Pulpitis is inflammation of the dental pulp resulting from untreated caries, trauma, or multiple restorations. Its principal symptom is pain. Diagnosis is based on clinical findings and is confirmed by x-ray. Treatment involves removing decay, restoring the damaged tooth, and sometimes doing root canal therapy or extracting the tooth.
Pulpitis can occur when
- Caries progresses deeply into the dentin
- A tooth requires multiple invasive procedures
- Trauma disrupts the lymphatic and blood supply to the pulp
Pulpitis is designated as
- Reversible: Pulpitis begins as limited inflammation, and the tooth can be saved by a simple filling.
- Irreversible: Swelling inside the rigid encasement of the dentin compromises circulation, making the pulp necrotic, which predisposes to infection.
Complications
Infectious sequelae of pulpitis include apical periodontitis, periapical abscess, cellulitis, and osteomyelitis of the jaw. Spread from maxillary teeth may cause purulent sinusitis, meningitis, brain abscess, orbital cellulitis, and cavernous sinus thrombosis. Spread from mandibular teeth may cause Ludwig angina, parapharyngeal abscess, mediastinitis, pericarditis, empyema, and jugular thrombophlebitis.
Symptoms and Signs
In reversible pulpitis, pain occurs when a stimulus (usually cold or sweet) is applied to the tooth. When the stimulus is removed, the pain ceases within 1 to 2 sec.
In irreversible pulpitis, pain occurs spontaneously or lingers minutes after the stimulus is removed. A patient may have difficulty locating the tooth from which the pain originates, even confusing the maxillary and mandibular arches (but not the left and right sides of the mouth). The pain may then cease for several days because of pulpal necrosis. When pulpal necrosis is complete, the pulp no longer responds to hot or cold but often responds to percussion. As infection develops and extends through the apical foramen, the tooth becomes exquisitely sensitive to pressure and percussion. A periapical (dentoalveolar) abscess elevates the tooth from its socket, and the tooth feels “high” when the patient bites down.
