Reversible & Irreversible Pulpitis – Cause & Treatment

The pulp is the formative organ of the tooth, present inside the innermost part of each tooth. It provides the blood and nerve supply to the tooth.

In the case of tooth decay or trauma, the pulp tissue can get inflamed and lead to a toothache. The inflammation of pulp is known, as pulpitis and it can be chronic or acute, just like any other inflammation in the body.

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There are two types of pulpitis- reversible and irreversible pulpitis. Both kinds of pulpitis cause pain and only differ in terms of severity.

Your dentist can diagnose the type of pulpitis and devise a treatment plan accordingly. Continue on this article to find out more about pulpitis and how to manage it.

What is pulpitis?

Pulpitis is inflammation of the dental pulp resulting from untreated caries, trauma or multiple restorations. It is characterized by tooth sensitivity that arises from excess blood flow to the tooth.

There are two forms of pulpitis- irreversible and reversible.

Reversible pulpitis refers to instances when the inflammation is mild, and the pulp can be restored to its healthy state. An acute sensitivity to cold is characterized by it.

Irreversible pulpitis occurs when inflammation and other symptoms are severe, and the pulp cannot be saved. It is characterized by prolonged sensitivity to cold and heat and sometimes to sweet.

Symptoms of pulpitis

Reversible pulpitisIrreversible pulpitis
  • Mild pain occurs while eating only
  • Inflammation
  • Sensitivity to cold
  • Sensitivity to sweet
  • Pain doesn’t continue when the stimulus has been removed
  • No swelling
  • The tooth can still detect a mild electrical stimulus
  • No low-grade toothache
  • Severe pain, occur throughout day and night
  • Inflammation
  • Sensitivity to hot and cold
  • Sensitivity to sweet
  • Running fever
  • Swollen lymph nodes
  • Bad breath
  • Bad taste in the mouth
  • Pain continues when the cause has been removed
  • Continuous low-grade ache

Causes of pulpitis

Pulpitis occurs when enamel and dentin are infected, allowing the bacteria to enter the pulp and cause swelling. Since the pulp is trapped inside a small chamber, the swelling causes pain and infection.

The following conditions can damage the enamel and dentin and cause pulpitis:

  • Cavities or tooth decay (1)
  • Injuries or trauma to the tooth
  • Fractured tooth exposing the pulp 
  • Repetitive trauma to the tooth caused by chronic bruxism
  • Attrition and abrasion of teeth (2)
  • Sweet and sour foodstuff
  • Overheating during cavity preparation

Risk factors for pulpitis

Any factor that can increase the risk of tooth decay also increases the chances for pulpitis.

Children and older adults are also at risk for pulpitis due to improper oral hygiene habits.

Lifestyle habits including poor oral hygiene habits, eating a diet high in sugar and refined carbohydrates, having a profession with increased risk of trauma to the teeth or chronic bruxism, also increases the risk of pulpitis.

Diagnosis of pulpitis

Your dentist will diagnose whether you have reversible or irreversible pulpitis, after a careful physical examination and thorough history taking. They make take x-rays to determine the extent of tooth decay and inflammation. (3)

A sensitivity test is also done to determine how much the pulp has been affected by observing the extent and duration of your reaction to hot, cold or sweet stimuli.

An additional tooth tap test or percussion test will help your dentist determine the extent of pulpal inflammation.

The dentist can also determine the extent of pulp damage with the help of an electric pulp tester. It delivers a small, electrical charge to the tooth and if you feel this charge, it is more likely that the pulp is viable and the pulp is reversible.

Treatment of pulpitis

The treatment strategy for pulpitis is decided on the basis if it is reversible or irreversible. (4)

In the case of reversible pulpitis, it can be treated once the stimulus is removed. For example, if the pulpitis is due to tooth decay, removing the decayed part and placing a filling will restore the pulp to its healthy state.

In the case of irreversible pulpitis, the pulp doesn’t go back to its normal state even after the cause is removed. Performing root canal treatment saves the tooth. The pulp is removed; the tooth is disinfected and filled with gutta-percha filling.

In severe cases, the tooth might need to be extracted if it can’t be saved.

Your dentist will also prescribe you non-steroidal anti-inflammatory drugs (NSAIDs) to provide relief from pain and inflammation.

Preventing pulpitis

Practicing good oral hygiene can prevent inflammation of pulp and scheduling regular visits to the dentist.

Proper oral care can also help increase the longevity of your existing fillings.

If you suffer from chronic bruxism, your dentist may suggest you wear a mouth guard while you sleep.

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Take away message

You can suffer from tooth pain or sensitivity even after you practice proper oral hygiene and prevention methods. You should visit your dentist on the first signs of inflammation.

Treating pulpal inflammation at an early stage can prevent the pulp from irreversible damage.

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