Pulpitis is an inflammation of the inner tissue of the tooth. Bacteria that enter the tooth through a cavity or crack cause infection. Early pulpitis is reversible. Without treatment, the inflammation will worsen, and removal of the nerve or the tooth may be required. Good oral hygiene and regular dental visits can help prevent pulpitis.
What is pulpitis?
A tooth has three layers: enamel on the outside, dentin that supports the enamel, and pulp inside the tooth. The pulp is the soft inner tissue of the tooth. It contains nerves, blood vessels, and connective tissue. The pulp supplies blood and nutrients to keep the teeth healthy.
Pulpitis is inflammation of the pulp. It usually occurs when there is irritation inside the tooth due to bruxism or tooth decay.
What types of pulpitis are there?
There are two types of pulpitis. Dentists classify them depending on the degree of infection.
Reversible pulpitis: at this early stage, pulpitis is reversible if the dentist treats the tooth and fills it.
Irreversible pulpitis: at this stage, inflammation progresses and the tooth cannot be restored. The pulp tissue eventually dies, leading to pulp necrosis.
What are the symptoms of pulpitis?
Tooth pain and increased sensitivity are the main symptoms of pulpitis. The pain you experience usually varies depending on the stage of inflammation.
Symptoms of reversible pulpitis include:
- sharp pain;
- no pain when the dentist taps on the tooth;
- no sensitivity to heat;
- sensitivity to cold or sweets that quickly disappears.
In irreversible pulpitis, the following symptoms may occur:
- pain when the dentist taps on the tooth;
- sensitivity to heat, cold, or sweets lasting more than a few seconds;
- throbbing, aching, or sharp pain;
- swelling around the tooth and gums;
- fever;
- bad breath;
- difficulty identifying which tooth is causing the pain.
If pulp necrosis occurs and the nerve tissue dies, you may not feel sensitivity to heat, cold, or sweets, but the tooth may still hurt when tapped. After that, the tooth can become infected and cause an abscess. Once this happens, it may feel like the affected tooth is higher than the others.
What causes pulpitis?
Tooth enamel protects the pulp. If the enamel is damaged, it can lead to pulpitis.
Damage to the tooth can occur due to:
- Tooth decay: bacteria in the mouth produce acid that can erode enamel and create cavities;
- Cracks: small cracks can occur if you chew hard food or injure a tooth;
- Dental procedures: treatment can cause pulpitis. If a tooth is improperly filled, it may lead to secondary decay and pulpitis;
- Worn enamel: teeth grinding or aggressive brushing can wear down enamel and make the nerve more vulnerable;
- Advanced periodontal disease: periodontitis is a serious gum disease caused by bacterial infection. It often begins as untreated gum inflammation and can lead to bone loss and pulpitis.
How is pulpitis diagnosed?
One of the main ways to diagnose pulpitis is by assessing the response of the pulp’s nerve tissue.
- Electric pulp testing: determines whether the pulp is alive or if necrosis has developed;
- Thermal testing (heat and cold): in irreversible pulpitis, sensitivity lasts longer than a few seconds. If the pulp is dead, there is no sensitivity;
- Percussion test (tapping): pain when tapping indicates irreversible pulpitis;
- Dental X-ray: used to detect defects and signs of infection.
How is pulpitis treated?
In reversible pulpitis, the dentist will try to eliminate the cause and preserve the pulp and function of the tooth. This often involves treating decay and placing a filling.
Irreversible pulpitis requires removal of the pulp tissue or the tooth.
Antibiotics do not treat pulpitis, but they may help prevent infection progression if treatment is delayed. However, experts have differing opinions on their use, as pulpitis is not always caused by bacteria.
What are the possible complications of pulpitis?
If untreated, pulpitis can lead to a periapical abscess, where infection localizes in the bone or soft tissues. A person may notice pus accumulation near the tooth.
Symptoms may include:
- swollen glands and lymph nodes;
- fever;
- chills;
- difficulty swallowing or opening the mouth.
If any of these symptoms occur, emergency medical care is required.
The infection can spread to the jawbone (osteomyelitis) and soft tissues of the head, neck, and chest. If left untreated, these infections can be life-threatening.
How to prevent pulpitis?
Good oral hygiene is the best way to prevent pulpitis.
To reduce the risk:
• brush your teeth twice a day;
• use dental floss;
• visit your dentist regularly for cleanings and check-ups;
• wear a mouthguard if you grind your teeth at night.
Also, be sure to consult a dentist immediately if you have tooth pain or strong sensitivity.
This article does not replace a medical consultation. For complete and personalized information, please consult your dentist.