Pulpitis: Types, Causes, Symptoms, Treatment, Risk Factors, Prevention, Diagnosis

Any inflammation or infection of dental pulp is termed as pulpitis. Tooth is made up of 3 parts: Pulp, Dentin and Enamel. Pulp is the heart of the tooth and is present in the center most cavity of each tooth. It has three main components: a pulp chamber, pulp horns and radicular canals. The pulp horns extend towards the tooth crown and the radicular canals extend towards the roots of the tooth. On the other hand, the pulp chamber comprises of living connective tissue, neurovascular elements and pulp cells that nourishes and regulates the tooth behavior to any injury or infection. Pulp is vascularized by superior and inferior alveolar arteries. Tooth pulp has the highest pressure as compared to the other tissues.

There are 52 pulps in humans – 32 in permanent and 20 in primary teeth. Total pulp volume in adults is approx 0.38cc. The shape of pulp chamber depends on the tooth morphology.

Pulpitis can be of 2 types:

Reversible Pulpitis: Reversible pulpitis is a pulp infection where only the pulp is inflamed as there is an active irritant causing the infection. These irritants are mostly bacteria from carious lesions which have not yet reached the pulp. The other common irritants are hot or harmful chemical agents.

Irreversible Pulpitis: It is a condition where there is an irreversible damage to the pulp since the bacteria has already the pulp area. Although the pulp tissues are still alive and active; the introduction of the bacteria to this area doesn’t allow the pulp to heal and ultimately leads to tissue death or necrosis.

The signs and symptoms associated with pulpitis includes:

• An inflammation in the pulp builds up pressure within the pulp cavity which exerts the pressure on the internal and neighboring neural tissues in pulp chamber. Since the pulp is surrounded by a hard layer of dentin and enamel, the inability to dissipate the pulpal pressure to the soft connective tissue of the tooth triggers severe pain.
• Often, the pain is so severe making it difficult to locate the infected tooth.
• Pain may radiate to the jaws, head or ear termed as referred pain.
• Severe sensitivity to hot and cold food or drinks can be a symptom of pulpitis.
• Pain aggravates on eating sweets
• Tenderness of infected tooth
• Difficulty in sleeping due to pain
• Fowl breath and halitosis can also be a symptoms of Pulpitis.
• Fever and swollen lymph nodes
• Bad taste of mouth.

The most common cause of pulpitis is dental caries. The bacterial infection extends from enamel, penetrating the dentin layer of tooth and affecting the pulp. The other causes are:

• Extended infection from periodontal tissues penetrating through roots.
• Pulpitis can occur due to external trauma like tooth fracture.
• Pulpitis may occur post physical abuse of the tooth.
• Inappropriate brushing habits causing extensive pressure to tooth.
• Thermal injury to the tooth caused by the use of overheated dental headpieces used during dental treatment.
• Cavity filling by dental curing lights may irritate pulp.
• Bruxism or teeth grinding condition.

• Increased risk of cavities in area with low fluorine content water
• Poor oral hygiene
• Diabetic patients
• Lack of regular dental check up
• Profession involving increased mechanical trauma to the teeth like hair dresser, tailors
• Dietary habits like high sugar diet, carbonated drinks etc.
• Stress
• Preexisting cardiovascular disorders.

• Pulpitis can be best diagnosed based on the signs and symptoms the patient presents.
• Severe throbbing pain and swelling in the jaw are most common characteristic of pulpitis.
• Tooth tapping test on the affected tooth to check for severity and extent of inflammation in the pulp chambers.
• X ray helps to understand the depth of the tooth decay or cavity if involving the pulp.

Sensitivity test can be performed to check for any pain or discomfort with heat, cold or sweet stimuli. For thermal test, ethyl chloride sprayed on cotton ball is used for cold stimuli and gutta percha is used for heat stimuli.

Electric Pulp Test: An electric stimulus is generated in the pulp cavity which leads to activation of neural membranes causing pain. The pain threshold is then calculated to check the extent of pulp involvement.

Regular dental checkups can avoid initiation of tooth decay.

There are two types of pulpitis that are diagnosed and are then treated accordingly: Reversible pulpitis and irreversible pulpitis.

Reversible Pulpitis Treatment: Reversible pulpitis is an inflamed condition where the infection has not reached the pulp and the pulp is vital. The pulp is inflamed and presents with sensitivity and pain in response to stimuli that may be heat, cold or sweet. The inflammation subsides once the irritants are removed. The pulp is intact. This is best treated by cavity filling for tooth decay, avoiding exposure to the known stimuli, practicing oral hygiene maintenance and following proper diet. The dental treatment can be formed using local anesthesia if pain is unbearable.

Irreversible Pulpitis: It is a condition where the inflammation has damaged the pulp irreversibly. Irreversible pulpitis commonly occurs when the infectious bacteria penetrates the pulp causing pulp necrosis, preventing healing activities causing pulp death. This generates severe pain radiating to the jaws, temple and ears called referred pain. Irreversible pulpitis is treated by Root canal treatment where the entire infected and necrosed pulp is removed from the canals and pulp cavity, cleaned multiply to remove all the dead tissues and nerves endings followed by placement of gutta percha. The tooth is then capped by prosthodontic treatment. Often the tooth is recommended for extraction to avoid the spreading of the bacterial infection to the surrounding tissues, tooth, and underlying bone.

The ways of prevention for pulpitis include:

• Regular dental check up
• Maintaining of oral hygiene
• Low sugar diet
• Avoid physical trauma
• Appropriate brushing technique by avoiding extra brushing pressure and over brushing the teeth
• Maintaining a healthy and stress free life style.

Also Read:

• Necrotic Pulp: Symptoms, Causes, Diagnosis, Treatments
• What is Pulp Capping: Types, How is Pulp Capping Done, Success & Prognosis of Pulp Capping