Pulpitis

PULPITIS

DEFINITION: “Pulpitis is the inflammation of the dental pulp within the tooth”. It is commonly manifested as toothache.

· Initially it presents itself as a dull to moderate pain, fairly well localized

· later it increases with time and becomes more severe and diffuse

· finally when the pulpal necrosis occurs pain ceases.

This can be attributed to the pulpal anatomy, wherein the soft pulpal tissue is surrounded by very hard dentin. the pressure created in the pulp has very little chance of dissipation to the neighbouring tissues where the lymph can reach unlike other parts of the body. This confinement mostly leads to pulpal necrosis.

CAUSES OF PULPITIS;

a) Dental caries is the most common cause.

b) Fractured restoration / fractured tooth

c) Physical agents such as –

i) pressure involved during cutting procedures

ii) high filling

iii) galvanic current produced by occluding amalgam restoration with gold one

d) Thermal agents such as heat from- cavity preparation, polishing restorations,inadequate thermal insulation(bases & liners)

e) Chemical agents- such as disinfecting chemicals such as alcohol / chloroform applied to exposed dentin, acid liquid components of cements, eugenol from zinc oxide eugenol etc..,

f) Exposure of dentin as a result of gingival recession, abrasion, attrition, erosion.

g) Advanced periodontal diseases.


CLASSIFICATION;

Based on the extent of pulpal damage pulpitis can be classified into:

a) Reversible pulpitis – Symptomatic (acute)

Asymptomatic (chronic)

b) Irreversible pulpitis- Symptomatic(acute)

Asymptomatic with exposure (chronic)

Pulp degeneration

Pulp necrosis


A) REVERSIBLE PULPITIS:

“ Mild to moderate inflammatory condition of the pulp caused by noxious stimuli, in which the pulp is capable of returning to the normal (uninflamed) state after the removal of the stimulus. “

SYMPTOMS:

· It is characterized by sharp pain lasting for a moment only

· Pain does not occur spontaneously

· It requires an external stimulus(cold, sugar, trauma, bacteria, chloroform, etc.,) and stops after the removal of irritant factor(stimulus)

· Pain can be localized.

· Pain is more often brought about by cold stimuli.

DIAGNOSIS:

· Based on symptoms

· Visual examination: caries, cervical erosion , abrasion.

· History regarding recent dental treatments, fractures or trauma.

· Radiography: depth of caries or cavity preparation can be judged.

Periapex negative - PDL and lamina dura are normal.

· Percussion: Negative response unless occlusal stress is present.

· Vitality test: Response is more to cold stimuli.

PREVENTION: Awareness of the causative agent

Control of the operative procedures

TREATMENT: A good restoration with adequate and effective insulation.

Iontophoresis with 1%NaF.

PROGNOSIS: Favourable if irritant is removed early… if delayed irreversible pulpitis can occur.

COMPLICATION: If neglected it can transform into Irreversible pulpitis.


B) IRREVERSIBLE PULPITIS:

“Persistent inflammatory condition of the pulp which is symptomatic or asymptomatic caused by a noxious stimulus”

SYMPTOMS:

a) Severe pain of sharp, piercing / shooting type.

b) Pain occurs spontaneously without an external stimulus

c) Pain is continuous/ intermittent in nature that lasts for several minutes to hours.

d) Pain may also be aggravated by sudden change in temp, pressure / by lying downi.e change in posture, on exertion, etc.,

e) Pain is more severe during nights while sleeping because of the increased cephalic blood pressure which increases the already excessive intra pulpal pressure.

f) Referred pain is common finding( to the temple or sinus if upper posteriors are involved., to the ears if the lower posteriors are involved)

g) At later stages Throbbing type of pain is present due to arterial pulsation in the area of increased pulpal pressure.

h) After pulpal necrosis pain is no more felt.

i) Difficulty in mastication

DIAGNOSIS:

· Based on symptoms

· History: patient may give history of pulp capping, deep caries, trauma, extensive restorations

· Visual examination: inspection discloses a deep cavity extending to the pulp or a decay under a filling.

· Radiographs: they show the extent and depth of caries and restorations involving the pulp. Widening of lamina dura is noticed in advanced stages.

· Percussion: tooth is sensitive to percussion as the periapical pressure increases due to hyperactive, exudative, inflammatory tissue.

· Vitality tests: thermal test is positive and persists after stimulus is removed. Electric testing: at early stages-response to less current is evoked and at advanced stages- more current is required to elicit a response.

TREATMENT: Root canal treatment.

COMPLICATIONS: If this condition is neglected it can lead to-

- apical periodontitis

- periapical abscess

- cellulitis …….