from irreversible pulpitis determines whether the pulp can be preserved.

Treatment

• Reversible pulpitis: remove the cause (fill the cavity) and the pulp recovers
• Indirect or direct pulp capping: places medicament over the pulp to encourage healing
• Root canal treatment (endodontic therapy): the definitive treatment for irreversible pulpitis
• Extraction: if the tooth cannot be saved

Prevention

• Treat dental caries early — small fillings prevent deep decay reaching the pulp
• Wear mouthguard during sports; wear night guard to prevent grinding wear
• Regular dental check-ups to catch decay before it reaches the pulp

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