Pulpitis

 

Pulpitis is a dental condition of an inflamed dental pulp. The dental pulp is the innermost and vital part of the tooth structure, which comprises of soft connective tissue, nerves, and the blood supply for the tooth. The Stages Of Caries Development

 Primary reasons for the onset of pulpitis is Dental Caries.

Pulpitis causes pain, swelling, and sensitivity. A bacterial infection from a cavity is typically the cause.

 

Most Common Sites of Occurrence

• Primary and permanent teeth
• Sites of recent or defective restoration
• Sites of recent trauma

 

CLASSIFICATION:

 

 

Investigations

1.  Dental history about recent restorations or trauma and previous history of pain on the offending tooth.
2.  Intraoral examination to check for exposed dentin, caries, a deep or defective restoration, or trauma. 
3. percussion test to rule out acute apical periodontitis.
4.  Cold test using a refrigerant spray or an ice stick. In order to better localize the offending tooth test the healthy control teeth.
5.  Hot test using hot water in a syringe  and rubber dam isolation, a heated gutta percha stick or heat source. Delayed and prolonged pain indicate irreversible pulpitis.
6.  Radiographs to identify teeth with large restorations or caries that are not clinically visible.

Reversible pulpitis: pulpal inflammation which should resolve once the cause is removed (defective restorations or caries).

Signs

• Caries
• Exposed dentin

Symptoms

• Non-throbbing type of pain to temperature or osmotic changes

Diagnosis

Based on clinical examination and testing:

• Cold test does not linger more than 30 s of pain
• No percussion sensitivity
• No spontaneous pain
• No heat sensitivity

Treatment

1.     Repair tooth structure by removing irritants (caries, exposed dentin, defective restoration). 

2.    Continue to monitor the patient’s symptoms.

3.     If symptoms persist or worsen then advice Ptient to return to Dentist.

Irreversible pulpitis: pulpal inflammation which will not resolve once the cause is removed.

Signs

• Deep caries

Symptoms

• Intense, throbbing type of pain to temperature changes
• Spontaneous pain

Diagnosis

Based on clinical examination and testing:

• Cold test lingers more than 30 s of pain
• May get pain from heat test
• May have spontaneous pain
• May be percussion sensitive
• Radiographically or clinically visible deep caries

Treatment

1.    Pulpectomy of tooth: complete removal of  pulp. If it is determined that the case in question is too complex, promptly refer to an endodontist. 

2.    Root canal treatment can be completed in one visit if treatment is undertaken and the appointed treatment time permits,.

Alternate Treatments

·       extraction

Advice

• The patient may take an anti-inflammatory  and analgesics for relieving of pain

PULP NECROSIS:

It is a condition where the pulp inside your teeth die. This is often the last stage of chronic pulpitis. It can lead to other problems with your teeth.

 The pulp can be affected and eventually die off when you have dental(oral) diseases. This can lead to other oral health issues if not treated promptly.

signs

·       A cavity starts with plaque build up, which leads to holes in your enamel. When caught early, cavities are filled in by a dentist and don’t cause any further issues.

·       If a cavity continues to decay your tooth enamel it move into the pulp and eventually the pulp can die.

·        Long-term inflammation (swelling) of pulp from long-term decay, multiple large restorations and trauma.

Symptoms

·       When onset of necrosis happens, the nerves may stop sending signals that alert you to any pain or discomfort, because the pulp has died.

·       In the early stages of pulp issues,  tooth is very sensitive to cold foods,sweets or drinks. Sweets can also bother the affected tooth.

           This discomfort lasts for about one to two seconds at a time.

·       Once pulp necrosis develops, you can’t feel cold at all. However, you might feel  pressure in the affected tooth from eating or grinding your teeth. This pressure also lasts for several minutes at a time

·       . If you have no feeling in your tooth at all, this could be a sign of necrosis. A tooth can be necrotic due to untreated decay, trauma, or multiple large fillings.

·       When the pulp is necrotic(irreversible pulpitis). In this case, you will need a root canal or a tooth extraction.

Diagnosis

·       Perform an examination of your teeth, gums, and other surrounding tissues. Sometimes, this condition isn’t known to the patient.  

·       Dental X-rays /Rsdiographs

·       Electric pulp testing. This tool delivers small shocks, If you feel the shock, then the pulp is alive. If not, then necrosis could be possible

Treatment

Treatment options for pulp necrosis may vary based on the stage and severity of the condition.

• Fillings. Your dentist may fill existing small cavities to prevent further decay of the tooth. At the same time, old failed fillings may be removed and replaced. This helps to protect tooth.
• Root canal treatment
• Extraction of tooth .Complications and associated conditions

 

 Complications may develop over time if the tooth is left untreated. However, treatment itself can also lead to complications.

• fever
• jaw swelling
• infection

Pulpitis and subsequent necrosis may be associated with:

• sinusitis
• periodontitis (deep pockets of bacteria and inflammation)
• bone loss
• cellulitis
• abscesses (including those in the brain).

 

 

THANK YOU

                                                                                             Dr.Sujatha.M

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